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1.
Lab Chip ; 24(8): 2335-2346, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38568477

RESUMO

We describe the first microfluidic device for in vitro testing of brachytherapy (BT), with applications in translational cancer research. Our PDMS-made BT-on-chip system allows highly precise manual insertion of clinical BT seeds, reliable dose calculation using standard clinically-used TG-43 formalism and easy culture of naturally hypoxic spheroids in less than 3 days, thereby increasing the translational potential of the device. As the BT-on-chip platform is designed to be versatile, we showcase three different gold-standard post-irradiation bioassays and recapitulate, for the first time on-chip, key clinical observations such as dose rate effect and hypoxia-induced radioresistance. Our results suggest that BT-on-chip can be used to safely and efficiently integrate BT and radiotherapy to translational research and drug development pipelines, without expensive equipment or complex workflows.


Assuntos
Braquiterapia , Braquiterapia/métodos , Dosagem Radioterapêutica , Biologia
2.
BMC Cancer ; 24(1): 481, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38627695

RESUMO

BACKGROUND: The treatment for lung oligometastasis from colorectal cancer (CRC) remains challenging. This retrospective study aimed to compare the local tumor control, survival and procedure-related complications in CRC patients undergoing low-dose rate stereotactic ablative brachytherapy (L-SABT) versus percutaneous microwave ablation (MWA) for lung oligometastasis. METHODS: Patients between November 2017 and December 2020 were retrospectively analyzed. Local tumor progression-free survival (LTPFS) and overall survival (OS) were analyzed in the entire cohort as well as by stratified analysis based on the minimal ablation margin (MAM) around the tumor. RESULTS: The final analysis included 122 patients: 74 and 48 in the brachytherapy and MWA groups, respectively, with a median follow-up of 30.5 and 35.3 months. The 1- and 3-year LTPFS rate was 54.1% and 40.5% in the brachytherapy group versus 58.3% and 41.7% in the MWA group (P = 0.524 and 0.889, respectively). The 1- and 3-year OS rate was 75.7% and 48.6% versus 75.0% and 50.0% (P = 0.775 and 0.918, respectively). Neither LTPFS nor OS differed significantly between the patients with MAM of 5-10 mm versus > 10 mm. Pulmonary complication rate did not differ in the overall analysis, but was significantly higher in the MWA group in the subgroup analysis that only included patients with lesion within 10 mm from the key structures (P = 0.005). The increased complications was primarily bronchopleural fistula. CONCLUSIONS: Considering the caveats associated with radioisotope use in L-SABT, MWA is generally preferable. In patients with lesion within 10 mm from the key pulmonary structures, however, L-SABT could be considered as an alternative due to lower risk of bronchopleural fistula.


Assuntos
Braquiterapia , Ablação por Cateter , Neoplasias Colorretais , Fístula , Neoplasias Hepáticas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Estudos Retrospectivos , Terapia de Salvação , Micro-Ondas/efeitos adversos , Braquiterapia/efeitos adversos , Resultado do Tratamento , Pulmão/patologia , Neoplasias Colorretais/radioterapia , Neoplasias Colorretais/cirurgia , Fístula/cirurgia , Neoplasias Hepáticas/cirurgia
3.
Sci Rep ; 14(1): 8011, 2024 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580670

RESUMO

We aimed to retrospectively review outcomes in patients with high-risk prostate cancer and a Gleason score ≤ 6 following modern radiotherapy. We analyzed the outcomes of 1374 patients who had undergone modern radiotherapy, comprising a high-risk low grade [HRLG] group (Gleason score ≤ 6; n = 94) and a high-risk high grade [HRHG] group (Gleason score ≥ 7, n = 1125). We included 955 patients who received brachytherapy with or without external beam radio-therapy (EBRT) and 264 who received modern EBRT (intensity-modulated radiotherapy [IMRT] or stereotactic body radiotherapy [SBRT]). At a median follow-up of 60 (2-177) months, actuarial 5-year biochemical failure-free survival rates were 97.8 and 91.8% (p = 0.017), respectively. The frequency of clinical failure in the HRLG group was less than that in the HRHG group (0% vs 5.4%, p = 0.012). The HRLG group had a better 5-year distant metastasis-free survival than the HRHG group (100% vs 96.0%, p = 0.035). As the HRLG group exhibited no clinical failure and better outcomes than the HRHG group, the HRLG group might potentially be classified as a lower-risk group.


