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INTRODUCTION: Inflammatory bowel disease (IBD) is a relative contraindication to external beam radiation therapy (EBRT) for prostate cancer patients due to fear of increased risk of gastrointestinal (GI) toxicity. High-dose-rate (HDR) brachytherapy, capable of minimizing radiation dose to surrounding tissues, is a feasible alternative. Given limited data, this study examined the safety profile of HDR brachytherapy in this setting. MATERIAL AND METHODS: We conducted a retrospective review of patients with localized prostate cancer and IBD treated with HDR brachytherapy at the University of California San Francisco (UCSF), between 2010 and 2022. Eligibility criteria included biopsy-proven prostate cancer, no distant metastases, absence of prior pelvic radiotherapy, IBD diagnosis, and at least one follow-up visit post-treatment. RESULTS: Eleven patients were included, with a median follow-up of 28.7 months. The median dose administered was 2700 cGy (range, 1500-3150 cGy) over 2 fractions (range, 1-3 fractions). Two patients also received EBRT. Rectal spacers (SpaceOAR) were applied in seven patients. All patients experienced acute genitourinary (GU) toxicity, ten of which were grade 1 and one was grade 2. Eight patients experienced late grade 1 GU toxicity, and three patients had late grade 2 GU toxicity. GI toxicities were similarly low-grade, with six grade 1 acute toxicity, no grade 2 or higher acute toxicity, six grade 1 late toxicity, and one late grade 2 GI toxicity. No grade 3 or higher acute or late GI or GU toxicities were reported. CONCLUSIONS: HDR brachytherapy appears to be a safe and tolerable treatment modality for patients with prostate cancer and IBD, with minimal acute and late GI and GU toxicity. These findings warrant multi-institutional validation due to small sample size.

Radioembolization using Yttrium-90 (90 Y) microspheres is widely used to treat primary and metastatic liver tumors. The present work provides minimum practice guidelines for establishing and supporting such a program. Medical physicists play a key role in patient and staff safety during these procedures. Products currently available are identified and their properties and suppliers summarized. Appropriateness for use is the domain of the treating physician. Patient work up starts with pre-treatment imaging. First, a mapping study using Technetium-99m (Tc-99m ) is carried out to quantify the lung shunt fraction (LSF) and to characterize the vascular supply of the liver. An MRI, CT, or a PET-CT scan is used to obtain information on the tumor burden. The tumor volume, LSF, tumor histology, and other pertinent patient characteristics are used to decide the type and quantity of 90 Y to be ordered. On the day of treatment, the appropriate dose is assayed using a dose calibrator with a calibration traceable to a national standard. In the treatment suite, the care team led by an interventional radiologist delivers the dose using real-time image guidance. The treatment suite is posted as a radioactive area during the procedure and staff wear radiation dosimeters. The treatment room, patient, and staff are surveyed post-procedure. The dose delivered to the patient is determined from the ratio of pre-treatment and residual waste exposure rate measurements. Establishing such a treatment modality is a major undertaking requiring an institutional radioactive materials license amendment complying with appropriate federal and state radiation regulations and appropriate staff training commensurate with their respective role and function in the planning and delivery of the procedure. Training, documentation, and areas for potential failure modes are identified and guidance is provided to ameliorate them.

Background: Model‐based dose calculation algorithms (MBDCA), such as the Advanced Collapsed cone Engine (ACE) in Oncentra Brachy® can be used to overcome the limitations of the TG‐43 formalism. ACE is a point kernel superposition algorithm that calculates the total dose separated into primary, first‐scatter, and multiple‐scatter dose. Albeit ACE yields accurate results under most circumstances, several studies have reported underestimations of the dose to cortical bone. These underestimations are likely caused by approximations in the handling of multiple‐scatter dose for non‐water media. Such would result in noticeable deviations where the multiple‐scatter is a considerable fraction of the total dose, that is, at greater distances from the source. Purpose: To improve and test the accuracy of the multiple‐scatter dose component in the ACE algorithm to remedy its inaccuracy for non‐water geometries. Methods: A careful analysis of the transport and absorption of the multiple‐scatter energy fluence revealed an inconsistency in the scaling of energy absorption ratios for non‐water media of the multiple‐scatter kernel. We implemented an updated algorithm version, ACEcorr, and tested it for three different geometries. All had a single 192Ir‐source at the center of a cubic water phantom with a box‐shaped heterogeneity of either cortical bone or air, positioned at different distances from the source. Dose distributions for the three cases were calculated with ACE and ACEcorr and compared to Monte Carlo simulations, using the percentage dose difference ratio as figure‐of‐merit. All dose calculation methods scored separately the dose deposited by primary, first‐scattered, and multiple‐scattered photons. Results: The accuracy of the updated algorithm ACEcorr was superior to ACE. In the cortical bone heterogeneity, the mean percentage dose difference ratio for the total dose improved from −11.7%$ - 11.7{\mathrm{\% }}$ to −2.2%$ - 2.2{\mathrm{\% }}$ (in the worst case) by our update. Less impact was seen in the air heterogeneity, where both ACE and ACEcorr deviated less than 2% from the Monte Carlo results. The algorithm update mainly concerns the multiple‐scattered dose component, but an accompanying data processing update also had a small effect (≤$ \le $0.5% difference) on the primary and first‐scattered dose. The calculation times were not affected. Conclusions: The updates to ACE improved the accuracy of multiple‐scatter dose calculation for non‐water media, without increasing calculation times. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsReport the results of Ruthenium plaque brachytherapy (106Ru) for the management of intraocular tumors in Thailand.We retrospectively reviewed the medical records of 46 eyes of 45 patients who received 106Ru brachytherapy for the treatment of various intraocular tumors in the Department of Ophthalmology of Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between April 2013 and December 2020.Of 46 eyes, 21 (46%) were diagnosed with small to medium choroidal melanoma, 13 (28%) with retinoblastoma, 4 (9%) with choroidal metastases, 2 (4%) with retinal vasoproliferative tumor (VPT), 3 (7%) with choroidal hemangioma (CH), 2 (4%) with RPE adenoma, and 1 (2%) with retinal hemangioblastoma. The mean tumor thickness was 4.8 mm (range, 2.4–6.6). After a mean follow-up of 62.4 months (range, 4.8–122.7), local tumor control was achieved in 39 eyes (85%), which were 100% for choroidal melanoma, 46% for RB, 100% for choroidal metastasis and 100% for benign tumors. Radiation-related complications were found in 28 eyes (61%), including cataracts in 10 (25%), radiation retinopathy in 14 (30%), radiation maculopathy in 14 (30%), radiation papillopathy in 6 (13%), and vitreous hemorrhage in 3 (7%) eyes. All patients with retinoblastoma currently alive without metastasis. Two patients with choroidal melanoma developed systemic metastases and three patients with choroidal metastases died at the end of the study.Patients with intraocular tumors treated with 106Ru brachytherapy showed excellent outcomes in relation to tumor control with few complications. [ABSTRACT FROM AUTHOR]

