Intraoperative Ultrasound-Guided 125I Implantation in the Treatment of Unresectable Pancreatic...
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Conclusions: The dosimetric influence of spacers near a low-energy photon-emitting source can approach 10% adjacent to the source long- axis. However, the dosimetric influence for all spacers studied did not exceed 3% for a volumetric implant mimicking a prostate implant when compared to the dose distributions generated using the AAPM TG-43 formalism. POSTER DISCUSSION: GENERAL Saturday April 16, 2011 8:00 AMe9:30 AM PD72 Intraoperative Ultrasound-Guided 125 I Implantation in the Treatment of Unresectable Pancreatic Carcinoma Junjie Wang, PhD 1 , Jinna Li, PhD 1 , Suqing Tian, MD 1 , Yuliang Jiang, MD 1 , Weiqiang Ran, MD 2 , Dianrong Xiu 3 . 1 Radiation Oncology, Peking University 3rd Hospital, Beijing, China; 2 Ultrasound, Peking University 3rd Hospital, Beijing, China; 3 Surgery, Peking University 3rd Hospital, Beijing, China. Purpose: The purpose of this preliminary study was to assess the feasibility and efficacy of intraoperative, ultrasound-guided 125 I seed interstitial brachytherapy for unresectable pancreatic carcinoma. Materials and Methods: 27 patients were diagnosed with unresectable pancreatic carcinoma that was not considered curable during laparotomy. Twelve patients with were diagnosed with stage II/III carcinoma, and fifteen patients with stage IV carcinoma. These patients were treated with 125 I seed implantation guided by intraoperative ultrasound. The matched peripheral doses (MPD) of 125 I resulting from seed implantation ranged from 110 Gy to 160 Gy. A subset of seven patients received additional external beam radiotherapy (EBRT) with a total dose of EBRT administered between 3500~4500 cGy at 200 cGy per fraction. Six patients received 2e6 cycles of chemotherapy. Results: Of the 20 patients treated with 125 I seed implantation only, 85% (17/20) experienced pain relief, while 15% (3/20) did not respond. The median time of pain relief was 5 days and ranged from 1 to 30 days. The overall median survival time in this study was 8 months (95% CI: 6.6e9.4). One- and two-year survival rates of 19.5% and 7.8% were observed, and local control of disease was achieved in 74% patients (20/ 27). For stage II and III patients, the one- and two-year survival rates were 33.9% and 16.9%, respectively, and the median survival was 10 months (95% CI: 7.8e12.2). In contrast, for stage IV patients the one-and two-year survival rates were 7.1% and 0%, with a median survival of 6 months (95% CI: 2.3e9.7). For patients receiving seed implant plus EBRT versus seed only, the median survival times were 9 and 7 months, respectively (p 5 0.1008). For patients receiving seed implants and chemotherapy versus seeds only, the median survival rates were the same, 8 months (p 5 0.2954). There were no deaths related to 125 I seed implantation. Conclusions: In this preliminary investigation, patients with stage II and III unresectable pancreatic cancer were shown to benefit from 125 I seed implantation. However, patients with stage IV pancreatic cancer did not respond. Therefore, intraoperative ultrasound-guided 125 I seed implantation has the potential to be a promising new modality to improve the treatment outcome in stage II and III unresectable pancreatic cancers. Ultrasound scan show the seed distribution in tumor after seed implant. PD73 Improving Clinical Target Volume (CTV) Dose Homogeneity and Normal Tissue Maximum Dose for Endoesophageal High-Dose-Rate (HDR) Brachytherapy: One Versus Three HDR Tube Technique John F. Greskovich, MD 1 , Matt D. Kolar, MS 1 , John A. Dumot, DO 2 , Allan Wilkinson, PhD 1 . 1 Radiation Oncology, Cleveland Clinic, Cleveland, OH; 2 Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH. Purpose: We conducted a dose-volume comparison for CTV and normal tissues after placement of one or three HDR brachytherapy tubes in a single patient undergoing esophageal HDR brachytherapy. Materials and Methods: A patient with squamous cell carcinoma in situ with foci suspicious for superficial invasion was treated definitively with HDR brachytherapy, 30Gy in six applications, delivered once per week. The first application was delivered with a single 1.5 meter brachytherapy tube and subsequent fractions using three tubes. The three tube technique involved taping the tubes together near the distal ends with approximately one centimeter spacing of the distal ends to facilitate endoscopic placement. Radiopaque clips were placed two centimeters proximal and S70 Abstracts / Brachytherapy 10 (2011) S14eS101
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Transcript of Intraoperative Ultrasound-Guided 125I Implantation in the Treatment of Unresectable Pancreatic...
