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1.
Interpretation of adverse reactions and complications in Chinese expert consensus of Iodine-125 brachytherapy for pancreatic cancer.
Li, Q, Liang, Y, Zhao, Y, Gai, B
Journal of cancer research and therapeutics. 2019;(4):751-754
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Abstract
Owing to the location of the pancreas and its complex anatomical relationship, it is difficult to perform radioactive Iodine-125 seed implantation in patients with pancreatic cancer as it can cause surgical side effects and further complications. To standardize the procedure of radioactive Iodine-125 seed implantation in the treatment of pancreatic cancer and reduce the occurrence of adverse reactions and complications during and after operation, the Chinese Medical Doctor Association of Radioactive Seed Implantation Technology Expert Committee, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, and the Radioactive Seed Therapy Branch organized and helped establish an expert consensus in China regarding radioactive Iodine-125 seed implantation in the treatment of pancreatic cancer. This article aims at interpreting the adverse reactions and complications after the implantation of radioactive seeds.
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Intraoperative brachytherapy for resected brain metastases.
Mahase, SS, Navrazhina, K, Schwartz, TH, Parashar, B, Wernicke, AG
Brachytherapy. 2019;(3):258-270
Abstract
Brain metastases are the most common intracranial malignancies in adults. Surgical resection is the preferred treatment approach when a pathological diagnosis is required, for symptomatic patients who are refractory to steroids, and to decompress lesions causing mass effect. Radiotherapy is administered to improve local control rates after surgical resection. After a brief review of the literature describing the treatment of brain metastases using whole-brain radiotherapy, postoperative stereotactic radiosurgery, preoperative radiosurgery, and brachytherapy, we compare patient-related, technical, practical, and radiobiological considerations of each technique. Finally, we focus our discussion on intraoperative brachytherapy, with an emphasis on the technical aspects, benefits, efficacy, and outcomes of studies utilizing permanent Cs-131 implants.
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3.
Iodine-125 seed implantation for synchronous pancreatic metastases from hepatocellular carcinoma: A case report and literature review.
Xiong, J, Kwong Chian, S, Li, J, Liu, X
Medicine. 2017;(46):e8726
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Abstract
RATIONALE The image-guided iodine-125 seed implantation has been widely used for a variety of tumors, including prostatic cancer, pulmonary cancer, hepatocellular carcinoma and pancreatic cancer. However, the clinical value of iodine-125 seed implantation for the treatment of pancreatic metastasis from hepatocellular carcinoma has not been reported. We presented the first case with ultrasound-guided iodine-125 seed implantation for this disease. PATIENT CONCERNS We presented the case of a 48-year-old man patient with primary hepatocellular carcinoma and pancreatic metastasis who was managed with ultrasound-guided iodine-125 seeds implantation. DIAGNOSES She was diagnosed with synchronous pancreatic metastases from hepatocellular carcinoma. INTERVENTIONS Puncture biopsy and ultrasound-guided iodine-125 seeds implantation. OUTCOMES The hepatic and pancreatic tumors were obviously reduced after 15 months. Moreover, the liver function test was mildly abnormal in glutamic-oxalacetic transaminase and glutamic-pyruvic transaminase. LESSONS The image-guided iodine-125 seeds implantation was an important therapeutic approache to unresectable hepatocellular carcinoma with pancreatic metastasis. However, more related cases should be reported for further evaluating the value of the way.
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Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy.
Wang, J, Zhang, F, Guo, J, Chai, S, Zheng, G, Zhang, K, Liao, A, Jiang, P, Jiang, Y, Ji, Z
Journal of cancer research and therapeutics. 2017;(4):607-612
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Abstract
Radioactive 125I seeds (RIS) interstitial implantation brachytherapy has been a first-line treatment for early-stage cancer of the prostate gland. However, its poor accuracy and homogeneity has limited its indication and hampered its popularization for a long time. Intriguingly, scholars based in China introduced computed tomography (CT)-guided technology to improve the accuracy and homogeneity of RIS implantation and broadened the indications. Then, they creatively designed and introduced three-dimensional printing coplanar template (3D-PCT) and 3D printing noncoplanar template (3D-PNCT) into the practice of RIS implantation. Use of such templates makes RIS implantation more precise and efficacious and aids preoperative planning, real-time dose optimization, and postoperative planning. However, studies on the standard workflow for 3D-PT-assisted CT-guided RIS implantation have not been published. Therefore, the China Northern Radioactive Seeds Brachytherapy Group organized multidisciplinary experts to formulate the guideline for this emerging treatment modality. This guideline aims at standardizing 3D-PT-assisted CT-guided RIS implantation procedures and criteria for selecting treatment candidates and assessing outcomes and for preventing and managing postoperative complications.