Purpose: This randomized controlled study was conducted to analyze the effect of hand massage on the fatigue level of the women receiving brachytherapy. Methods: It was determined that 12 patients were included in each group (control and hand massage group), so 24 women with gynecologic cancer were included in the study. The application was performed on each hand for 5 min, a total of 10 min in hand massage group. Hand massage was applied before each brachytherapy (at the first, second, and third sessions, a total of three times) every other day for 1 week in the hand massage group. No intervention was performed to the control group during the study. The data were collected using the Patient Information Form and Brief Fatigue Inventory (BFI). Results: At the end of the brachytherapy, the fatigue severity score and impact of fatigue on activities of daily living scores of the group that applied hand massage were determined to be lower than the control group (p < 0.05). Conclusion: It was determined that hand massage effectively controlled fatigue and the impact of fatigue on activities of daily living. Hand massage is a safe and economical method that can be performed by certified nurses. Trial registration: This clinical trial is registered at ClinicalTrials.gov (NCT06056713-09/21/2023). [ABSTRACT FROM AUTHOR]

Background: High dose rate (HDR) intracavitary brachytherapy (ICBT) plays a crucial role in cervix cancer treatment, with variations in fractionation schedules across different radiation societies. This study aims to assess the effectiveness and tolerability of a 7 Gy per fraction twice daily schedule over two successive weeks versus an 8 Gy per fraction once weekly schedule over three successive weeks. Patients and Methods: From 2020 to 2022, 87 patients with uterine cervix cancer (Stages II and III) underwent concomitant external beam radiotherapy (EBRT) and chemotherapy, followed by HDR-ICBT. Patients were randomised into two arms: Arm A (8 Gy per fraction once weekly for 3 fractions) and Arm B (7 Gy per fraction twice daily once a week for 4 fractions). Local control is defined as any patient free from local progression (CR + PR + SD) in the first year after ending brachytherapy (BTH). Results: The median follow-up was 16·5 months. Local control at 1 year was 78·7% in Arm A and 89·2% in Arm B (p = 0·24). No clinically significant differences in rectal and bladder toxicities were observed between the two arms (p = 0·40). Conclusion: There were limited treatment machines and other BTH challenges in Egypt, and the HDR BTH schedule of 7 Gy per fraction twice daily over 2 successive weeks presents an acceptable alternative to the current national standard of 8 Gy per fraction once weekly over 3 weeks. Both schedules demonstrate comparable local control, late toxicity and progression-free survival. Notably, the 7 Gy per fraction twice daily per week for 4 fractions offers the advantage of a reduced total treatment time. [ABSTRACT FROM AUTHOR]

Background: Brachytherapy (BT) is routinely used in the treatment of various cancers. Current BT relies on the placement of large sources of radioactivity at the tumor site, requiring applicators that may cause local traumas and lesions. Further, they suffer from inflexibility in where they can be placed and some sources reside permanently in the body, causing potential long-term discomfort. These issues can be circumvented through injectable sources, prepared as biodegradable materials containing radionuclides that form solid seeds after administration. The level of radioactivity contained in such seeds must be sufficient to achieve substantial local irradiation. In this report, we investigate two different strategies for biodegradable BT seeds. Results: The first strategy entails injectable seeds based on 103Pd-labeled palladium-gold alloy nanoparticles ([103Pd]PdAuNPs). These were prepared by combining [103Pd]PdH2Cl4 and AuHCl4, followed by lipophilic surface coating and dispersed in lactose octaisobutyrate and ethanol (LOIB:EtOH), in overall radiochemical yield (RCY) of 83%. With the second strategy, [103Pd]Pd-SSIB was prepared by conjugating the [16]aneS4 chelator with lipophilic sucrose septaisobutyrate (SSIB) followed by complexation with [103Pd]PdH2Cl4 (RCY = 99%) and mixed with LOIB:EtOH. [103Pd]Pd-SSIB was likewise formulated as injectable liquid forming seeds by mixing with LOIB. Both formulations reached activities of 1.0–1.5 GBq/mL and negligible release of radioactivity after injection of 100 µL (100–150 MBq) into aqueous buffer or mouse serum of less than 1% over one month. Conclusion: Both strategies for forming injectable BT seeds containing high 103Pd activity resulted in high radiolabeling yields, high activity per seed, and high activity retention. We consider both strategies suitable for BT, with the preferable strategy using a [16]aneS4 chelator due to its higher biodegradability. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusions To investigate the safety and cancer control of a novel bioabsorbable, low‐dose rate brachytherapy device, CivaSheet® (CivaTech Oncology Inc., Durham, NC, USA), in combination with radical prostatectomy (RP) with or without adjuvant external beam radiation therapy (EBRT) for the management of prostate cancer (PCa).This is an initial, single‐centre experience, two‐dose level, two‐stage study conducted on patients with intermediate‐ and high‐risk PCa. The CivaSheet was implanted during RP, followed by adjuvant EBRT in patients with adverse pathological features. Toxicities and peri‐ and postoperative complications were assessed. Biochemical recurrence (BCR) at the 6‐month follow‐up after EBRT was also evaluated.Six patients were enrolled, with a median (range) age of 56 (53–71) years. No intraoperative complications occurred. No dose‐limiting toxicities were observed at a maximum tested dose of 75 Gy. BCR occurred in one patient at 6 months, while another patient had residual disease and metastasis at 6 months. All patients reported having postoperative erectile dysfunction and one patient experienced urinary incontinence after EBRT.This study demonstrated the feasibility and safety of CivaSheet combined with RP and adjuvant EBRT for high‐risk PCa. The short‐term toxicity profile was well‐tolerated, supporting further prospective evaluation with clinical trials. [ABSTRACT FROM AUTHOR]