S70 Abstracts / Brachytherapy 10 (2011) S14eS101
Conclusions: The dosimetric influence of spacers near a low-energyphoton-emitting source can approach 10% adjacent to the source long-axis. However, the dosimetric influence for all spacers studied did notexceed 3% for a volumetric implant mimicking a prostate implant whencompared to the dose distributions generated using the AAPM TG-43formalism.
POSTER DISCUSSION: GENERAL
Saturday April 16, 2011
8:00 AMe9:30 AM
PD72
Intraoperative Ultrasound-Guided 125I Implantation in the
Treatment of Unresectable Pancreatic Carcinoma
Junjie Wang, PhD1, Jinna Li, PhD1, Suqing Tian, MD1, Yuliang Jiang,
MD1, Weiqiang Ran, MD2, Dianrong Xiu3. 1Radiation Oncology, Peking
University 3rd Hospital, Beijing, China; 2Ultrasound, Peking University
3rd Hospital, Beijing, China; 3Surgery, Peking University 3rd Hospital,
Beijing, China.
Purpose: The purpose of this preliminary study was to assess the feasibilityand efficacy of intraoperative, ultrasound-guided 125I seed interstitialbrachytherapy for unresectable pancreatic carcinoma.Materials and Methods: 27 patients were diagnosed with unresectablepancreatic carcinoma that was not considered curable during laparotomy.Twelve patients with were diagnosed with stage II/III carcinoma, andfifteen patients with stage IV carcinoma. These patients were treated with125I seed implantation guided by intraoperative ultrasound. The matched
peripheral doses (MPD) of 125I resulting from seed implantation rangedfrom 110 Gy to 160 Gy. A subset of seven patients received additionalexternal beam radiotherapy (EBRT) with a total dose of EBRTadministered between 3500~4500 cGy at 200 cGy per fraction. Sixpatients received 2e6 cycles of chemotherapy.Results: Of the 20 patients treated with 125I seed implantation only, 85%(17/20) experienced pain relief, while 15% (3/20) did not respond. Themedian time of pain relief was 5 days and ranged from 1 to 30 days. Theoverall median survival time in this study was 8 months (95% CI:6.6e9.4). One- and two-year survival rates of 19.5% and 7.8% wereobserved, and local control of disease was achieved in 74% patients (20/27). For stage II and III patients, the one- and two-year survival rateswere 33.9% and 16.9%, respectively, and the median survival was 10months (95% CI: 7.8e12.2). In contrast, for stage IV patients the one-andtwo-year survival rates were 7.1% and 0%, with a median survival of 6months (95% CI: 2.3e9.7). For patients receiving seed implant plusEBRT versus seed only, the median survival times were 9 and 7 months,respectively (p 5 0.1008). For patients receiving seed implants andchemotherapy versus seeds only, the median survival rates were the same,8 months (p 5 0.2954). There were no deaths related to 125I seedimplantation.Conclusions: In this preliminary investigation, patients with stage II and IIIunresectable pancreatic cancer were shown to benefit from 125I seedimplantation. However, patients with stage IV pancreatic cancer did notrespond. Therefore, intraoperative ultrasound-guided 125I seedimplantation has the potential to be a promising new modality to improvethe treatment outcome in stage II and III unresectable pancreatic cancers.
Ultrasound scan show the seed distribution in tumor after seed implant.
PD73
Improving Clinical Target Volume (CTV) Dose Homogeneity and
Normal Tissue Maximum Dose for Endoesophageal High-Dose-Rate
(HDR) Brachytherapy: One Versus Three HDR Tube Technique
John F. Greskovich, MD1, Matt D. Kolar, MS1, John A. Dumot, DO2, Allan
Wilkinson, PhD1. 1Radiation Oncology, Cleveland Clinic, Cleveland, OH;2Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.
Purpose: We conducted a dose-volume comparison for CTV and normaltissues after placement of one or three HDR brachytherapy tubes ina single patient undergoing esophageal HDR brachytherapy.Materials and Methods: A patient with squamous cell carcinoma in situwith foci suspicious for superficial invasion was treated definitively withHDR brachytherapy, 30Gy in six applications, delivered once per week.The first application was delivered with a single 1.5 meter brachytherapytube and subsequent fractions using three tubes. The three tube techniqueinvolved taping the tubes together near the distal ends with approximatelyone centimeter spacing of the distal ends to facilitate endoscopicplacement. Radiopaque clips were placed two centimeters proximal and