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Mesonephric adenocarcinoma of the vagina : Diagnosis and multimodal treatment of a rare tumor and analysis of worldwide experience.
Mueller, I, Kametriser, G, Jacobs, VR, Bogner, G, Staudach, A, Koch, H, Wolfrum-Ristau, P, Schausberger, C, Fischer, T, Sedlmayer, F
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2016;(9):668-71
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Abstract
BACKGROUND Mesonephric adenocarcinoma of the vagina is an extremely rare tumor of the female genital tract, with only a few cases reported so far worldwide. Consequently, there is no established standard treatment and limited knowledge about the prognosis and biologic behavior of vaginal mesonephric adenocarcinoma. METHODS This report documents a new case of vaginal mesonephric adenocarcinoma diagnosed in a 54-year-old woman, and analyzes this in the context of all previously published cases. RESULTS MRI demonstrated that the 2.5 × 1.8 cm tumor of the vaginal wall was invading urethra and bladder. Following surgical excision, histologic analysis determined mesonephric adenocarcinoma of the vagina, stage pT2 R1. In order to avoid the mutilating extended surgery which would be required to reach R0 and considerable impairment of quality of life, adjuvant radiochemotherapy was administered with external radiation and brachytherapy, including 5 cycles of cisplatin (40 mg/m²) for radiosensitization. After 4 years of continuous oncologic follow-up, the patient is alive and clinically free of disease. CONCLUSION In this case it was shown that adjuvant radiochemotherapy with radiation and brachytherapy was effective to manage the surgical R1 situation and maintain the patient's life quality. More published cases reports are needed to gradually substantiate optimal treatment strategies.
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review.
Duijzentkunst, DA, Peters, M, van der Voort van Zyp, JR, Moerland, MA, van Vulpen, M
World journal of urology. 2016;(11):1521-1531
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Abstract
BACKGROUND/AIM: Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. METHODS A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. RESULTS One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69-100, 49-100, 50-91 and 46.5-54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0-33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. CONCLUSION Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function.
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Commissioning of a well type chamber for HDR and LDR brachytherapy applications: a review of methodology and outcomes.
Mukwada, G, Neveri, G, Alkhatib, Z, Waterhouse, DK, Ebert, M
Australasian physical & engineering sciences in medicine. 2016;(1):167-75
Abstract
For safe and accurate dose delivery in brachytherapy, associated equipment is subject to commissioning and ongoing quality assurance (QA). Many centres depend on the use of a well-type chamber ('well chamber') for performing brachytherapy dosimetry. Documentation of well chamber commissioning is scarce despite the important role the chamber plays in the whole brachytherapy QA process. An extensive and structured commissioning of the HDR 1000 plus well chamber (Standard Imaging Inc, Middleton WI) for HDR and LDR dosimetry was undertaken at Sir Charles Gairdner Hospital. The methodology and outcomes of this commissioning is documented and presented as a guideline to others involved in brachytherapy. The commissioning tests described include mechanical integrity, leakage current, directional dependence, response, length of uniform response, the influence of insert holders, ion collection efficiency, polarity effect, accuracy of measured air kerma strength (S(K)) or reference air kerma rate (K(R)) and baseline setting (for ongoing constancy checks). For the HDR 1000 plus well chamber, some of the insert holders modify the response curve. The measured sweet length was 2.5 cm which is within 0.5% of that specified by the manufacturer. Correction for polarity was negligible (0.9999) and ion recombination was small (0.9994). Directional dependence was small (less than 0.2%) and leakage current was negligible. The measured K(R) for (192)Ir agreed within 0.11% compared with a second well chamber of similar model and was within 0.5% of that determined via a free-in-air measurement method. Routine constancy checks over a year agreed with the baseline within 0.4%.