Background/Objectives: Radiotherapy represents the only treatment option for patients with inoperable endometrial cancer (EC). The aim of our study was to evaluate the efficacy and safety of brachytherapy (BT) in this selected patient population. Methods: Between 1990 and 2019, 18 patients with inoperable EC in stage FIGO I–IV were treated with intracavitary brachytherapy using the "Heyman Packing technique". BT was performed either as sole PDR- or HDR-brachytherapy with a median cumulative dose up to 60.0 Gy (67.9 Gy EQD2 α/β = 3Gy) and 34.0 Gy (75.6 Gy EQD2 α/β = 3Gy), respectively. Results: The median follow-up was 46 months (6–219). The mean age was 71 years. The 5-year cumulative local recurrence rate (CLRR) for the whole cohort was 27.3%. The 5-year overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 51%, 79%, and 69%. The 5-year DFS for low-, intermediate-, and high-risk EC was 89%, 50%, and 44% (p = 0.51). No significant difference in DFS was observed in patients over 70 (p = 0.526). No late side effects of grade > 1 were documented. Conclusions: Brachytherapy for inoperable EC is a safe and effective treatment option, offering good local control and OS with minimal toxicity. Moreover, brachytherapy effectively controls hemoglobin-relevant bleeding. Therefore, BT should be considered a viable alternative to non-curative treatment strategies in gynecological multidisciplinary conferences. [ABSTRACT FROM AUTHOR]

Background: The inclusion of pelvic lymph node (PLN) metastasis in the FIGO staging system has impacted disease classification and patient survival. Brachytherapy is a key component in managing carcinoma cervix; however, the dose contribution of brachytherapy to PLNs remains unclear. Aims and Objectives: This study aims to quantify the dose contribution of highdose rate (HDR) brachytherapy to individual pelvic nodal groups. Materials and Methods: We included 40 biopsy-proven carcinoma cervix patients, stages IIA to IVA. All patients underwent external beam radiotherapy (EBRT) with concurrent cisplatin chemotherapy, followed by HDR brachytherapy, either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT). A total dose of 21 Gy in 3 fractions (7 Gy per fraction) was prescribed to the high-risk clinical target volume. Results: For ICBT, the mean absolute doses received by the external iliac, internal iliac, and obturator groups were 0.56 Gy, 1.02 Gy, and 1.22 Gy, corresponding to EQD2 (a/ß=10) values of 0.49 Gy, 0.93 Gy, and 1.14 Gy, respectively. In the ISBT group, the mean absolute doses were 0.49 Gy, 0.86 Gy, and 1.11 Gy, with corresponding EQD2s of 0.43 Gy, 0.85 Gy, and 1.02 Gy. Conclusion: PLNs received significant dose contributions from HDR brachytherapy in cervical cancer patients, providing valuable reference data for determining the EBRT boost dose in cases of enlarged PLNs. [ABSTRACT FROM AUTHOR]

Introduction: Biliary tract cancers (BTC) are rare and aggressive neoplasms. The current management of locally advanced or unresectable BTC is primarily based on chemotherapy (CHT) alone, linked to a median overall survival (OS) of approximately 12 months. However, international guidelines still consider concurrent chemoradiation (CRT) as an alternative treatment option. This study aims to review the current evidence on "modern" CRT for primary or recurrent unresectable BTC. Materials and Methods: A comprehensive search was conducted on PubMed, Scopus, and Cochrane Library to identify relevant papers. Prospective or retrospective trials reporting outcomes after concurrent CRT of unresectable non‐metastatic, primary, or recurrent BTC were included. Only English‐written papers published between January 2010 and June 2022 were considered. Results: Seventeen papers, comprising a total of 1961 patients, were included in the analysis. Among them, 11 papers focused solely on patients with primary unresectable BTC, while two papers included patients with isolated local recurrences and four papers encompassed both settings. In terms of tumor location, 12 papers included patients with intrahepatic, extrahepatic, and hilar BTC, as well as gallbladder cancer. The median CRT dose delivered was 50.4 Gy (range: 45.0–72.6 Gy) using conventional fractionation. Concurrent CHT primarily consisted of 5‐Fluorouracil or Gemcitabine. The pooled rates of 1‐year progression‐free survival (PFS) and OS were 40.9% and 56.2%, respectively. The median 1‐ and 2‐year OS rates were 63.1% and 29.4%, respectively. Grade ≥3 acute gastrointestinal toxicity ranged from 5.6% to 22.2% (median: 10.9%), while grade ≥3 hematological toxicity ranged from 1.6% to 50.0% (median: 21.7%). Conclusion: Concurrent CRT is a viable alternative to standard CHT in patients with locally advanced BTC, offering comparable OS and PFS rates, along with an acceptable toxicity profile. However, prospective trials are needed to validate and further explore these findings. [ABSTRACT FROM AUTHOR]

Brachytherapy (BT) is recommended for vaginal cancer treatment, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in utilization rates. This study examines recent trends in BT utilization to assess for reversal in trends. This study analyzed the National Cancer Database (NCDB) of patients with FIGO stage I to IVA vaginal cancer treated between 2004 and 2021. A log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization over time and identify potential factors associated with receipt. Brachytherapy use increased from 48.0 % in 2004 to 63.3 % in 2021. Factors associated with increased brachytherapy use included, receiving care at an academic/research program (IRR: 1.35 95 % CI: 1.18–1.55), integrated cancer program (1.22 [1.06–1.41]), and diagnosis after 2018 (1.31 [1.21–1.42]). Factors associated with decreased use included American Indian or Alaskan Native race (0.55 [0.31–0.97]) when compared to white race, age over 70 (≥ 70–79 years: 0.91 [0.83–0.99]; ≥ 80 years: 0.68 [0.61–0.76]) when compared to age less than 50, and stage II (0.91 [0.86–0.96]), III (0.71 [0.67–0.75]), or IVA (0.43 [0.37–0.50]) disease when compared to stage I. Finally, geographic differences were also observed in BT use. In patients with stage I – IVA vaginal cancer from 2004 to 2021, brachytherapy utilization has significantly increased. These results indicate a recent start of the reversal of previously identified declining use of brachytherapy. However, more work is needed to ensure equitable use across demographic strata. • Brachytherapy utilization for vaginal cancer has significantly increased in the period between 2004 and 2021. • Several disparities exist in the use of brachytherapy across racial, geographic, and treatment-related strata. • Brachytherapy receipt is associated with improved survival in vaginal cancer patients. • More effort to ensure equitable access and distribution of the procedure is necessary. [ABSTRACT FROM AUTHOR]