Assuntos
Braquiterapia , Neoplasias da Próstata , Radioterapia de Intensidade Modulada , Masculino , Humanos , Gradação de Tumores , Estudos Retrospectivos , Neoplasias da Próstata/patologia , Radioterapia de Intensidade Modulada/efeitos adversos , Dosagem Radioterapêutica , Resultado do Tratamento , Antígeno Prostático Específico
4.
BMC Cancer ; 24(1): 304, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38448897

RESUMO

BACKGROUND: To analyze the efficacy of stereotactic ablative brachytherapy (SABT) and percutaneous microwave ablation (MWA) for the treatment of early-stage non-small cell lung cancer (NSCLC). METHODS: Patients with early-stage (T1-T2aN0M0) NSCLC who underwent CT-guided SABT or MWA between October 2014 and March 2017 at four medical centers were retrospectively analyzed. Survival, treatment response, and procedure-related complications were assessed. RESULTS: A total of 83 patients were included in this study. The median follow-up time was 55.2 months (range 7.2-76.8 months). The 1-, 3-, and 5-year overall survival (OS) rates were 96.4%, 82.3%, and 68.4% for the SABT group (n = 28), and 96.4%, 79.7%, and 63.2% for MWA group (n = 55), respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 92.9%, 74.6%, and 54.1% for SABT, and 92.7%, 70.5%, and 50.5% for MWA, respectively. There were no significant differences between SABT and MWA in terms of OS (p = 0.631) or DFS (p = 0.836). The recurrence rate was also similar between the two groups (p = 0.809). No procedure-related deaths occurred. Pneumothorax was the most common adverse event in the two groups, with no significant difference. No radiation pneumonia was found in the SABT group. CONCLUSIONS: SABT provided similar efficacy to MWA for the treatment of stage I NSCLC. SABT may be a treatment option for unresectable early-stage NSCLC. However, future prospective randomized studies are required to verify these results.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Braquiterapia/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Micro-Ondas/efeitos adversos , Estudos Retrospectivos
5.
World J Urol ; 42(1): 165, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38492111

RESUMO

PURPOSE: Treatment intensification of external beam radiotherapy (EBRT) plays a crucial role in the treatment of high-risk prostate cancer. METHODS: We performed a critical narrative review of the relevant literature and present new developments in evidence-based treatment intensification strategies. RESULTS: For men with high-risk prostate cancer, there is strong evidence to support prolonging androgen deprivation therapy (ADT) to 18-36 months and escalating the dose to the prostate using a brachytherapy boost. A potentially less toxic alternative to a brachytherapy boost is delivering a focal boost to dominant intraprostatic lesions using EBRT. In patients who meet STAMPEDE high-risk criteria, there is evidence to support adding a second-generation anti-androgen agent, such as abiraterone acetate, to long-term ADT. Elective pelvic lymph node irradiation may be beneficial in select patients, though more prospective data is needed to elucidate the group of patients who may benefit the most. Tumor genomic classifier (GC) testing and advanced molecular imaging will likely play a role in improving patient selection for treatment intensification as well as contribute to the evolution of treatment intensification strategies for future patients. CONCLUSION: Treatment intensification using a combination of EBRT, advanced hormonal therapies, and brachytherapy may improve patient outcomes and survival in men with high-risk prostate cancer. Shared decision-making between patients and multidisciplinary teams of radiation oncologists, urologists, and medical oncologists is essential for personalizing care in this setting and deciding which strategies make sense for individual patients.


Assuntos
Braquiterapia , Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/patologia , Antagonistas de Androgênios/uso terapêutico , Estudos Prospectivos , Braquiterapia/métodos , Terapia Combinada , Radioterapia
6.
BMC Cancer ; 24(1): 360, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509492

