Iridium-Knife: Another knife in radiation oncology

Milickovic, N.; Tselis, Nikolaos; Karagiannis, Efstratios; Ferentinos, Konstantinos P.; Zamboglou, Nikolaos

doi:10.1016/j.brachy.2017.03.005

Cited by 23 publications

(22 citation statements)

References 60 publications

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“…In our research, the SBT and SBRT plan had comparable PTV D90 values (104.73±2.10Gy vs . 107.64±2.29Gy), which is in agreement with the results of Pennington J Det al[ 23 ] and Milickovic N et al[ 24 ].…”

Section: Discussionsupporting

confidence: 92%

“…In their study, brachytherapy led to a higher target dose, a similar dose to OARs, but potentially had lower target coverage compared with SBRT. Milickovic Net al compared the dosimetric differences between interstitial Ir-192 high-dose-rate (HDR) brachytherapy and linear accelerator-based SBRT for intrathoracic malignancies[ 24 ]. They showed that volume coverage in HDR plans was comparable to that calculated for SBRT with no statistically significant difference in terms of conformity.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 92%

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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“…In a recent dosimetric comparison, Milickovic et al . [ 16 ] showed equivalent target conformity with HDRBRT and sharper dose fall-off than historic SBRT plans based on nine to ten non-coplanar static beams. This study aimed to provide a pilot dosimetric analysis to understand the potential role of HDRBRT and the most state-of-the art SBRT technique realized by inversely optimized dynamic arc delivery through real-time MLC tracking.…”

Section: Purposementioning

confidence: 99%

Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors?

Chan

Lee

Chiang

et al. 2018

jcb

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PurposeTo provide a pilot dosimetric study of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy (BRT) and stereotactic body radiotherapy (SBRT) for primary and metastatic lung lesions.Material and methodsFor nine lung primary and metastasis patients, 3D image-based BRT plan using a single virtual catheter was planned for 34 Gy in single fraction to the gross tumor volume (GTV) + 3 mm margin to account for tumor deformation. These plans were compared to margin-based (MB-) and robustness optimized (RO-) SBRT, assuming the same tumor deformation under real-time tumor tracking. Consistent dose calculation was ensured for both BRT and SBRT plans using the same class of collapsed cone convolution superposition algorithm. Plan quality metrics were compared by Friedman tests and Wilcoxon t-tests.Results and ConclusionsBrachytherapy plans showed significant higher GTV mean dose compared to MB- and RO-SBRT (122.2 Gy vs. 50.4 and 44.7 Gy, p < 0.05), and better dose gradient index (R50) = 2.9 vs. 4.3 and 8.4 for MB- and RO-SBRT, respectively. Dose constraints per the RTOG 0915 protocol were achieved for all critical organs except chest wall in BRT. All other dose-volume histograms (DVH) metrics are comparable between BRT and SBRT. Treatment delivery time of BRT and SBRT plans significantly increased and decreased with increasing GTV size, respectively. SBRT using advanced MLC tracking technique and non-coplanar VMAT can achieve comparable dosimetric quality to HDR BRT. Whether or not, the significantly higher GTV dose can increase killing of radioresistant tumor cells and offset the effect of tumor reoxygenation in single fraction BRT, requires further clinical investigation.

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“…Image-guided high dose rate (HDR) single-modality interstitial brachytherapy (SM-ISBT) has the benefit of providing highly conformal hypofractionated radiation dose to the target with a sharp radiation dose fall-off to avoid OARs [14,15]. This allows for increasing therapeutic advantage by dose escalation in the target while protecting normal structures, which is favourable for re-irradiation.…”

Section: Introductionmentioning

confidence: 99%

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

et al. 2020

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Aims: Recurrent gynaecological tumours can cause significant morbidity with limited salvage options. This study investigates the strategy of salvage singlemodality interstitial brachytherapy (SM-ISBT) for recurrent gynaecological pelvic cancer at two specialised ISBT centres. Materials and methods: Patients who had received salvage SM-ISBT for pelvic recurrence of gynaecological cancers from September 2008 to January 2017 were included. None had distant metastasis at the time of recurrence. Local control, progression-free and overall survival and long-term toxicities were evaluated. Results: Twenty-six patients with a median follow-up of 24 months (range 2.5e106.3 months) after SM-ISBT were included. Primary cancer sites were endometrium (20), cervix (4), vulva (1) and vagina (1). All patients had prior whole-pelvic external beam irradiation and 16 had prior brachytherapy. The median disease-free survival prior to SM-ISBT was 20.3 months (interquartile range 9.9e30.5). SM-ISBT was delivered with high dose rate technique over three to six fractions. The median high-risk clinical target volume was 34.6 cm 3 , with a median D90 of 29.1 Gy (range 16.1e64.6). The median bladder, rectum and sigmoid D2cm 3 were 15.5, 18.7 and 3.7 Gy, respectively. After SM-ISBT, complete and partial responses were achieved in 17 (64%) and 5 (19%) patients, respectively. Two (7.4%) patients had grade 3 toxicities (both vaginal stenosis), with no grade 4 complications. Eighteen patients (69%) recurred, including local, regional and metastatic in 14 (54%), 8 (30%) and 5 (19%) patients, respectively. Two-year local control, progression-free survival and overall survival were 50, 38 and 78%, respectively. In follow-up, 12 patients (46%) remained in local control. Conclusions: Salvage SM-ISBT re-irradiation for pelvic recurrence of gynaecological malignancies was feasible and safe. With limited salvage options, the local control obtained in more than a quarter of patients seems reasonable. Further efforts are needed to establish a consensus about the optimal patient selection, dose fractionation, implant technique and combination with systemic therapies.

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Iridium-Knife: Another knife in radiation oncology

Cited by 23 publications

References 60 publications

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

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

Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors?

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

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