The field of gynaecologic oncology has evolved rapidly in recent years, largely driven by advances in both radiotherapy and systemic therapies. These innovations have reshaped the management of key gynaecologic cancers, including cervical, endometrial, vaginal, and vulvar cancers, leading to more personalized and effective treatment approaches. This review explores pivotal clinical trials conducted between 2023 and 2024 that have potentially modified current practices. Through an extensive analysis of randomized controlled trials and meta-analyses, we examine the evolving role of radiotherapy, the integration and sequencing of immunotherapy, and the refinement of neoadjuvant and adjuvant treatments based on molecular classifications. The combination of immunotherapy with chemoradiotherapy has shown promising outcomes, particularly in patients with locally advanced cervical cancer. For endometrial cancer, molecular profiling has enabled a more precise classification of tumour subtypes, leading to better-targeted adjuvant therapies that reduce unnecessary interventions and increase treatment efficacy. In parallel, radiotherapy has advanced with the increasing use of modern techniques such as intensity-modulated radiotherapy and more recently the developments of adaptive treatments in order to minimize exposure to healthy tissue, thereby reducing toxicity and enhancing patient quality of life. Integration of image-guided brachytherapy and expansion of capabilities with newer generation of brachytherapy applicators have also increased possibilities to achieve efficient local treatments, including in very advanced cases. However, despite progress in common gynaecologic cancers, the management of rare cancers such as vulvar and vaginal cancers continues to face challenges due to limited clinical research and treatment data. This review highlights the transformative potential of these innovations and emphasizes the need for continued research and personalized treatment strategies to optimize patient outcomes in gynaecologic oncology. [ABSTRACT FROM AUTHOR]

High dose rate (HDR) brachytherapy procedures for cervical cancer require multiple applicator insertions for multiple (typically 5) fractions of a single plan, which carries a risk for variability in applicator position between fractions. Due to applicator displacement relative to patient anatomy, the dose to nearby organs-at-risk (OARs) may vary significantly from one fraction to the next. The purpose of this study was to evaluate the effect of changes in HDR tandem and ring (T&R) applicator position on doses to nearby OARs and to present a quick and simple method to estimate doses to OARs inter-fractionally without having to perform a re-plan. Ninety CT image sets for 20 patients, ages 44 to 86, undergoing T&R-based HDR for cervical cancer were used retrospectively for this study. Measures of applicator positional and angular changes relative to the bony anatomy were obtained using image fusion in MIM software, between the planning CT (plan CT) and the CT on the treatment day (CT-TX). Dosimetric data were determined, also using MIM software, using the original (first fraction) dose distribution applied to organs at risk (rectum and bladder), transferred via rigid registration from the plan CT to each CT-TX. Bladder and rectum contours were also transferred from each plan CT to each CT-TX and were tweaked manually to match anatomy on each CT-TX and examined visually for appropriateness. Differences in translation and rotation of the T&R applicator between the planning CT and subsequent individual fractions were recorded and plotted against dose differences between each fraction of treatment and the original (first) fraction. Absolute dose (D 2cc) and volume (V 50) differences vs positional shifts were calculated and plotted, and the Pearson Product-Moment correlation coefficient between dose parameters and measured positional shifts was determined. Average dosimetric differences between planned dose and subsequent fractional doses obtained through rigid registration were 1.48 ± 1.92 Gy, 14.91 ± 11.92 cm3, 0.56 ± 0.93 Gy, and 1.77 ± 2.18 cm3 for Bladder D 2cc , Bladder V 50 , Rectum D 2cc , and Rectum V 50 , respectively. Correlation between Bladder V 50 and sagittal plane rotation gave an r2 of 0.4, showing the most correlation of all parameters studied. Bladder dose and volume increased by a maximum of about 2.7 Gy and 50 cm3 overall for Bladder D 2cc and Bladder V 50 , respectively. Bladder V 50 was most sensitive to T&R applicator displacements. We have quantified the effects of applicator positional changes on dose changes for the bladder and rectum. Even large changes in applicator position between fractions did not result in significant changes in dose to these normal tissues, indicating that adaptive re-planning is not necessary. [ABSTRACT FROM AUTHOR]

Background: There has been no study in which the correlation between clinical results and dosimetry based on a 3D treatment planning system in patients with 198Au grains for head and neck cancer was evaluated. Methods: Thirty‐two patients who were treated with 198Au grains for head and neck cancer were reviewed. Twenty‐five patients were treated with brachytherapy alone and seven patients were treated with a combination of brachytherapy and neoadjuvant external beam radiation therapy. Results: With a median observation period of 60 months, the 5‐year local control rate was 82.9%. V85Gy of CTV in patients with local recurrence tended to be lower than that in patients without local recurrence (p = 0.07). The maximum dose of the keratinized gingiva in patients in whom bone exposure occurred was significantly higher than that in patients in whom bone exposure did not occur (p = 0.001). Conclusions: Dose distribution with 198Au grains can predict local control and late adverse events. [ABSTRACT FROM AUTHOR]

Background: Aim was to compare the efficacy of interventional radiotherapy (IRT) boost vs. external beam radiotherapy (EBRT) boost after chemoradiation (CCRT) in patients with anal cancer (AC). Methods: The P.I.C.O. framework was: in patients with AC [P], is IRT boost [I] superior to EBRT boost [C] in terms of local control (LC), cancer specific survival (CSS), overall survival (OS), distant meta-static free Survival (DMFS), colostomy free survival (CFS) and toxicity [O]? Results: 651 patients were analyzed. The median 5-year locoregional control rates was 87.8% in the IRT boost group versus 72.8% in the EBRT boost group. The 5-year cancer-specific survival rate was 91% in the IRT boost group versus 78% in the EBRT boost group. 5-years overall survival was 74.6% in IRT boost versus 67.7% in the EBRT boost. 5-years disease metastasis-free survival rate was 92.9% in IRT boost group vs. 85.6% for the EBRT boost group. Cancer-free survival rate was 76.8% in the IRT group vs. 63.1% in the EBRT boost group. Acute toxicity above grade 2 was less common in the IRT boost group while chronic toxicity was similar between both groups. Conclusion: IRT boost after CCRT could lead to better outcomes than EBRT boost in treating AC. [ABSTRACT FROM AUTHOR]