RESUMO

BACKGROUND: Endometrial cancer is a prevalent gynecologic malignancy found in postmenopausal women. However, in the last two decades, the incidence of early-stage has doubled in women under 40 years old. This study aimed to investigate the clinical and pathological characteristics and adjuvant therapeutic modalities of both young and not -young patients with early-stage endometrial cancer in China's real world. METHODS: This retrospective study analyzed patients with early-stage endometrial cancer at 13 medical institutions in China from 1999 to 2015. The patients were divided into two groups: young (≤ 45 years old) and non-young (> 45 years old). Statistical comparisons were conducted between the two groups for clinical characteristics, pathological features, and survival. The study also identified factors that affect local recurrence-free survival (LRFS) using Cox proportional risk regression analysis. Propensity score matching (1:1) was used to compare the effects of local control between vaginal brachytherapy (VBT) alone and pelvic external beam radiotherapy (EBRT) ± VBT. RESULTS: The study involved 1,280 patients, 150 of whom were 45 years old or younger. The young group exhibited a significantly higher proportion of stage II, low-risk, lower uterine segment infiltration (LUSI), and cervical invasion compared to the non-young group. Additionally, the young patients had significantly larger maximum tumor diameters. The young group also had a significantly higher five-year overall survival (OS) and a five-year LRFS. Age is an independent risk factor for LRFS. There was no significant difference in LRFS between young patients with intermediate- to high-risk early-stage endometrial cancer who received EBRT ± VBT and those who received VBT alone. CONCLUSIONS: In the present study, young patients had better characteristics than the non-young group, while they exhibited higher levels of aggressiveness in certain aspects. The LRFS and OS outcomes were better in young patients. Age is an independent risk factor for LRFS. Additionally, VBT alone may be a suitable option for patients under 45 years of age with intermediate- to high-risk early-stage endometrial cancer, as it reduces the risk of toxic reactions and future second cancers while maintaining similar local control as EBRT.


Assuntos
Braquiterapia , Neoplasias do Endométrio , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Braquiterapia/efeitos adversos , Radioterapia Adjuvante , Vagina/patologia , Estadiamento de Neoplasias
7.
Phys Med Biol ; 69(8)2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38484398

RESUMO

Objective.In brachytherapy, deep learning (DL) algorithms have shown the capability of predicting 3D dose volumes. The reliability and accuracy of such methodologies remain under scrutiny for prospective clinical applications. This study aims to establish fast DL-based predictive dose algorithms for low-dose rate (LDR) prostate brachytherapy and to evaluate their uncertainty and stability.Approach.Data from 200 prostate patients, treated with125I sources, was collected. The Monte Carlo (MC) ground truth dose volumes were calculated with TOPAS considering the interseed effects and an organ-based material assignment. Two 3D convolutional neural networks, UNet and ResUNet TSE, were trained using the patient geometry and the seed positions as the input data. The dataset was randomly split into training (150), validation (25) and test (25) sets. The aleatoric (associated with the input data) and epistemic (associated with the model) uncertainties of the DL models were assessed.Main results.For the full test set, with respect to the MC reference, the predicted prostateD90metric had mean differences of -0.64% and 0.08% for the UNet and ResUNet TSE models, respectively. In voxel-by-voxel comparisons, the average global dose difference ratio in the [-1%, 1%] range included 91.0% and 93.0% of voxels for the UNet and the ResUNet TSE, respectively. One forward pass or prediction took 4 ms for a 3D dose volume of 2.56 M voxels (128 × 160 × 128). The ResUNet TSE model closely encoded the well-known physics of the problem as seen in a set of uncertainty maps. The ResUNet TSE rectum D2cchad the largest uncertainty metric of 0.0042.Significance.The proposed DL models serve as rapid dose predictors that consider the patient anatomy and interseed attenuation effects. The derived uncertainty is interpretable, highlighting areas where DL models may struggle to provide accurate estimations. The uncertainty analysis offers a comprehensive evaluation tool for dose predictor model assessment.


Assuntos
Braquiterapia , Aprendizado Profundo , Masculino , Humanos , Braquiterapia/métodos , Próstata , Incerteza , Reprodutibilidade dos Testes , Estudos Prospectivos , Método de Monte Carlo , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos
9.
Biosens Bioelectron ; 255: 116237, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38537429

RESUMO

Scintillation-based fiber dosimeters are a powerful tool for minimally invasive localized real-time monitoring of the dose rate during Low Dose Rate (LDR) and High Dose Rate (HDR) brachytherapy (BT). This paper presents the design, fabrication, and characterization of such dosimeters, consisting of scintillating sensor tips attached to polymer optical fiber (POF). The sensor tips consist of inorganic scintillators, i.e. Gd2O2S:Tb for LDR-BT, and Y2O3:Eu+4YVO4:Eu for HDR-BT, dispersed in a polymer host. The shape and size of the tips are optimized using non-sequential ray tracing simulations towards maximizing the collection and coupling of the scintillation signal into the POF. They are then manufactured by means of a custom moulding process implemented on a commercial hot embossing machine, paving the way towards series production. Dosimetry experiments in water phantoms show that both the HDR-BT and LDR-BT sensors feature good consistency in the magnitude of the average photon count rate and that the photon count rate signal is not significantly affected by variations in sensor tip composition and geometry. Whilst individual calibration remains necessary, the proposed dosimeters show great potential for in-vivo dosimetry for brachytherapy.