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Current treatments and preventive strategies for radiation retinopathy.
Reichstein, D
Current opinion in ophthalmology. 2015;(3):157-66
Abstract
PURPOSE OF REVIEW Radiation retinopathy remains a devastating cause of visual morbidity in patients undergoing radiation for globe, orbit, and head and neck malignancies. This review discusses the recent efforts of several authors to treat radiation retinopathy once it has developed and efforts to prevent its development with early aggressive management. RECENT FINDINGS Intravitreal anti-vascular endothelial growth factor agents and intravitreal steroid agents have been used to successfully treat radiation-induced macular edema and neovascular events secondary to radiation retinopathy. The visual outcomes, however, have varied. Recent work has been directed towards prevention of radiation retinopathy prior to its development. This has been done with preventive scatter laser and intravitreal bevacizumab therapy. Effective customization of radiation dose to the tumor has also reduced some collateral radiation damage. Preventive vitrectomy and silicone oil placement at the time of plaque brachytherapy may shield normal ocular structures from radiation injury. SUMMARY Radiation retinopathy remains a major source of visual morbidity following radiotherapy for malignancies. Promising, albeit unproven, new therapies and preventive efforts may ameliorate the negative visual outcomes.
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Postmortem radiation safety and issues pertaining to permanent prostate seed implantation in Japan.
Satoh, T, Dokiya, T, Yamanaka, H, Saito, S, Ishiyama, H, Itami, J, Shibuya, H, Nakano, T, Shigematsu, N, Aoki, M, et al
Brachytherapy. 2015;(2):136-41
Abstract
PURPOSE If a prostate cancer patient treated with (125)I brachytherapy dies within 12 months after the treatment, prostate removal before cremation is recommended to avoid problems related to radioactivity in the ashes, such as inhalation of airborne particulate matter by crematorium staff or nearby residents. To provide guidance for such cases, a manual prepared under the editorial supervision of several professional associations was issued in 2008 in Japan. Herein, we investigated the incidence and causes of death, and the actions taken subsequent to death, among prostate cancer patients who died within 12 months after (125)I brachytherapy over a 10-year period in Japan; and we compared the results before and after the manual was issued. METHODS AND MATERIALS Data extracted from the Japan Radioisotope Association database for the period from September 2003 to the end of December 2013 were used. RESULTS Of 27,976 patients who underwent (125)I brachytherapy during the specified period, 79 died within 12 months after implantation, including 3 who died in the 2011 earthquake and tsunami. The prostate and brachytherapy source were retrieved at autopsy from 69 of the 79 patients. Autopsy could not be performed on the other 10 patients, 2 of whom died in the earthquake. Autopsy and retrieval of the brachytherapy source were significantly more common after issuance of the manual than before (22/28 cases before; 47/49 cases after; p=0.021). CONCLUSION In most cases of early death after (125)I brachytherapy in Japan, the brachytherapy source was retrieved.
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Comparative effectiveness research in radiation oncology: stereotactic radiosurgery, hypofractionation, and brachytherapy.
Aneja, S, Yu, JB
Seminars in radiation oncology. 2014;(1):35-42
Abstract
Radiation oncology encompasses a diverse spectrum of treatment modalities, including stereotactic radiosurgery, hypofractionated radiotherapy, and brachytherapy. Though all these modalities generally aim to do the same thing-treat cancer with therapeutic doses of radiation while relatively sparing normal tissue from excessive toxicity, the general radiobiology and physics underlying each modality are distinct enough that their equivalence is not a given. Given the continued innovation in radiation oncology, the comparative effectiveness of these modalities is important to review. Given the broad scope of radiation oncology, this article focuses on the 3 most common sites requiring radiation treatment: breast, prostate, and lung cancer.