Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer.

Purpose: To evaluate the efficacy and toxicity of interstitial temporary brachytherapy boost for prostate cancer patients using real-world data.

Material And Methods: Between 2008 and 2016, 115 patients treated with external beam radiotherapy (EBRT) followed by a brachytherapy boost (BT boost) were eligible for this retrospective analysis. Patients received either interstitial high-dose-rate brachytherapy (HDR-BT) with 2 x 9-9.

Assessment of needle bending and tracking requirements for optimized needle placement in combined intracavitary/interstitial gynecologic brachytherapy.

Purpose: Needle tracking using external prediction techniques such as optical tracking is a modern approach aimed at improving implantation accuracy in gynecologic brachytherapy. This study aims to investigate the corresponding impact of needle bending in situ and to analyze needle path deviations from the intended locations occurring in our current clinical workflow that only considers ultrasound imaging without tracking.

Methods: We developed a semi-automated approach for reconstructing brachytherapy needles based on planning CTs and compared the respective accuracy to the also determined intra-observer variability of manual reconstructions.

Safety and Efficacy of Brachytherapy in Inoperable Endometrial Cancer.

: 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. : Between 1990 and 2019, 18 patients with inoperable EC in stage FIGO I-IV were treated with intracavitary brachytherapy using the "Heyman Packing technique".

Outcomes of I-125 Low-Dose-Rate Brachytherapy in Patients with Localized Prostate Cancer: A Comprehensive Analysis from a Specialized Tertiary Referral Center.

Low-dose-rate (LDR) brachytherapy with I-125 seeds is one of the most common primary tumor treatments for low-risk and low-intermediate-risk prostate cancer. This report aimed to present an analysis of single-institution long-term results. We analyzed the treatment outcomes of 119 patients with low- and intermediate-risk prostate cancer treated with LDR brachytherapy at our institution between 2014 and 2020.

Brachytherapy in vaginal cancer for organ preservation: Clinical outcome and safety from a single center experience.

Background: 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.

Materials And Methods: 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.

Improving the safety of radiotherapy treatment processes via incident-driven FMEA feedback loops.

Background: Failure mode and effects analysis (FMEA) is a valuable tool for radiotherapy risk assessment, yet its outputs might be unreliable due to failures not being identified or due to a lack of accurate error rates.

Purpose: A novel incident reporting system (IRS) linked to an FMEA database was tested and evaluated. The study investigated whether the system was suitable for validating a previously performed analysis and whether it could provide accurate error rates to support the expert occurrence ratings of previously identified failure modes.

Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation-a curative approach.

Objective: There are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario.

Inter-observer effects in needle reconstruction for temporary prostate brachytherapy: Dosimetric implications and adaptive CBCT-TRUS registration solutions.

Purpose: To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions.

Methods And Materials: The needles implanted in 28 patients were reconstructed on TRUS by three physicists.

Investigating the impact of breast positioning control on physical treatment parameters in multi-catheter breast brachytherapy.

Purpose: To assess the effects of a workflow for reproducible patient and breast positioning on implant stability during high-dose-rate multi-catheter breast brachytherapy.

Methods: Thirty patients were treated with our new positioning control workflow. Implant stability was evaluated based on a comparison of planning-CTs to control-CTs acquired halfway through the treatment.

Development and clinical implementation of a digital system for risk assessments for radiation therapy.

Before introducing new treatment techniques, an investigation of hazards due to unintentional radiation exposures is a reasonable activity for proactively increasing patient safety. As dedicated software is scarce, we developed a tool for risk assessment to design a quality management program based on best practice methods, i.e.

On the implant stability in adaptive multi-catheter breast brachytherapy: Establishment of a decision-tree for treatment re-planning.

Background And Purpose: To assess implant stability and identify causes of implant variations during high-dose-rate multi-catheter breast brachytherapy.

Materials And Methods: Planning-CTs were compared to control-CTs acquired halfway through the treatment for 100 patients. For assessing geometric stability, Fréchet-distance and button-to-button distance changes of all catheters as well as variations of Euclidean distances and convex hulls of all dwell positions were determined.

Seed-displacements in the immediate post-implant phase in permanent prostate brachytherapy.

Purpose: To investigate differences in seed-displacements between the immediate post-implant phase (day 0-1) and the time to post-plan computed tomography (CT) (day 1-30) in seed prostate brachytherapy.

Materials And Methods: Seed positions were identified on the intra-operatively created ultrasound-based treatment plan (day 0) and CT scans of day 1 and 30 for 33 patients. The day 1 (30) seed arrangement was registered onto the day 0 (1) arrangement using a seed-only approach.

End-to-end testing for stereotactic radiotherapy including the development of a Multi-Modality phantom.

Purpose: A new insert for a commercially available end-to-end test phantom was designed and in-house manufactured by 3D printing. Subsequently, the insert was tested for different stereotactic radiation therapy workflows (SRS, SBRT, FSRT, and Multimet) also in comparison to the original insert.

Material And Methods: Workflows contained imaging (MR, CT), treatment planning, positioning, and irradiation.

Automating implant reconstruction in interstitial brachytherapy of the breast: A hybrid approach combining electromagnetic tracking and image segmentation.

Background And Purpose: To develop a method for automatic reconstruction of catheter implants in interstitial brachytherapy (iBT) of the breast by means of electromagnetic tracking (EMT) with the goal of making treatment planning as time-effective and accurate as possible.