Assuntos
Técnicas Biossensoriais , Braquiterapia , Dosímetros de Radiação , Fibras Ópticas , Polímeros
11.
PLoS One ; 19(3): e0298014, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38547200

RESUMO

PURPOSE: This study aimed to assess the difference in prognosis of patients with early-stage liver cancer after surgery or external radiation. METHODS: Between 2010 and 2015, 2155 patients with AJCC 7th stage I liver cancer were enrolled in the SEER database. Among these, 1972 patients had undergone surgery and 183 had undergone external beam radiation. The main research endpoints were overall survival (OS) and disease-specific survival (DSS). The competitive risk model was used to calculate the risk ratio of liver cancer-specific deaths when there was a competitive risk. Propensity Score Matching (PSM) method using a 1:1 ratio was used to match confounders such as sex, age, and treatment method. Conditional survival was dynamically assessed for patient survival after surgery or external radiation. RESULTS: Multivariate analysis of the competitive risk model showed that age, disease diagnosis time, grade, and treatment [surgery and external beam radiation therapy (EBRT)] were independent prognostic factors for patients with hepatocellular carcinoma. Surgery had a higher survival improvement rate than that of EBRT. As the survival of patients with liver cancer increased, the survival curve of surgery declined more slowly than that of radiotherapy patients and stabilized around 3 years after surgery. The survival curve of radiotherapy patients significantly dropped within 4 years and then stabilized. CONCLUSION: Surgery was better than EBRT for patients with stage I liver cancer. Close follow-up was required for 3 years after surgery or 4 years after external radiation. This study can help clinicians make better informed clinical decisions.


Assuntos
Braquiterapia , Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Prognóstico , Braquiterapia/métodos , Taxa de Sobrevida , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirurgia
12.
Phys Med Biol ; 69(9)2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38537309

RESUMO

Objective.Predicting the probability of having the plan approved by the physician is important for automatic treatment planning. Driven by the mathematical foundation of deep learning that can use a deep neural network to represent functions accurately and flexibly, we developed a deep-learning framework that learns the probability of plan approval for cervical cancer high-dose-rate brachytherapy (HDRBT).Approach.The system consisted of a dose prediction network (DPN) and a plan-approval probability network (PPN). DPN predicts organs at risk (OAR)D2ccand CTVD90%of the current fraction from the patient's current anatomy and prescription dose of HDRBT. PPN outputs the probability of a given plan being acceptable to the physician based on the patients anatomy and the total dose combining HDRBT and external beam radiotherapy sessions. Training of the networks was achieved by first training them separately for a good initialization, and then jointly via an adversarial process. We collected approved treatment plans of 248 treatment fractions from 63 patients. Among them, 216 plans from 54 patients were employed in a four-fold cross validation study, and the remaining 32 plans from other 9 patients were saved for independent testing.Main results.DPN predicted equivalent dose of 2 Gy for bladder, rectum, sigmoidD2ccand CTVD90%with a relative error of 11.51% ± 6.92%, 8.23% ± 5.75%, 7.12% ± 6.00%, and 10.16% ± 10.42%, respectively. In a task that differentiates clinically approved plans and disapproved plans generated by perturbing doses in ground truth approved plans by 20%, PPN achieved accuracy, sensitivity, specificity, and area under the curve 0.70, 0.74, 0.65, and 0.74.Significance.We demonstrated the feasibility of developing a novel deep-learning framework that predicts a probability of plan approval for HDRBT of cervical cancer, which is an essential component in automatic treatment planning.


Assuntos
Braquiterapia , Aprendizado Profundo , Neoplasias do Colo do Útero , Feminino , Humanos , Dosagem Radioterapêutica , Braquiterapia/métodos , Neoplasias do Colo do Útero/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Órgãos em Risco
13.
Radiat Oncol ; 19(1): 35, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481285