Background: Endometrial cancer is one of the most common gynecological malignancies in the world. Vaginal brachytherapy is an important postoperative adjuvant treatment for endometrial cancer. However, a common problem with existing applicators is insufficient dose at the vaginal apex. Purpose: This study describes the Hangzhou (HZ) cylinder, a novel 3D printed vaginal intracavity brachytherapy applicator, detailing its characteristics, dose distribution, and clinical applications. Methods and Materials: The HZ cylinder is distinguished by its unique structure: a U‐shaped channel with a 2 mm diameter, a straight central axis channel of the same diameter, and 10 parallel straight channels. For comparison, standard plans were employed, designed to ensure that a minimum of 95% of the prescribed dose reached 5 mm beneath the mucosal surface. We conducted comparative analyses of mucosal surface doses and doses at a 5 mm depth below the mucosa between the HZ cylinder and a conventional single‐channel cylinder across various treatment schemes. Additionally, the study examined dose differences in target volume and organs at risk (OARs) between actual HZ cylinder plans and hypothetical single‐channel plans. Results: In the standard plans, mucosal surface doses at the apex of the vagina were 209.32% and 200.61% of the prescribed dose with the HZ and single‐channel cylinders, respectively. The doses on the left and right wall mucosal surfaces varied from 149.26% to 178.13% and 142.98% to 180.75% of the prescribed dose, and on the anterior and posterior wall mucosal surfaces varied from 128.87% to 138.50% and 142.98% to 180.75% of the prescribed dose. Analysis of 24 actual treatment plans revealed that when the vaginal tissue volume dose covering 98% (vaginal D98%) was comparable between the HZ cylinder and virtual single‐channel plans (6.74 ± 0.07 Gy vs. 6.69 ± 0.10 Gy, p = 0.24), rectum doses of HZ cylinder plans were significantly lower than those of single‐channel plans (D1cc, 5.96 ± 0.56 Gy vs. 6.26 ± 0.71 Gy, p = 0.02 and D2cc, 5.26 ± 0.52 Gy vs. 5.56 ± 0.62 Gy, p = 0.02). Conclusions: The HZ cylinder demonstrates a reduction in dose to the rectum and bladder while maintaining adequate target volume coverage. Its mucosal surface dose is comparable to that of the traditional single‐channel cylinder. These findings suggest that the HZ cylinder is a viable and potentially safer alternative for vaginal brachytherapy, warranting further investigation with larger sample sizes. [ABSTRACT FROM AUTHOR]

Background: Brachytherapy (BT) treatments involving temporary high‐dose rate (HDR) sources are extensively employed in clinical practice. Ensuring the consistency of all measurement equipment at the hospital level is crucial, requiring a robust redundancy and consistency program. This enables the institution to verify the stability of the dosimetry system over time. Purpose: To describe, justify, and analyze a component of the redundancy program of the calibration protocols followed by the Radiotherapy Department of the Hospital Universitari i Politècnic La Fe (València, Spain) during the last 10 years for the case of HDR BT as an additional component to ensure long term stability of the measurement equipment. Methods: At the time the HDR BT source is replaced, its Air Kerma Strength (SK) is measured. By comparing this value with the one obtained at the time of installation (corrected by decay), a clear determination of the stability of the measurement equipment can be performed. Results: Difference between SK,vendor and SK,hosp as a function of the measurement date is reported for a 10 years' period. All measurements are well within the ±3% tolerance level recommended in current international guidelines. Percentage differences of SK,hosp values at the time of replacement compared to SK,hosp ones at the time when the source was installed are within the ±0.5% range, reflecting oscillations around a null deviation. Conclusions: The method proposed allows any hospital to ensure a redundancy component of the long‐term stability of all equipment involved in BT measurements in a very simple and time efficient manner. Additionally, it enables the hospital to maintain a detailed log of historical differences, facilitating the identification and correction of potential systematic deviations over time. [ABSTRACT FROM AUTHOR]

Cervical cancer is a common malignant tumor of female reproductive system. Radiation therapy is one of the main methods of cervical cancer treatment, of which brachytherapy is an essential and important part of radiation therapy for locally advanced cervical cancer. With the rapid development of imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI), brachytherapy for cervical cancer has gradually developed from traditional two-dimensional image-guided technology to three-dimensional image-guided technology. And there are more and more treatment methods, including intracavitary brachytherapy, interstitial brachytherapy, and intracavitary combined interstitial implantation brachytherapy. We performed a PubMed search for introduce the application progress of intracavity, implantation, intracavity combined implantation brachytherapy and radioactive seed implantation, and discuss the dosimetric feasibility of internal and external fusion irradiation. [ABSTRACT FROM AUTHOR]

Introduction: Surgical resection is gold standard for treatment of liver metastasis, locally ablative techniques including computer tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy (CT-BRT) and stereotactic body radiotherapy (SBRT) have gained prominence as alternatives, offering comparable outcomes in selected patients. We aim to compare CT-BRT and SBRT - based on dosimetric analysis. Material and methods: Patients who underwent CT-BRT for oligometastatic, ≤4cm liver metastases between 2018 and 2024 were eligible. SBRT plans for Halcyon (SBRTh) and TrueBeam (SBRTtb) were prepared virtually. In the CT-BRT group CTV was equal to PTV, for SBRTh and SBRTtb planning, a 5 mm margin was applied to CTV to create PTV. Dose calculation was carried out with the TG-43 algorithm for CT-BRT and Anisotropic Analytical Algorithm for SBRTh and SBRTtb group. Descriptive statistics were used to compare the data. The Wilcoxon pairwise order test was utilized to compare dependent groups. Results: CT-BRT resulted in a more favorable dose distribution within PTVs for Dmean, D50, and D90, while SBRT showed better results for D98 and V27.5Gy. No significant differences were observed for V25Gy between CT-BRT and SBRTtb, but SBRTh favored over CT-BRT. For OARs, CT-BRT plans showed better values for V5, V10, and V11.6Gy in the uninvolved liver volume. There were no significant differences in dose distribution for the duodenum, bowel, and heart. SBRT modalities performed better in the kidney. CT-BRT had improved dose distribution in the esophagus, great vessels, ribs, skin, spinal cord, and stomach compared to SBRT. Conclusions: CT-BRT could be a viable alternative to SBRT for certain patients with liver malignancies. [ABSTRACT FROM AUTHOR]

