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Purpose. To evaluate the feasibility of use of an 1.5 T magnetic resonance (MR)-linear accelerator MR-linac for imaging in gynaecologic high-dose-rate (HDR) brachytherapy.Method. Commissioning measurements for MR images quality control, geometric distortion, dwell position accuracy, applicator reconstruction and end-to-end test for a tandem-and-ring applicator were performed following the recommendations of American Brachytherapy Society, International Commission on Radiation Units and Measurements and Report of the Brachytherapy Working Group of the Spanish Society of Medical Physics. The values for MR-based IGABT were compared to the corresponding values with computed tomography (CT).Results. Measured distorsions for the MR images were less than 0.50 mm compared to the CT images. The differences between 3D displacements for all dwell positions were 0.66 mm and 0.62 mm for the tandem and ring, respectively. The maximum difference is 0.64 mm for the distances from the applicator tip obtained using the films. The CT and MR dose differences for the right and left 'A' points were 0.9% and -0.7%, respectively. Similar results were observed in terms of dose distribution for CT and Mr The gamma passing rate was 99.3% and 99.5%, respectively.Conclusion. The use of MR images from an MR-linac used in a radiotherapy service for gynaecological brachytherapy was proved to be feasible, safe and precise as the geometrical differences were less than 1 mm, and the dosimetric differences were less than 1% when comparing to the use of CT images for the same purpose.
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Braquiterapia , Imageamento por Ressonância Magnética , Dosagem Radioterapêutica , Radioterapia Guiada por Imagem , Tomografia Computadorizada por Raios X , Braquiterapia/métodos , Humanos , Feminino , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Radioterapia Guiada por Imagem/métodos , Aceleradores de Partículas , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Imagens de Fantasmas , Estudos de ViabilidadeRESUMO
PURPOSE: The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document addresses sexual health management in patients with gynaecological cancer after pelvic radiotherapy. METHODS: A modified two-round online Delphi study was conducted, where GINECOR members were surveyed on the diagnosis, treatment, and follow-up of sexual health problems. An expert panel of radiation oncologists, nurses and a gynaecologist participated in the Delphi study to reach a consensus, applying GRADE criteria to establish the level of agreement. RESULTS: The consensus recommendations cover both diagnosis and treatment, with an emphasis on patient-reported outcome measures (PROMs). They highlight recommendations such as the systematic assessment of genitourinary, gastrointestinal, and sexual symptoms, and the use of several treatments after radiotherapy. Recommendations include pharmacological options like vaginal lubricants and hormone therapy, and mechanical interventions such as vaginal dilators and vibrators. These suggestions stem from both scientific evidence and clinical expertise. CONCLUSION: This consensus statement describes a comprehensive, multidisciplinary approach developed to address the sexual needs and enhance the quality of life of patients with gynaecological tumours after pelvic radiotherapy. It offers specific recommendations for managing sexual issues, emphasizing the importance of specialized care and regular assessment. The document underscores the significance of proactive, patient-centered sexual health management in gynaecological cancer patients.
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PURPOSE: This study aimed to map the use of hyaluronic acid (HA) in preventing and controlling radiotoxicity in women with gynecological cancer undergoing radiotherapy. METHODS: We conducted a scoping review of eight electronic databases: CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Embase, LIVIVO, and the Web of Science Core Collection. In addition, a grey literature search was performed using Google Scholar and ProQuest Dissertations & Theses Global. A manual search was also identified additional references. The search was conducted on May 18, 2023. We included primary studies, reviews, and guidelines that discussed the use of HA to prevent and manage the toxicities resulting from gynecological radiotherapy. RESULTS: Eighteen studies were included in this scoping review, published between 2009 and 2022. There was heterogeneity in the use of HA, particularly in the method of application (moisturizing gel, vaginal ovules, spacer gel, and bladder instillations). Furthermore, the radiotoxicities varied among studies, encompassing, among others, vaginal atrophy, dryness, dyspareunia, telangiectasis, adhesions, vaginal stenosis, bleeding, hematuria, and bladder issues. Most studies addressed the potential benefits of HA in managing the signs and symptoms resulting from radiotherapy. CONCLUSION: HA has been utilized in clinical practice, in various formulations, for managing signs and symptoms in patients with gynecological cancer undergoing radiotherapy. However, further studies are necessary to thoroughly investigate the most effective method of HA application and its effectiveness in managing radiotoxicity.
