Dosimetric comparison of brachyablation and stereotactic ablative body radiotherapy in the treatment of liver metastasis

Pennington, J. Daniel; Park, Sang June; Abgaryan, Narine; Banerjee, Robyn; Lee, Percy P.; Loh, Christopher; Lee, Edward; Demanes, D. Jeffrey; Kamrava, Mitchell

doi:10.1016/j.brachy.2015.04.002

Cited by 17 publications

(16 citation statements)

References 23 publications

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“…However, many of the lesions in our series were either close to major vessels, close to other critical structures, and/or had a large diameter – all issues that can limit the appropriateness of either EBRT or interventional radiology-ablation techniques [ 3 , 4 , 5 , 6 , 7 , 8 ]. In a recent dosimetric study comparing stereotactic body radiation therapy (SBRT) and IG-HDR plans for liver lesions, investigators found that IG-HDR could provide intra-tumoral dose escalation and decreased low dose spill to surrounding tissues [ 35 ]. On the other hand, for small lesions, SBRT may be preferred.…”

Section: Discussionmentioning

confidence: 99%

Image-guided high-dose rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases

Kishan¹,

Lee

McWilliams

et al. 2015

jcb

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PurposeTo determine the ability of image-guided high-dose-rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies.Material and methodsThis retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival.ResultsThe median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in 2 Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.ConclusionsWe demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.

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Section: Discussionmentioning

confidence: 99%

Image-guided high-dose rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases

Kishan¹,

Lee

McWilliams

et al. 2015

jcb

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“…Recently, some researchers reported that SBT is also a safe and effective modality for the treatment of inoperable early stage NSCLC[ 8 – 10 ]. Pennington JD et al compared the dosimetric differences between brachytherapy and SBRT in the treatment of liver metastasis[ 23 ]. In their study, brachytherapy led to a higher target dose, a similar dose to OARs, but potentially had lower target coverage compared with SBRT.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of CT-guided iodine-125 seed stereotactic brachytherapy and stereotactic body radiation therapy in the treatment of NSCLC

Zhang

Yuan

et al. 2017

PLoS ONE

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This study aimed to assess the dosimetric differences between iodine-125 seed stereotactic brachytherapy (SBT) and stereotactic body radiation therapy (SBRT) in the treatment of non-small cell lung cancer (NSCLC). An SBT plan and an SBRT plan were generated for eleven patients with T1-2 NSCLC. Prescription of the dose and fractionation (fr) for SBRT was 48Gy/4fr. The planning aim for SBT was D90 (dose delivered to 90% of the target volume)≥120Gy. Student’s paired t test was used to compare the dosimetric parameters. The SBT and SBRT plans had comparable PTV D90 (104.73±2.10Gyvs.107.64±2.29Gy), and similar mean volume receiving 100% of the prescription dose (V100%) (91.65% vs.92.44%, p = 0.410). The mean volume receiving 150% of the prescribed dose (V150%) for SBT was 64.71%, whereas it was 0% for SBRT. Mean heterogeneity index (HI) deviation for SBT vs. SBRT was 0.73 vs. 0.19 (p<0.0001), and the mean conformity index (CI) for SBT vs. SBRT was 0.77 vs. 0.81 (p = 0.031). The mean lung doses (MLD) in SBT were significantly lower than those in SBRT (1.952±0.713 vs. 5.618±2.009, p<0.0001). In conclusion, compared with SBRT, SBT can generate a comparable dose within PTV, while the organs at risk (OARs) only receive a very low dose. But the HI and CI in SBT were lower than in SBRT.

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“…As normal tissue toxicity after repeated full course of conventional EBRT has shown to be significant, it seems reasonable to assume that further improvements in the therapeutic ratio can be generated by escalating the treatment dose while ameliorating conformity. [50][51][52][53][54][55][56] Up to now, however, no investigations have been performed for comparison of SBRT, nonstereotactic IMRT, and image-based interstitial brachytherapy for the reirradiation of extensive recurrent head and neck cancer. At this point, the intrinsic characteristic of HDR to generate high intratarget dosing is of particular importance, as it facilitates the application of ablative doses to central tumor volumes that are thought to experience increased radioresistance.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to SBRT, however, HDR provides a higher degree of intratarget dose heterogeneity with no upper dose limits and a sharper dose fall-off gradient outside the target volume with a lower low-dose spill. [50][51][52][53][54][55][56] Up to now, however, no investigations have been performed for comparison of SBRT, nonstereotactic IMRT, and image-based interstitial brachytherapy for the reirradiation of extensive recurrent head and neck cancer. Against this background, the presented cases underpin the potential of brachytherapy to provide local tumor control in unresectable recurrent ENT malignancies in which repeat EBRT is only feasible to a limited extend.…”

Section: Discussionmentioning

confidence: 99%

Image-guided interstitial high-dose-rate brachytherapy in the treatment of inoperable recurrent head and neck malignancies: An effective option of reirradiation

et al. 2017

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Dosimetric comparison of brachyablation and stereotactic ablative body radiotherapy in the treatment of liver metastasis

Cited by 17 publications

References 23 publications

Image-guided high-dose rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases

Image-guided high-dose rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases

Dosimetric comparison of CT-guided iodine-125 seed stereotactic brachytherapy and stereotactic body radiation therapy in the treatment of NSCLC

Image-guided interstitial high-dose-rate brachytherapy in the treatment of inoperable recurrent head and neck malignancies: An effective option of reirradiation

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