RESUMO

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) provides a measurement of tumor cellularity. We evaluated the potential of apparent diffusion coefficient (ADC) values obtained from post-external beam radiation therapy (EBRT) DWI and prior to brachytherapy (BT) to predict for complete metabolic response (CMR) in bulky cervical cancer. METHODS: Clinical and DWI (b value = 500 s/mm2) data were obtained from patients undergoing interstitial BT with high-risk clinical target volumes (HR-CTVs) > 30 cc. Volumes were contoured on co-registered T2 weighted images and 90th percentile ADC values were calculated. Patients were stratified by CMR (defined by PET-CT at three months post-BT). Relation of CMR with 90th percentile ADC values and other clinical factors (International Federation of Gynecology and Obstetrics (FIGO) stage, histology, tumor and HR-CTV size, pre-treatment hemoglobin, and age) was assessed both in univariate and multivariate logistic regression analyses. Youden's J statistic was used to identify a threshold value. RESULTS: Among 45 patients, twenty-eight (62%) achieved a CMR. On univariate analysis for CMR, only 90th percentile ADC value was significant (p = 0.029) while other imaging and clinical factors were not. Borderline significant factors were HR-CTV size (p = 0.054) and number of chemotherapy cycles (p = 0.078). On multivariate analysis 90th percentile ADC (p < 0.0001) and HR-CTV size (p < 0.003) were highly significant. Patients with 90th percentile ADC values above 2.10 × 10- 3 mm2/s were 5.33 (95% CI, 1.35-24.4) times more likely to achieve CMR. CONCLUSIONS: Clinical DWI may serve to risk-stratify patients undergoing interstitial BT for bulky cervical cancer.


Assuntos
Braquiterapia , Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Braquiterapia/métodos , Imagem de Difusão por Ressonância Magnética/métodos
14.
Urologia ; 91(1): 8-10, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38465607

RESUMO

The role of the radiation oncologist in the management of patients affected by prostate cancer is increasingly considered thanks to important technological innovations that have marked the radiotherapeutic approach in its three main fields: external beam radiotherapy (EB-RT), brachytherapy (interventional radiotherapy, I-RT), and metabolic radiotherapy (M-RT) through the use of new radiopharmaceuticals. Regarding the modern brachytherapy, the introduction of intensity-modulated techniques (IM-IRT), thanks to the implementation of HDR remote-after loading machines, and image-guided techniques (IG-IRT), has led to advantages in optimizing dose distribution after implantation with the possibility of modulating the dose according to the intraprostatic dominant lesions, limiting the dose to the surrounding tissues with improvement in local control and a significant reduction in side effects. I-RT today represents a safe, scientifically established, effective and well-tolerated treatment for patients affected by prostate cancer. Like most special techniques, in order to obtain the best results, it must be performed in centers with a high volume of activity and consolidated experience with an interdisciplinary approach.


Assuntos
Braquiterapia , Neoplasias da Próstata , Masculino , Humanos , Radio-Oncologistas , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica
15.
Anticancer Res ; 44(4): 1583-1589, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38537975

RESUMO

BACKGROUND/AIM: Concurrent cisplatin-based chemoradiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer. Especially, CCRT with magnetic resonance imaging (MRI) or computed tomography-based image-guided brachytherapy (CT-based 3D-IGBT) for cervical cancer has resulted in good LC rates. However, progression-free survival (PFS) and overall survival (OS) rates for locally advanced cervical cancer are still low and could be improved. The aim of the study was to evaluate treatment efficacy and late toxicity of external beam radiotherapy (EBRT) and CT-based IGBT with or without concurrent chemotherapy in patients with squamous cell carcinoma of the uterine cervix and investigate patterns of failure. PATIENTS AND METHODS: We retrospectively analyzed clinical data of cervical squamous cell carcinoma patients treated with definitive radiotherapy with or without concurrent chemotherapy at Saitama Medical University International Medical Center. Local control (LC), PFS, patterns of failure, and late toxicity were the evaluated outcomes. RESULTS: Overall, 290 patients were enrolled in the study. Median follow-up was 51.5 months. During follow-up, 74 patients developed recurrence: 10 patients with intra-pelvic failure only, 45 with extra-pelvic failure only, and 19 with both. The 3-year LC was 100% for T1b-T2a, 96.8% for T2b, 89.5% for T3b, and 88.5% for T4 disease. The 3-year PFS was 100% for stage IB-IIA, 89.0% for stage IIB, 70.7% for stage IIIB, 72.6% for stage IIIC1r, and 40.1% for stage IVA. The incidence of grade 3-4 gastrointestinal and genitourinary toxicities was 3.0% and 1.7%, respectively. CONCLUSION: Combination of EBRT and CT-based IGBT with or without concurrent chemotherapy produced favorable LC with acceptable rates of late toxicities. However, extra-pelvic failures frequently occurred and PFS was less satisfactory in patients with stage III-IVA disease, which indicated the need for additional treatment in these patients.