This study compares dosimetric outcomes of high-dose-rate (HDR) interventional radiotherapy (IRT) using Iridium-192, Volumetric Modulated Arc Therapy (VMAT), and electron beam therapy for non-melanoma skin cancer (NMSC). A retrospective analysis of 25 patients showed that IRT provided a significantly higher mean dose to the clinical target volume (CTV) compared to VMAT and electron beam therapy. IRT and VMAT had comparable V95%CTV coverage, whilst electron therapy was less feasible for large CTVs. IRT delivered higher surface doses while minimizing deep tissue exposure compared to partial arc VMAT. Our findings support IRT for personalized and effective NMSC treatment. [ABSTRACT FROM AUTHOR]

High dose-rate brachytherapy presents a promising therapeutic avenue for prostate cancer management, involving the temporary implantation of catheters which deliver radioactive sources to the cancerous site. However, as catheters puncture and penetrate the prostate, tissue deformation is evident which may affect the accuracy and efficiency of the treatment. In this work, a data-driven in silico modelling procedure is proposed to simulate brachytherapy while accounting for prostate biomechanics. Comprehensive magnetic resonance and transrectal ultrasound images acquired prior, during and post brachytherapy are employed for model personalisation, while the therapeutic procedure is simulated via sequential insertion of multiple catheters in the prostate gland. The medical imaging data are also employed for model evaluation, thus, demonstrating the potential of the proposed in silico procedure to be utilised pre- and intra-operatively in the clinical setting. [ABSTRACT FROM AUTHOR]

Interstitial and/or intracavitary brachytherapy is an integral part of the treatment of vaginal cancer Brachytherapy (BT) has shown to improve local control, overall survival (OS) and disease-free survival (DFS). The aim of our study was to analyze the efficacy and safety of brachytherapy in patients with vaginal cancer. Between 2000 and 2023, 27 patients with vaginal cancer in stage FIGO I-III were treated with brachytherapy with or without external beam radiotherapy (EBRT) and simultaneous chemotherapy. Brachytherapy has been performed either as PDR-brachytherapy alone with a median cumulative dose up to 62.5 Gy (EQD2 = 63.9 Gy) or with PDR-BT boost with median dose of 30.9 Gy (EQD2 = 30.4 Gy). HDR-BT was administered solely as boost with a median dose of 25.5 Gy (EQD2 = 47.8 Gy). The median dose of EBRT was 48.7 Gy and 49.4 Gy for primary and for pelvic lymph nodes. Median follow-up was 39 months (2−120). 5/27 patients developed local recurrences and the 5-year cumulative local recurrence rate for whole patient population was 18.5%. 5-year OS and DFS was 90% and 68%. 5-year DFS for Stage I-II was 72% and for Stage III 65% (p = 0.933). Grade 3 late side effects of brachytherapy were documented in 3/22 patients (13.6%), one patient experienced Grade 4 toxicity (4.5%). Brachytherapy with or without EBRT and concomitant chemotherapy for vaginal cancer is a safe and effective treatment option with excellent local control and overall survival and acceptable toxicity. • There are few organ-sparing treatment options when treating vaginal cancer. • External beam radiotherapy alone is a possible treatment strategy, but it often fails to achieve curative doses. • Brachytherapy allows for dose-escalation while still preserving surrounding organs at risk. • Combined EBRT and image-guided BT has shown encouraging outcomes in both survival rates and local disease control. [ABSTRACT FROM AUTHOR]

This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels. This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively. Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels >0.2 or >0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA <0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR. Patients with normal serum testosterone levels who reached PSA of <0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control. [ABSTRACT FROM AUTHOR]

A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging. Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity. All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (<1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value. Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use. [ABSTRACT FROM AUTHOR]

Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings. Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort. Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death. Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (p = 0.003; p = 0.0001). Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications. Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures. They are a viable alternative or addition to a surgical approach in treating liver lesions. [ABSTRACT FROM AUTHOR]

Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities. Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnifeⓇ (CK), Gamma KnifeⓇ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED 10Gy (BED 10Gy 95% and BED 10Gy 90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V8 3Gy , V10 3Gy , V12 3Gy and V24 3Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test. For RC + 0 mm, median BED 10Gy 90% for STaRT (90.1 Gy 10 , range: 64.1–140.9 Gy 10) was significantly higher than CK (74.3 Gy 10 , range:59.3–80.4 Gy 10 , p = 0.04), GK (69.4 Gy 10 , range: 59.8–77.1 Gy 10 , p = 0.005), and IMPT (49.3 Gy 10 , range: 49.0–49.7 Gy 10 , p = 0.003), respectively. However, for the RC + 5 mm, the median BED 10Gy 90% for STaRT (34.1 Gy 10 , range: 22.2–59.7 Gy 10) was significantly lower than CK (44.3 Gy 10 , range: 37.8–52.4 Gy 10), and IMPT (46.6 Gy 10 , range: 45.1–48.5 Gy 10), respectively, but not significantly different from GK (34.1 Gy 10 , range: 22.8–47.0 Gy 10). The median V24 3Gy was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (p < 0.01). This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches. [ABSTRACT FROM AUTHOR]

We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I – IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 – 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS. NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68–0.97; p = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade. Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation. [ABSTRACT FROM AUTHOR]

This study was conducted to compare the differences between 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins. Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non–co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed. The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (p < 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (p < 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, p = 0.041) and PFS (63.0% vs. 44.2%, p = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, p = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted. The 3D-printed multichannel non–co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value. [ABSTRACT FROM AUTHOR]

The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer. This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients. Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS. These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment. [ABSTRACT FROM AUTHOR]

Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects. [ABSTRACT FROM AUTHOR]

Environ 10 à 15 % des patientes atteintes d'un cancer du sein seront atteintes d'une récidive locale après un traitement conservateur initial ou une mastectomie. La mastectomie totale est historiquement le traitement de référence en cas de récidive locale. Cependant, la réirradiation peut être une option en cas de second traitement conservateur en association à une segmentectomie ou en cas de récidive sur la paroi thoracique afin d'améliorer le taux de contrôle local. Différentes modalités sont disponibles : la curiethérapie, la radiothérapie externe avec ou sans hyperthermie. Bien que les résultats carcinologiques soient encourageants, cette situation complexe nécessite une sélection rigoureuse des patientes et une maîtrise technique afin d'obtenir le meilleur taux de contrôle local et de limiter la toxicité. Cet article présente une revue des données de la littérature sur les indications et différentes techniques de réirradiation des récidives homolatérales des carcinomes mammaires afin d'apporter une aide à la prise de décision en pratique clinique. Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice. [ABSTRACT FROM AUTHOR]