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Neoplasias dos Genitais Femininos , Ácido Hialurônico , Lesões por Radiação , Humanos , Ácido Hialurônico/administração & dosagem , Feminino , Neoplasias dos Genitais Femininos/radioterapia , Lesões por Radiação/etiologiaRESUMO
INTRODUCTION: Iodine-125 (I-125) seeds, commonly used in low-dose rate brachytherapy for ocular malignancies, are often discarded after a single use. This study examines the potential cost savings at an institution with high ocular melanoma referrals, by re-using I-125 seeds for eye-plaque brachytherapy. METHODS: In this single-institutional retrospective analysis, data was collected from I-125 seed orders from 8/2019 through 10/2022. Information including number of seeds ordered per lot, number of plaques built per lot, and number of seeds used per lot were collected. Cost per lot of seed was assumed to be the current cost from the most recent lot of 35 seeds. RESULTS: During the study, 72 I-125 seed lots were ordered bi-weekly, with a median of 35 seeds per lot (Range: 15-35). Each seed was used on average 2.26 times prior to being discarded. The average duration of each seed lot used was 62.2 days (Range: 21-126). Each seed lot contributed to the construction of an average of 8.4 eye plaques (Range: 2-20). With seed recycling, 2,475 seeds were used to construct 608 eye-plaques. Without re-using practice this would require 5,694 seeds. This resulted in a percentage cost savings of 56.5%, with a total seed cost reduction of $344,884, or $559 per eye-plaque on average. CONCLUSION: This is the first study to evaluate cost savings relative to re-using I-125 seeds for eye plaques. The data demonstrates how an institution can decrease costs associated with I-125 radiation seeds used for eye-plaque brachytherapy by re-using them.
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Braquiterapia , Redução de Custos , Neoplasias Oculares , Radioisótopos do Iodo , Melanoma , Braquiterapia/economia , Radioisótopos do Iodo/uso terapêutico , Humanos , Estudos Retrospectivos , Melanoma/radioterapia , Melanoma/economia , Neoplasias Oculares/radioterapia , Neoplasias Oculares/economiaRESUMO
BACKGROUND: Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer. METHODS: Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results. DISCUSSION: Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life.
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Terapia por Exercício , Educação de Pacientes como Assunto , Distúrbios do Assoalho Pélvico , Diafragma da Pelve , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Telerreabilitação , Incontinência Urinária , Humanos , Feminino , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/reabilitação , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia , Resultado do Tratamento , Terapia por Exercício/métodos , Distúrbios do Assoalho Pélvico/reabilitação , Distúrbios do Assoalho Pélvico/etiologia , Distúrbios do Assoalho Pélvico/fisiopatologia , Autocuidado , Inquéritos e Questionários , Fatores de Tempo , Recuperação de Função Fisiológica , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/reabilitação , Neoplasias Pélvicas/radioterapia , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
Introduction: To prevent vaginal stenosis, the use of a vaginal dilator is recommended. Objective: To analyze sociodemographic data, gynecological conditions and the use of vaginal dilator after pelvic brachytherapy. Materials and Methods: Cross-sectional, retrospective study, period 2016-2020, collected between October/2020 and February /2021, from records of women with gynecological cancer treated with brachytherapy at the Centro de Pesquisa Oncológicas (Brazil). The variables included sociodemographic data and gynecological conditions in following the treatment. In the analysis, descriptive statistics, chi-squaretest, Fisher's exact test and Mann-Whitney test were applied. Results: 519 patients records were included in the investigation; the analyzes showed significant associations between the topography and staging (p<0.001), education (p=0.004) and age (p<0.001); the comparison between the distribution of the ionizing radiation dose showed a difference with the continued sexual relationship category (p=0.006); the comparison between the proportions of continued sexual relationship and using a vaginal dilator was significant (p<0.001); 49.10% (131) adhered to the use of vaginal dilator; 24.50% (127) are not sexually active and do not adhere to the use of the dilator. Discussion: It is evident that social and gynecological conditions interfere with the presence of vaginal stenosis and the use of a vaginal dilator after pelvic brachytherapy. Conclusions: The adherence found in the use of dilator affirms the contributions and the need for health education by nurses and physicaltherapists during and following the treatment.