Materials And Methods: The implant geometry of 64 patients was recorded using an afterloader prototype with EMT functionality immediately after the planning CT. EMT data were transferred to the CT image space by rigidly registering the catheter fixation buttons as landmarks.

Permanent LDR prostate brachytherapy: Comprehensive characterization of seed-dynamics within the prostate on a seed-only level.

Purpose: Seed brachytherapy is a well-established treatment modality for prostate cancer. However, there is still a lack of profound characterizations of seed motions within the prostate. We assessed these dynamics between day 0 and day 30 of brachytherapy.

Brachytherapy focal dose escalation using ultrasound based tissue characterization by patients with non-metastatic prostate cancer: Five-year results from single-center phase 2 trial.

Purpose: This prospective trial investigates side effects and efficacy of focal dose escalation with brachytherapy for patients with prostate cancer.

Methods And Materials: In the Phase II, monocentric prospective trial 101 patients with low-/intermediate- and high-risk prostate cancer were enrolled between 2011 and 2013. Patients received either PDR-/HDR-brachytherapy alone with 86-90 Gy (EQD2, α/β = 3 Gy) or PDR-/HDR-brachytherapy as boost after external beam radiation therapy up to a total dose of 91-96 Gy (EQD2, α/β = 3 Gy).

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy.

Background And Purpose: On-site cone-beam computed tomography (CBCT) has gained in importance in adaptive brachytherapy during recent years. Besides treatment planning, there is increased need particularly for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide.

Risk analysis for radiotherapy at the Universitätsklinikum Erlangen.

Purpose: Risk analysis is required by various laws and regulations in Germany and has an impact on each department of a large clinic. We provide an overview of the relevant laws and regulations in Germany and present the technical and organizational experience of introducing risk analysis in the Department of Radiation Oncology at the Universitätsklinikum Erlangen.

Methods: Risk analysis was performed with an in-house developed extension of our intranet platform and ticketing system.

Dosimetry, Optimization and FMEA of Total Skin Electron Irradiation (TSEI).

Purpose: Total Skin Electron Irradiation (TSEI) is a method for treating malignant cutaneous T-cell lymphomas. This work aims to implement and optimize the total skin technique established at Strahlenklinik Erlangen, Germany on two new linear accelerators and to quantify the risks using failure mode and effects (FMEA) analysis.

Material And Methods: TSEI is performed at a VersaHD accelerator (Elekta, Stockholm) with 6MeV in the "high dose rate mode" HDRE and a nominal field size of 40×40cm.

Long-term results of a protocol-based ultrasound-guided salvage brachytherapy as re-irradiation for local recurrent prostate cancer.

Background And Purpose: To assess the long-term results of protocol-based ultrasound-guided salvage pulsed-dose rate brachytherapy in locally recurrent prostate cancer following previous radiation therapy.

Materials And Methods: A total of 82 patients (median age 69 years) with locally recurrent prostate cancer after previous external beam radiation therapy (43/82, 52.4%), prostatectomy and adjuvant radiation therapy (24/82, 29.

Is adaptive treatment planning in multi-catheter interstitial breast brachytherapy necessary?

Purpose: For 55 patients treated with interstitial multi-catheter breast brachytherapy the need for adaptive treatment planning was assessed.

Methods And Materials: For all patients a treatment planning computed tomography (CT) and a follow-up CT were acquired and used for the retrospective evaluation. Keeping dwell time and dwell positions constant, the treatment plan assessed directly after catheter implantation was compared to the situation 48 h after implantation.

Estimation of inter-fractional variations in interstitial multi-catheter breast brachytherapy using a hybrid treatment delivery system.

Purpose: Irradiation of the tumor bed using interstitial multi-catheter brachytherapy is one of the treatment options for breast cancer patients. In order to ensure the planned dose delivery an advanced quality intervention method using an electromagnetic tracking (EMT) system is presented. The system is used to assess inter-fractional variations within the framework of a patient study.

Impact of inter- and intra-observer variabilities of catheter reconstruction on multi-catheter interstitial brachytherapy of breast cancer patients.

Purpose: The aim of this study was to evaluate inter- and intra-observer variabilities of catheter reconstruction and its dosimetric impact for multi-catheter interstitial breast cancer patients.

Methods And Materials: In order to evaluate inter-observer variabilities (IOV) three medical physicists reconstructed the catheter traces of 13 patients. These manual reconstructions were further compared to the automatic reconstruction algorithm integrated into the planning system and one on purpose imprecise manual reconstruction.

ESTRO-ACROP guideline: Interstitial multi-catheter breast brachytherapy as Accelerated Partial Breast Irradiation alone or as boost - GEC-ESTRO Breast Cancer Working Group practical recommendations.

Purpose: This consensus statement from the Breast Cancer Working Group of Groupe Européen de Curiethérapie of European Society for Radiotherapy and Oncology (GEC-ESTRO) aims at generating practical guidelines for multi-catheter image-guided brachytherapy in the conservative management of breast cancer patients used for either Accelerated Partial Breast Irradiation (APBI) or for a breast boost.

Methods: Recent advances in techniques of multi-catheter brachytherapy were summarized and all the relevant literature was reviewed by a panel of experts. Panel members of the GEC-ESTRO experts participated in a series of conferences, supplemented their clinical experience, were surveyed to determine their current practices and patterns, performed a literature review, and formulated recommendations for implementing APBI with multi-catheter brachytherapy, focusing on treatment planning issues, catheter insertion, dosimetry and quality assurance.