In this narrative review, we will explore the different options for salvage re-irradiation for locally recurrent prostate cancer. Brachytherapy (BT) and stereotactic body radiation therapy (SBRT) appear to be successful options. We detailed doses, volumes, oncological outcomes, and toxicity events to identify the best salvage strategy. Salvage reirradiation can only be proposed in certain cases, depending on the patient and the clinical scenario. Specific imaging and tests are needed to safely deliver this treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the efficacy and safety of 3D printing technology in brachytherapy for cervical cancer, comparing its outcomes with conventional free hand implantation brachytherapy. Methods: A total of 50 cervical cancer patients treated at the First Affiliated Hospital of Gannan Medical College from January 2019 to July 2023 were included in this study. Patients were divided into two groups: 25 patients received intensity-modulated radiotherapy (IMRT) combined with 3D-printed brachytherapy, and 25 patients underwent IMRT combined with free hand brachytherapy implantation. Key indicators analyzed included short-term therapeutic effects, survival outcomes, operation times, the number of CT scans, the number of needles inserted, dosimetric parameters, and complications. Results: The use of 3D-printed brachytherapy significantly improved the safety of radiation therapy operations, especially for large tumors (≥ 30 mm), by providing more precise dose distribution and reducing the radiation doses received by critical organs such as the bladder and rectum. Compared to the artificial implant group (88% prevalence), the 3D-printed brachytherapy group showed a significantly lower incidence of radiation enteritis (29.2% prevalence, p < 0.001). There were no significant differences in other complications between the two groups. For instance, the incidence of radiation cystitis was relatively high in the 3D-printed brachytherapy group (79.2% prevalence) compared to the artificial implant group (64% prevalence, p = 0.240). The median follow-up period in this study was 22.5 months [IQR 18–29]. Among the 49 patients included, 43 had cervical squamous carcinoma and 6 had cervical adenocarcinoma. Short-term therapeutic response rates were comparable, with no significant difference in overall survival observed between the two groups. Conclusion: 3D-printed brachytherapy offers a more effective and safer therapeutic option for patients with cervical cancer, particularly for those with large tumors or complex anatomical structures. [ABSTRACT FROM AUTHOR]

Nasal vestibule squamous cell carcinoma (NVSCC) is an exceedingly rare malignancy, often misclassified due to its anatomical location and lack of a standardized definition. This review aims to consolidate current evidence on NVSCC, focusing on epidemiology, risk factors, classification, clinical presentation, treatment modalities, and prognostic factors. The NV anatomy is delineated, emphasizing the need for a clear definition to avoid misclassification. Risk factors include smoking, sunlight exposure, and debated associations with chalk exposure or viral factors. Clinical presentation includes symptoms like nasal obstruction, pain, burning, and bleeding, often misdiagnosed as inflammatory conditions. NVSCC exhibits distinct local spread patterns along cartilaginous surfaces, with the facial and submandibular lymph nodes at higher metastatic risk. Current classifications lack consensus, hindering comparison of outcomes. Treatment varies, with surgery or radiotherapy for early-stage tumors and multimodality approaches for advanced cases. The choice between surgery and radiotherapy is debated, with potential advantages and drawbacks for each. Radiotherapy, especially with Interventional RadioTherapy (IRT, previously known as brachytherapy), is gaining prominence, showing promising outcomes in terms of local control and cosmetic results. Prophylactic neck treatment remains controversial, with indications based on tumor characteristics. Prognostic factors include T classification, tumor size, surgical margins, nodal involvement, and histological features. Long-term survival rates range widely, emphasizing the need for further studies to refine management strategies for this rare malignancy. In conclusion, NVSCC poses diagnostic and therapeutic challenges, warranting multidisciplinary approaches and continued research efforts to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Brachytherapy (BT), especially in high dose rate (HDR), has become increasingly complex owing to the use of image-guided techniques and the introduction of advanced applicators. Consequently, radiotherapy technologists and medical physicists (RTMPs) require substantial training to enhance their knowledge and technical skills in image-guided brachytherapy. However, the current status of the RTMP workload, individual abilities and quality control (QC) of BT units in Japan remains unclear. To address this issue, we conducted a questionnaire survey from June to August 2022 in all 837 radiation treatment facilities in Japan involving RTMPs. This survey focused on gynecological cancers treated with HDR-BT (GY-HDR) and permanent prostate implantation using low-dose-rate BT (PR-LDR). The responses revealed that the average working time in the overall process for HDR varied: 120 min for intracavitary BT and 180 min for intracavitary BT combined with interstitial BT. The QC implementation rate, in accordance with domestic guidelines, was 65% for GY-HDR and 44% for PR-LDR, which was lower than the 69% observed for external beam radiation therapy (EBRT). Additionally, the implementation rate during regular working hours was low. Even among RTMP working in facilities performing BT, the proportion of those able to perform QC for BT units was ~30% for GY-HDR and <20% for PR-LDR, significantly lower than the 80% achieved for EBRT. This study highlights the vulnerabilities of Japan's BT unit QC implementation structure. Addressing these issues requires appropriate training of the RTMP staff to safely perform BT tasks and improvements in practical education and training systems. [ABSTRACT FROM AUTHOR]

Background: A survey of medical physics residency program directors was conducted in Spring 2021 to examine the current state of brachytherapy (BT) training during residency. In this related work, a subsequent survey of therapeutic medical physics residents in 2022 was conducted to assess the confidence and experience of the trainees. Concerns for access to high‐quality and diverse training in BT have escalated in importance due to recent declines in BT utilization. Methods: A survey consisting of 26 questions was designed by a working unit of the Brachytherapy Subcommittee of the American Association of Physicists in Medicine (AAPM) and approved for distribution by the Executive Committee of the AAPM. The survey was distributed to current trainees and recent graduates of the Commission on Accreditation of Medical Physics Education Programs accredited therapeutic medical physics residency programs by the AAPM. The participant response was anonymously recorded in an online platform and subsequently analyzed using spreadsheet software. Results: The survey was distributed to 796 current medical physics residents or recent graduates over the course of 6 weeks in February and March of 2022. The survey received 736 views and a total of 182 responses were collected, with 165 respondents completing the survey in full. Among those responses, 110 had completed their residency training, with program start dates ranging from calendar years 2015 to 2021. Individual responses from the survey takers (including partial survey submissions) were evaluated and analyzed to compile results. Conclusions: Medical physics residents reported the highest levels of confidence and caseload for gynecological BT procedures when compared with other surveyed treatment techniques. This indicates opportunities to improve training and increase access to clinical caseload are needed in order to improve competency and confidence. Time constraints (clinical and rotation‐based) were indicated as impediments to BT proficiency. Medical physics residents reported enthusiasm for additional training opportunities in BT, and it is evident that additional structure and programs are required to ensure adequate access to BT training during residency. [ABSTRACT FROM AUTHOR]