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Serviço Hospitalar de Fisioterapia , Braquiterapia , Constrição , Constrição Patológica , Neoplasias dos Genitais FemininosRESUMO
Simulation is a technique used in healthcare to replicate clinical scenarios and improve patient safety, efficacy, and efficiency. Simulation-based medical education facilitates training and assessment in healthcare without increasing risk to patients, supported by ample evidence from surgical/procedural specialties. Simulation in radiation oncology has been leveraged to an extent, with successful examples of both screen-based and hands-on simulators that have improved confidence and performance in trainees. In the current era, evidence substantiates a significant deficit in brachytherapy procedure education, with radiation oncology residents reporting low confidence in this procedural skill, largely attributable to insufficient caseloads at some centers. Simulation-based medical education can facilitate structured training and competency-based assessment in brachytherapy skills. This review discusses existing advances and future directions in brachytherapy simulation, using examples from simulation in surgical specialties.
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Braquiterapia , Competência Clínica , Internato e Residência , Radioterapia (Especialidade) , Treinamento por Simulação , Humanos , Radioterapia (Especialidade)/educaçãoRESUMO
BACKGROUND: Non-melanoma skin cancer is one of the most common types of cancer and one of the main approaches is brachytherapy. For small lesions, the treatment of this cancer with brachytherapy can be done with two commercial applicators, one of these is the Large Field Valencia Applicators (LFVA). PURPOSE: The aim of this study is to test the capabilities of the LFVA to use clinically 60Co sources instead of the 192Ir ones. This study was designed for the same dwell positions and weights for both sources. METHODS: The Penelope Monte Carlo code was used to evaluate dose distribution in a water phantom when a 60Co source is considered. The LFVA design and the optimized dwell weights reported for the case of 192Ir are maintained with the only exception of the dwell weight of the central position, that was increased. 2D dose distributions, field flatness, symmetry and the leakage dose distribution around the applicator were calculated. RESULTS: When comparing the dose distributions of both sources, field flatness and symmetry remain unchanged. The only evident difference is an increase of the penumbra regions for all depths when using the 60Co source. Regarding leakage, the maximum dose within the air volume surrounding the applicator is in the order of 20% of the prescription dose for the 60Co source, but it decreases to less than 5% at about 1 cm distance. CONCLUSIONS: Flatness and symmetry remains unaltered as compared with 192Ir sources, while an increase in leakage has been observed. This proves the feasibility of using the LFVA in a larger range of clinical applications.
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Braquiterapia , Radioisótopos de Cobalto , Método de Monte Carlo , Radiometria , Dosagem Radioterapêutica , Braquiterapia/instrumentação , Radioisótopos de Cobalto/uso terapêutico , Radiometria/instrumentação , Imagens de Fantasmas , Radioisótopos de Irídio/uso terapêutico , HumanosRESUMO
BACKGROUND: For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS: The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS: Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION: Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY: Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.
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Neoplasias , Humanos , Neoplasias/radioterapia , África do Sul , Jordânia , Brasil , Costa Rica , Medicina de Precisão , Radioterapia , Nanomedicina TeranósticaRESUMO
BACKGROUND: Managing residual and recurrent craniopharyngioma effectively is crucial for improving patient outcomes. This study evaluates the combined use of gamma knife and phosphorus-32 brachytherapy, offering insights into alternative, less invasive treatment strategies. METHODS: We conducted a retrospective analysis of 97 patients treated from 2010 to 2016 for residual and recurrent craniopharyngioma using gamma knife and phosphorus-32 brachytherapy. We classified these patients into three groups: superficial solid (Group A), simple cystic (Group B), and mixed cystic-solid (Group C). We assessed the treatment's effectiveness by the tumor control rates and evaluated safety by monitoring vision, endocrine function improvements, and complication rates. RESULTS: The treatment achieved complete and adequate control rates of 49.5% and 87.6%, respectively. We observed improvements in vision or visual fields in 55.1% of the patients. The morbidity rate was 15.5%. The study found no significant differences in tumor control rates among the various lesion types. CONCLUSION: The combination of gamma knife and phosphorus-32 brachytherapy presents a viable, minimally invasive alternative for treating residual and recurrent craniopharyngioma. It offers high tumor control and functional improvement rates, suggesting its potential as a preferred strategy in some instances.