Assuntos
Braquiterapia , Carcinoma de Células Escamosas , Neoplasias do Colo do Útero , Feminino , Humanos , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapia , Braquiterapia/métodos , Estudos Retrospectivos , Cisplatino/uso terapêutico , Resultado do Tratamento , Quimiorradioterapia/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Tomografia , Estadiamento de Neoplasias
16.
Medicina (Kaunas) ; 60(3)2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38541177

RESUMO

Background and Objectives: Advanced lung cancer is usually manifested by endoluminal tumor propagation, resulting in central airway obstruction. The objective of this study is to compare the high dose rate brachytherapy treatment outcomes in non-small-cell lung cancer (NSCLC) depending on the treatment planning pattern-two-dimension (2D) or three-dimension (3D) treatment planning. Materials and Methods: The study was retrospective and two groups of patients were compared in it (a group of 101 patients who underwent 2D planned high-dose-rate endobronchial brachytherapy (HDR-EBBT) in 2017/18 and a group of 83 patients who underwent 3D planned HDR-EBBT between January 2021 and June 2023). Results: In the group of 3D planned brachytherapy patients, there was a significant improvement in terms of loss of symptoms of bronchial obstruction (p = 0.038), but no improvement in terms of ECOG PS (European Cooperative Oncology Group Performance Status) of the patient (p = 0.847) and loss of lung atelectasis (if there was any at the beginning of the disease) (p = 0.781). Two-year overall survival and time-to-progression periods were similar for both groups of patients (p = 0.110 and 0.154). Fewer treatment complications were observed, and 91.4% were in 3D planned brachytherapy (BT) patients. Conclusions: Three-dimensionally planned HDR-EBBT is a suggestive, effective palliative method for the disobstruction of large airways caused by endobronchial lung tumor growth. Independent or more often combined with other types of specific oncological treatment, it certainly leads to the loss of symptoms caused by bronchial obstruction and the improvement of the quality of life of patients with advanced NSCLC. Complications of the procedure with 3D planning are less compared to 2D planned HDR-EBBT.


Assuntos
Obstrução das Vias Respiratórias , Braquiterapia , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/radioterapia , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Estudos Retrospectivos , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Qualidade de Vida , Dosagem Radioterapêutica
19.
Radiat Oncol ; 19(1): 22, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38351013

RESUMO

INTRODUCTION: Characterizing the landscape of clinical trials including brachytherapy can provide an overview of the current status and research trends which may guide further areas of investigation. METHOD: We queried 449,849 clinical trials from the ClinicalTrials.gov registry using brachytherapy-related keywords from 1980 to 2023, yielding 245 multi-arm and 201 single-arm, brachytherapy trials. Multi-arm and single-arm brachytherapy trials were compared using 12 trial protocol elements. RESULTS: The number of trials including brachytherapy has increased over time, with over 60% of trials registered in 2010 onwards. The majority of clinical trials were Phase 2 or 3, evaluated both safety and efficacy, and were funded by academic sponsors. The most common tumor sites evaluated in brachytherapy clinical trials include prostate, cervix, liver, endometrium, and breast. CONCLUSION: There remains continued interest in clinical trials including brachytherapy focused on evaluation of novel delivery systems, treatment planning, and new indications. More brachytherapy clinical trials are needed to define the optimal clinical utilization and advance prospective research in this field.


Assuntos
Braquiterapia , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Estudos Transversais
20.
PLoS One ; 19(2): e0298550, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38335156

RESUMO

After 2010, the source model of the microSelectron HDR Afterloader System was slightly modified from the previous model. Granero et al. named the modified source model "mHDR-v2r (revised model mHDR-v2)" and the previous model "mHDR-v2". They concluded that the dosimetric differences arising from the dimensional changes between the mHDR-v2 and mHDR-v2r designs were negligible at almost all locations (within 0.5% for r ≥ 0.25 cm), the two-dimensional anisotropy function difference between the two sources is found 2.1% at r = 1.0 cm when compared with the results of the other experimental group. To confirm this difference, we performed a full Monte Carlo simulation without energy-fluence approximation. This is useful near the radiation source where charged-particle equilibrium does not hold. The two-dimensional anisotropy function of the TG-43U1 dataset showed a few percent difference between the mHDR-v2r and mHDR-v2 sources. There was no agreement in the immediate vicinity of the source (0.10 cm and 0.25 cm), when compared to Granero et al. in mHDR-v2r sources. The differences in these two-dimensional anisotropy functions were identified.


Assuntos
Braquiterapia , Braquiterapia/métodos , Radioisótopos de Irídio/uso terapêutico , Dosagem Radioterapêutica , Método de Monte Carlo , Radiometria/métodos
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