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

Abstract

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.

Image-guided high-dose-rate brachytherapy of head and neck – a case series study

“…Similarly, to other studies, no complications occurred during application and no early toxicity was observed [22, 23, 24]. Moreover, positive effects were achieved in case of both treatment efficiency and quality of life.…”

“…In a study by Kishan et al . [24] data were retrospectively analyzed from 18 patients with cancer, located in various areas including 2 in the head and neck area, who had undergone HDR brachytherapy performed under guidance of different imaging methods. Various dose fractioning schemes were used: 6 Gy in 6 fractions and 10 Gy in one fraction (as a boost after external beam radiation therapy).…”

“…[22] and Kishan et al . [24], it is only possible to compare biological equivalent dose (BED) of the total dose. Biological equivalent dose of the total dose in Kolotas et al .…”

Neither high-dose nor low-dose brachytherapy increases flap morbidity in salvage treatment of recurrent head and neck cancer

“…Similarly, Kishan et al . showed good local recurrence rates and low long-term morbidity with HDR [ 11 ].…”

Palliative treatment of pelvic bone tumors using radioiodine (125I) brachytherapy

“…A recent study using ablative radiation dose approach showed that CT-guided interstitial brachytherapy for recurrent anorectal cancer achieved durable tumor control, effective palliation, improved long-term survival, and minimal long-term morbidity [30]. Another study showed that high-dose brachytherapy achieved high local control rates and low toxicity in patients with pelvis tumors that were not readily accessible to other therapies [31]. Taken together, these previous studies and the present study suggest that brachytherapy could achieve high-precision treatment of tumors of the pelvic area, with minimal damage to other organs and tissues.…”