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Background: The inclusion of pelvic lymph node (PLN) metastasis in the FIGO staging system has impacted disease classification and patient survival. Brachytherapy is a key component in managing carcinoma cervix; however, the dose contribution of brachytherapy to PLNs remains unclear. Aims and Objectives: This study aims to quantify the dose contribution of high-dose rate (HDR) brachytherapy to individual pelvic nodal groups. Materials and Methods: We included 40 biopsy-proven carcinoma cervix patients, stages IIA to IVA. All patients underwent external beam radiotherapy (EBRT) with concurrent cisplatin chemotherapy, followed by HDR brachytherapy, either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT). A total dose of 21 Gy in 3 fractions (7 Gy per fraction) was prescribed to the high-risk clinical target volume. Results: For ICBT, the mean absolute doses received by the external iliac, internal iliac, and obturator groups were 0.56 Gy, 1.02 Gy, and 1.22 Gy, corresponding to EQD2 (α/β=10) values of 0.49 Gy, 0.93 Gy, and 1.14 Gy, respectively. In the ISBT group, the mean absolute doses were 0.49 Gy, 0.86 Gy, and 1.11 Gy, with corresponding EQD2s of 0.43 Gy, 0.85 Gy, and 1.02 Gy. Conclusion: PLNs received significant dose contributions from HDR brachytherapy in cervical cancer patients, providing valuable reference data for determining the EBRT boost dose in cases of enlarged PLNs.

Introduction: Adverse events, such as erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), are significant concerns in prostate cancer (PCa) patients treated with Iodine 125 (I-125) low-dose rate (LDR) prostate brachytherapy (PB). Alpha antagonists and phosphodiesterase-5 inhibitors are used to manage these events. The present study compared the efficacy of low-dose tadalafil with that of tamsulosin for concomitant ED and LUTS in PCa patients treated with I-125 LDR PB. Materials and methods: One hundred and seventeen patients who received PB for low- or intermediate-risk localized PCa were analyzed. They were randomized into two groups, one receiving tamsulosin (N = 58) and the other receiving low-dose tadalafil (N = 59) immediately after PB. Sexual and urinary functions were assessed at various time points post-PB using questionnaires and objective measurements. The primary endpoint was sexual function measured by the International Index of Erectile Function-15 (IIEF-15) EF domain scores 6 months after PB. Secondary endpoints were sexual function measured by total IIEF-15 scores and Erection Hardness Scores 6 months after PB. The exploratory endpoint was the LUTS status 6 months after PB. Results: No significant differences were observed in baseline characteristics between the two groups. Tadalafil exerted stronger effects on sexual function, particularly erection hardness, than tamsulosin. No significant differences were observed in the management of LUTS between both treatments. Conclusion: Low-dose tadalafil and tamsulosin may manage LUTS equally after PB. Low-dose tadalafil may contribute to the maintenance of erectile function, particularly erection hardness, after PB; therefore, it is a viable option for patients with baseline erectile function.

Abstract Objective This study aims to evaluate the efficacy and safety of 3D printing technology in brachytherapy for cervical cancer, comparing its outcomes with conventional free hand implantation brachytherapy. Methods A total of 50 cervical cancer patients treated at the First Affiliated Hospital of Gannan Medical College from January 2019 to July 2023 were included in this study. Patients were divided into two groups: 25 patients received intensity-modulated radiotherapy (IMRT) combined with 3D-printed brachytherapy, and 25 patients underwent IMRT combined with free hand brachytherapy implantation. Key indicators analyzed included short-term therapeutic effects, survival outcomes, operation times, the number of CT scans, the number of needles inserted, dosimetric parameters, and complications. Results The use of 3D-printed brachytherapy significantly improved the safety of radiation therapy operations, especially for large tumors (≥ 30 mm), by providing more precise dose distribution and reducing the radiation doses received by critical organs such as the bladder and rectum. Compared to the artificial implant group (88% prevalence), the 3D-printed brachytherapy group showed a significantly lower incidence of radiation enteritis (29.2% prevalence, p

PURPOSE: The FLAME trial provides strong evidence that MR-guided external beam radiation therapy (EBRT) focal boost for localized prostate cancer increases biochemical disease-free survival (bDFS) without increasing toxicity. Yet, there are many barriers to implementation of focal boost. Our objectives are to systemically review clinical outcomes for MR-guided EBRT focal boost and to consider approaches to increase implementation of this technique. METHODS: We conducted literature searches in four databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. We included prospective phase II/III trials of patients with localized prostate cancer underdoing definitive EBRT with MR-guided focal boost. The outcomes of interest were bDFS and acute/late gastrointestinal and genitourinary toxicity. RESULTS: Seven studies were included. All studies had a median follow-up of greater than 4 years. There were heterogeneities in fractionation, treatment planning, and delivery. Studies demonstrated effectiveness, feasibility, and tolerability of focal boost. Based on the Phoenix criteria for biochemical recurrence, the reported 5-year biochemical recurrence-free survival rates ranged 69.7-100% across included studies. All studies reported good safety profiles. The reported ranges of acute/late grade 3 + gastrointestinal toxicities were 0%/1-10%. The reported ranges of acute/late grade 3 + genitourinary toxicities were 0-13%/0-5.6%. CONCLUSIONS: There is strong evidence that it is possible to improve oncologic outcomes without substantially increasing toxicity through MR-guided focal boost, at least in the setting of a 35-fraction radiotherapy regimen. Barriers to clinical practice implementation are addressable through additional investigation and new technologies.

INTRODUCTION: Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison. METHODS: We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance. RESULTS: The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions. CONCLUSIONS: Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries. The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis.