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Victor J Zannis - One of the best experts on this subject based on the ideXlab platform.
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CLI N IC AL UP DATE Surgical Considerations for the Strut-Adjusted Volume Implant (SAVI™) Breast Brachytherapy Device
2015Co-Authors: Victor J ZannisAbstract:Irradiation after breast conservation therapy for breast cancer is now a routine practice to minimize local recurrence. The need for traditional whole-breast radiation over a 6 to 7 week period has been challenged by the evolution of accelerated courses of therapy that, at least initially, are allowing shorter (5 day) periods of applications, lesser toxicities, and equivalent local recurrence rates. Accelerated partial breast irradiation (APBI) techniques include Brachytherapy, where a radioactive source is placed inside or next to the area to be treated, or external beam radiotherapy, where radiation is applied externally. Breast Brachytherapy began with the use of multiple catheters being inserted into the breast lumpectomy walls, creating multiple localized accessible conduits for a high dose 192Ir radiation pellet sitting at the leading edge of an applicator cable. Because of the complexity of this multi-catheter technique, a balloon Brachytherapy catheter Device (MammoSite®) (Hologic, Inc., Bedford, MA) was invented to allow a simpler alternative for the application of the high dose radiation. In spite of its simplicity in placement and radiation delivery, the MammoSite has limitations, including the risk of toxic skin dosages if the skin-to-balloon distance is less than 5 to 7 mm secondary to the lumpectomy cavity being superficial in the breast. In light of this history, the SAVI breast Brachytherapy Device was created to maintain a simple design and placement procedure, to have fewer anatomic constraints, and to allow greater flexibility in treatment planning. (Figure 1) As a single-entry expandable bundle of catheters, this Device blends the adjustable dosimetry of multi-catheter therapy with the simple lumpectomy cavity indwelling design of a balloon catheter. Additionally, the SAVI is made in three different sizes to accommodate a broad range of cavity volumes
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Spacer Balloons prior to Partial Breast Irradiation: Helpful or Hurtful?
Annals of surgical oncology, 2011Co-Authors: Robert R. Kuske, Victor J ZannisAbstract:Spacer balloons, otherwise known as ‘‘cavity evaluation Devices’’ (CEDs), are frequently placed intraoperatively at the time of lumpectomy to facilitate accelerated partial breast irradiation (PBI). CEDs provide a pathway to the excision cavity, preserve cavity shape/volume, and simplify delayed insertion of a single-entry Brachytherapy Device such as MammoSite, Contura or SAVI. Despite these intentions, significant issues have become apparent with widespread utilization of CEDs:
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Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast Brachytherapy Device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.
International journal of radiation oncology biology physics, 2010Co-Authors: Catheryn M. Yashar, Victor J Zannis, Daniel J. Scanderbeg, Robert R. Kuske, Anne M. Wallace, Sarah L. Blair, Emily Grade, Virginia H. Swenson, Coral A QuietAbstract:Purpose The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry Brachytherapy Device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No Devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon Brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon Brachytherapy. The recurrence rate was 1%. Conclusions The SAVI appears to safely allow an increase in eligibility for APBI over balloon Brachytherapy or three-dimensional conformal radiation, highlighting the outstanding Device flexibility to maximize the target dose and minimize the normal tissue dose. The Device was well tolerated by patients.
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Local Control, Toxicity, and Cosmesis in Women Younger Than 50 Enrolled Onto the American Society of Breast Surgeons MammoSite Radiation Therapy System Registry Trial
Annals of Surgical Oncology, 2009Co-Authors: A. J. Khan, Coral A Quiet, F. Vicini, P. Beitsch, B. Haffty, A. Keleher, D. Garcia, H. Snider, M. Gittleman, Victor J ZannisAbstract:Background The American Society of Breast Surgeons enrolled women onto a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System (RTS) breast Brachytherapy Device. This report examines local recurrence (LR), toxicity, and cosmesis as a function of age in women enrolled onto the trial. Methods A total of 1449 primary early-stage breast cancers were treated in 1440 women. Of these, 130 occurred in women younger than 50 years of age. Fisher’s exact test was performed to correlate age (
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local control toxicity and cosmesis in women younger than 50 enrolled onto the american society of breast surgeons mammosite radiation therapy system registry trial
Annals of Surgical Oncology, 2009Co-Authors: Atif J. Khan, Coral A Quiet, F. Vicini, P. Beitsch, A. Keleher, H. Snider, M. Gittleman, Bruce G. Haffty, Delia M Garcia, Victor J ZannisAbstract:BACKGROUND: The American Society of Breast Surgeons enrolled women onto a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System (RTS) breast Brachytherapy Device. This report examines local recurrence (LR), toxicity, and cosmesis as a function of age in women enrolled onto the trial. METHODS: A total of 1449 primary early-stage breast cancers were treated in 1440 women. Of these, 130 occurred in women younger than 50 years of age. Fisher's exact test was performed to correlate age ( or = 50 years) with toxicity and with cosmesis. The association of age with LR failure times was investigated by fitting a parametric model. RESULTS: Women younger than 50 were more likely to develop fat necrosis: 4.6% (6 of 130) vs. 1.8% (24 of 1319) (P = .0456). Other toxicities were comparable. At 2 years, cosmesis was excellent or good in 87% of assessable women aged <50 years (n = 74) and in 94% of assessable older women (n = 751) (P = .0197). At 3 years, this difference disappeared: excellent or good in 90% (56 of 62) of younger women vs. 93% (573 of 614) of older women (P = .2902). The crude LR rate for the group was 1.7% (25 of 1449). There was no statistically significant difference in LR as a function of age. In women <50, 3.1% (4 of 130) developed a LR; in the older patients, 1.6% (21 of 1319) developed LR (3-year actuarial LR rates, 2.9% vs. 1.7%, respectively; P = .2284). CONCLUSIONS: Accelerated partial breast irradiation with the MammoSite RTS results in low toxicity and produces similar cosmesis and local control at 3 years in women younger than 50 when compared with older women.
Coral A Quiet - One of the best experts on this subject based on the ideXlab platform.
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Outcomes for APBI with strut-based Brachytherapy: First 100 accrued patients (5-year median follow-up).
Journal of Clinical Oncology, 2014Co-Authors: Robert R. Kuske, Coral A Quiet, Margaret Snyder, Maureen Lyden, Deanna J. Attai, Lydia Komarnicky, Jay E. Reiff, Constantine Mantz, Steven E. Finkelstein, Daniel J. ScanderbegAbstract:114 Background: The SAVI Collaborative Research Group (SCRG), was created to study the long-term outcomes of women receiving accelerated partial breast irradiation (APBI) using strut-based applicators. The outcomes for the first 100 accrued patients in the study are reported. Methods: Patients for this subset analysis weretaken as the initial 100 treated across all participating sites. Median follow-up of this cohort was 56.3 months at the time of the abstract. Patients were treated with APBI using the strut-based Brachytherapy Device with conventional dose and fractionation (3.4 Gy x 10 fx, BID). Treatment planning goals for the planning target volume were a V90>90%, V150
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Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast Brachytherapy Device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.
International journal of radiation oncology biology physics, 2010Co-Authors: Catheryn M. Yashar, Victor J Zannis, Daniel J. Scanderbeg, Robert R. Kuske, Anne M. Wallace, Sarah L. Blair, Emily Grade, Virginia H. Swenson, Coral A QuietAbstract:Purpose The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry Brachytherapy Device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No Devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon Brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon Brachytherapy. The recurrence rate was 1%. Conclusions The SAVI appears to safely allow an increase in eligibility for APBI over balloon Brachytherapy or three-dimensional conformal radiation, highlighting the outstanding Device flexibility to maximize the target dose and minimize the normal tissue dose. The Device was well tolerated by patients.
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Local Control, Toxicity, and Cosmesis in Women Younger Than 50 Enrolled Onto the American Society of Breast Surgeons MammoSite Radiation Therapy System Registry Trial
Annals of Surgical Oncology, 2009Co-Authors: A. J. Khan, Coral A Quiet, F. Vicini, P. Beitsch, B. Haffty, A. Keleher, D. Garcia, H. Snider, M. Gittleman, Victor J ZannisAbstract:Background The American Society of Breast Surgeons enrolled women onto a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System (RTS) breast Brachytherapy Device. This report examines local recurrence (LR), toxicity, and cosmesis as a function of age in women enrolled onto the trial. Methods A total of 1449 primary early-stage breast cancers were treated in 1440 women. Of these, 130 occurred in women younger than 50 years of age. Fisher’s exact test was performed to correlate age (
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local control toxicity and cosmesis in women younger than 50 enrolled onto the american society of breast surgeons mammosite radiation therapy system registry trial
Annals of Surgical Oncology, 2009Co-Authors: Atif J. Khan, Coral A Quiet, F. Vicini, P. Beitsch, A. Keleher, H. Snider, M. Gittleman, Bruce G. Haffty, Delia M Garcia, Victor J ZannisAbstract:BACKGROUND: The American Society of Breast Surgeons enrolled women onto a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System (RTS) breast Brachytherapy Device. This report examines local recurrence (LR), toxicity, and cosmesis as a function of age in women enrolled onto the trial. METHODS: A total of 1449 primary early-stage breast cancers were treated in 1440 women. Of these, 130 occurred in women younger than 50 years of age. Fisher's exact test was performed to correlate age ( or = 50 years) with toxicity and with cosmesis. The association of age with LR failure times was investigated by fitting a parametric model. RESULTS: Women younger than 50 were more likely to develop fat necrosis: 4.6% (6 of 130) vs. 1.8% (24 of 1319) (P = .0456). Other toxicities were comparable. At 2 years, cosmesis was excellent or good in 87% of assessable women aged <50 years (n = 74) and in 94% of assessable older women (n = 751) (P = .0197). At 3 years, this difference disappeared: excellent or good in 90% (56 of 62) of younger women vs. 93% (573 of 614) of older women (P = .2902). The crude LR rate for the group was 1.7% (25 of 1449). There was no statistically significant difference in LR as a function of age. In women <50, 3.1% (4 of 130) developed a LR; in the older patients, 1.6% (21 of 1319) developed LR (3-year actuarial LR rates, 2.9% vs. 1.7%, respectively; P = .2284). CONCLUSIONS: Accelerated partial breast irradiation with the MammoSite RTS results in low toxicity and produces similar cosmesis and local control at 3 years in women younger than 50 when compared with older women.
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postoperative ultrasound guided percutaneous placement of a new breast Brachytherapy balloon catheter
American Journal of Surgery, 2003Co-Authors: Victor J Zannis, Lise C Walker, Belinda Barclaywhite, Coral A QuietAbstract:Abstract Background The optimal technique and timing for the implantation of a recently developed breast Brachytherapy balloon catheter (MammoSite; Proxima Therapeutics, Alpharetta, Georgia) have not been well defined. We hypothesized that placing this postoperatively, utilizing percutaneous ultrasound-guided placement, would be preferable. Methods Patients who met eligibility requirements for breast Brachytherapy were implanted with the MammoSite Device utilizing percutaneous ultrasound-guided technique. Additionally, to study optimal timing, a historical cohort of patients operated upon for breast cancer by two of the authors were analyzed to compare the intraoperative and postoperative candidacy for MammoSite placement. Results Twenty-one of 23 patients successfully completed Brachytherapy after implantation, with only 2 (9%) requiring catheter removal secondary to unfavorable balloon positioning. There were no serious complications. Of 343 historical patients with breast cancer, 137 were intraoperative candidates for Brachytherapy, but final postoperative histology disqualified 40 (29%). Conclusions Implantation of the MammoSite Brachytherapy Device is optimally performed postoperatively, after the final pathology is defined, utilizing ultrasound-guided percutaneous technique.
Daniel J. Scanderbeg - One of the best experts on this subject based on the ideXlab platform.
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Outcomes for APBI with strut-based Brachytherapy: First 100 accrued patients (5-year median follow-up).
Journal of Clinical Oncology, 2014Co-Authors: Robert R. Kuske, Coral A Quiet, Margaret Snyder, Maureen Lyden, Deanna J. Attai, Lydia Komarnicky, Jay E. Reiff, Constantine Mantz, Steven E. Finkelstein, Daniel J. ScanderbegAbstract:114 Background: The SAVI Collaborative Research Group (SCRG), was created to study the long-term outcomes of women receiving accelerated partial breast irradiation (APBI) using strut-based applicators. The outcomes for the first 100 accrued patients in the study are reported. Methods: Patients for this subset analysis weretaken as the initial 100 treated across all participating sites. Median follow-up of this cohort was 56.3 months at the time of the abstract. Patients were treated with APBI using the strut-based Brachytherapy Device with conventional dose and fractionation (3.4 Gy x 10 fx, BID). Treatment planning goals for the planning target volume were a V90>90%, V150
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SU‐D‐108‐06: Dosimetry of 108 Strut‐Based Accelerated Partial Breast Irradiation (APBI) Treatments With Applicator Distance Less Than 7 Mm From Both the Skin and Ribs
Medical Physics, 2013Co-Authors: Jay E. Reiff, Daniel J. Scanderbeg, Ernest Butler, Serban Morcovescu, K. ImhoffAbstract:Purpose: To report on the dosimetry of 108 strut‐based APBI treatments where the applicators were less than 7 mm from both the skin and the ribs Methods: Data from 108 patients whose applicators were sandwiched between the skin and ribs were analyzed. The patients were divided into three cohorts: those where the applicator was less than 7 mm from the skin and ribs (n=67), those where the distance was less than 5 mm (n=33), and those with less than 3 mm between both the skin and ribs (n=8). Dosimetric parameters analyzed include PTVEVAL volume (cm3), V90 (%), V95 (%), V100 (%), V150 (cm3), V200 (cm3), and the maximum doses to the skin and ribs. Results: Over all three cohorts the PTV_EVAL volumes ranged from 20.5 cm3 to 125.7 cm3 with a median value of 55.5 cm3. In each of the three groups, the V90 averaged between 94% and 95%, the V95 averaged between 90% and 92%, and the V100 averaged between 85% and 87%. The average V150 ranged between 21.8 cm3 and 26.6 cm3, and the average V200 ranged from 10.9 cm3 to 13.1 cm3. Across the three cohorts, the maximum skin dose ranged from 8.4% of the prescription dose to 117% of the prescription dose (median values were between 85% and 87%) and the maximum rib dose fell between 1.8% of the prescription dose and 198% of the prescription dose with the median values falling between 100% and 107%. Conclusion: This study demonstrates the dosimetric versatility of the strut‐based Brachytherapy Device. It has been used in patients where the proximity of the skin and chest wall precludes the use of other types of single‐entry Brachytherapy Devices. It allows for optimized dose coverage of the target while providing dose sparing to the adjacent critical structures. This project was partially funded by Cianna Medical, Inc.
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NOVEL USE OF THE CONTURA FOR HIGH DOSE RATE CRANIAL Brachytherapy
Medical dosimetry : official journal of the American Association of Medical Dosimetrists, 2010Co-Authors: Daniel J. Scanderbeg, John F. Alksne, Joshua D. Lawson, Kevin T. MurphyAbstract:A popular choice for treatment of recurrent gliomas was cranial Brachytherapy using the GliaSite Radiation Therapy System. However, this Device was taken off the market in late 2008, thus leaving a treatment void. This case study presents our experience treating a cranial lesion for the first time using a Contura multilumen, high-dose-rate (HDR) Brachytherapy balloon applicator. The patient was a 47-year-old male who was diagnosed with a recurrent right frontal anaplastic oligodendroglioma. Previous radiosurgery made him a good candidate for Brachytherapy. An intracavitary HDR balloon Brachytherapy Device (Contura) was placed in the resection cavity and treated with a single fraction of 20 Gy. The implant, treatment, and removal of the Device were all completed without incident. Dosimetry of the Device was excellent because the dose conformed very well to the target. V90, V100, V150, and V200 were 98.9%, 95.7%, 27.2, and 8.8 cc, respectively. This patient was treated successfully using the Contura multilumen balloon. Contura was originally designed for deployment in a postlumpectomy breast for treatment by accelerated partial breast irradiation. Being an intracavitary balloon Device, its similarity to the GliaSite system makes it a viable replacement candidate. Multiple lumens in the Device also make it possible to shape the dose delivered to the target, something not possible before with the GliaSite applicator.
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Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast Brachytherapy Device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.
International journal of radiation oncology biology physics, 2010Co-Authors: Catheryn M. Yashar, Victor J Zannis, Daniel J. Scanderbeg, Robert R. Kuske, Anne M. Wallace, Sarah L. Blair, Emily Grade, Virginia H. Swenson, Coral A QuietAbstract:Purpose The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry Brachytherapy Device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No Devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon Brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon Brachytherapy. The recurrence rate was 1%. Conclusions The SAVI appears to safely allow an increase in eligibility for APBI over balloon Brachytherapy or three-dimensional conformal radiation, highlighting the outstanding Device flexibility to maximize the target dose and minimize the normal tissue dose. The Device was well tolerated by patients.
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Initial clinical experience with the Strut-Adjusted Volume Implant Brachytherapy applicator for accelerated partial breast irradiation
Brachytherapy, 2009Co-Authors: Catheryn M. Yashar, Anne M. Wallace, Sarah L. Blair, Daniel J. ScanderbegAbstract:PURPOSE: Accelerated partial breast irradiation is becoming increasingly popular. The Cianna single-entry high-dose-rate applicator, Strut-Adjusted Volume Implant (SAVI, Cianna Medical, Ali- so Viejo, CA), contains peripheral struts allowing greater planning flexibility for small-breasted women, technically easier insertion, and normal tissue exposure minimization. This study evaluates early clinical experience. METHODS AND MATERIALS: Thirty patients treated with the SAVI with a median followup of 12 months were evaluated. The median age was 59.5. Tumor size averaged 0.9 cm. Fifteen cancers were ductal carcinoma in situ (50%), 1 was invasive lobular (3.3%), 4 were tubular (6.7%), and the rest infiltrating ductal (40%). Most of them were estrogen receptor (ER) positive (90%). Nine women (30%) were premenopausal. RESULTS: Dosimetry was outstanding with median V90, V150, and V200 of 96.2%, 24.8, and 12.8 cc. There were no symptomatic seromas, and one report of asymptomatic fat necrosis seen on mammogram at 1 year. In patients who had skin spacing of less than 1 cm, the median skin dose was 245 cGy/fraction. The median rib and lung dose per fraction for those patients with either structure less than 1 cm was 340 and 255 cGy (75% of prescribed dose), respectively. There have been no local recurrences to date. CONCLUSIONS: Early clinical experience with the SAVI demonstrates the ease of placement of a single-entry Brachytherapy Device combined with the increased dose modulation of interstitial Brachytherapy. Dose to normal structures has remained exceedingly low. Almost half of evaluated patients were not candidates for other single-entry Brachytherapy Devices because of skin spacing or breast size, demonstrating an expansion of candidates for single-entry partial breast Brachytherapy.
Robert R. Kuske - One of the best experts on this subject based on the ideXlab platform.
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Outcomes for APBI with strut-based Brachytherapy: First 100 accrued patients (5-year median follow-up).
Journal of Clinical Oncology, 2014Co-Authors: Robert R. Kuske, Coral A Quiet, Margaret Snyder, Maureen Lyden, Deanna J. Attai, Lydia Komarnicky, Jay E. Reiff, Constantine Mantz, Steven E. Finkelstein, Daniel J. ScanderbegAbstract:114 Background: The SAVI Collaborative Research Group (SCRG), was created to study the long-term outcomes of women receiving accelerated partial breast irradiation (APBI) using strut-based applicators. The outcomes for the first 100 accrued patients in the study are reported. Methods: Patients for this subset analysis weretaken as the initial 100 treated across all participating sites. Median follow-up of this cohort was 56.3 months at the time of the abstract. Patients were treated with APBI using the strut-based Brachytherapy Device with conventional dose and fractionation (3.4 Gy x 10 fx, BID). Treatment planning goals for the planning target volume were a V90>90%, V150
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Accelerated partial breast irradiation using a strut-based Brachytherapy Device: A multi-institutional initial report on acute and late toxicity with greater than 24-month follow-up.
Journal of Clinical Oncology, 2012Co-Authors: Jon Strasser, Deanna J. Attai, Lydia Komarnicky, Steven E. Finkelstein, Ernest Butler, Ben Han, D Jacob, C.d. Koprowski, R.l. Hong, Robert R. KuskeAbstract:149 Background: Accelerated partial breast irradiation (APBI) is commonly used in early-stage breast cancer. The SAVI Collaborative Research Group is a multi-institutional group created to study outcomes in patients who received APBI utilizing strut-based Brachytherapy. This analysis reports the acute and late toxicities for patients with greater than 2-year follow-up (F/U) from this study. Methods: 904 APBI patients (ductal carcinoma in situ [n=267] or invasive breast cancer [n=637]), received HDR Brachytherapy (34 Gy in 10 fractions) using the SAVI Device (Cianna Medical). Patients with dosimetry and documented follow-up were evaluated within 6 weeks of treatment for early adverse events (AEs), and at 1 year, 2 years, and beyond for late AEs. Dosimetric parameters were evaluated with respect to toxicity and will be presented. Results: In 212 patients (median age 62.9 years, range 40-88) all with follow-up greater than 24 months, the median tumor size was 12mm. As of last follow-up (>24 months) cumulativ...
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Spacer Balloons prior to Partial Breast Irradiation: Helpful or Hurtful?
Annals of surgical oncology, 2011Co-Authors: Robert R. Kuske, Victor J ZannisAbstract:Spacer balloons, otherwise known as ‘‘cavity evaluation Devices’’ (CEDs), are frequently placed intraoperatively at the time of lumpectomy to facilitate accelerated partial breast irradiation (PBI). CEDs provide a pathway to the excision cavity, preserve cavity shape/volume, and simplify delayed insertion of a single-entry Brachytherapy Device such as MammoSite, Contura or SAVI. Despite these intentions, significant issues have become apparent with widespread utilization of CEDs:
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Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast Brachytherapy Device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.
International journal of radiation oncology biology physics, 2010Co-Authors: Catheryn M. Yashar, Victor J Zannis, Daniel J. Scanderbeg, Robert R. Kuske, Anne M. Wallace, Sarah L. Blair, Emily Grade, Virginia H. Swenson, Coral A QuietAbstract:Purpose The Strut-Adjusted Volume Implant (SAVI; Cianna Medical, Aliso Viejo, CA) is a multichannel single-entry Brachytherapy Device designed to allow dose modulation to minimize normal tissue dose while simultaneously maximizing target coverage. This is the first report on the initial 102 patients with nearly 2 years of median follow-up. Methods and Materials One hundred two patients were treated at two institutions. Data were collected on eligibility and dosimetry and followed for toxicity and recurrence. Results The median follow-up is 21 months. Overall dosimetry is outstanding (median percent of target volume receiving 90% of the prescription dose was 95.9%, volume of target receiving 150% of the prescription dose was 27.8 mL, and volume of target receiving 200% of the prescription dose was 14.0 cm 3 ). No Devices were pulled prior to treatment completion. For patients with a skin bridge of less than 7 mm, the maximum median skin dose was 280 cGy (median percent of target volume receiving 90% of the prescription dose was 95.2%, volume of target receiving 150% of the prescription dose was 25.8 cm 3 and volume of target receiving 200% of the prescription dose was 12.7 mL). For patients with both chest wall and skin of less than 7 mm, the maximum median lung dose was 205 cGy with simultaneous skin dose of 272 cGy. The rate of telangiectasia was 1.9%. Grade 1 hyperpigmentation developed in 10 patients (9.8%) and Grade 2 fibrosis in 2 patients (1.9%). There were 2 symptomatic seromas and 2 cases of asymptomatic fat necrosis (1.9%). Of the patients, 27% were not eligible for MammoSite balloon Brachytherapy (Hologic, Inc., Marlborough, MA) and 5% were not eligible for any balloon Brachytherapy. The recurrence rate was 1%. Conclusions The SAVI appears to safely allow an increase in eligibility for APBI over balloon Brachytherapy or three-dimensional conformal radiation, highlighting the outstanding Device flexibility to maximize the target dose and minimize the normal tissue dose. The Device was well tolerated by patients.
S Ahmad - One of the best experts on this subject based on the ideXlab platform.
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A novel conformal superficial high-dose-rate Brachytherapy Device for the treatment of nonmelanoma skin cancer and keloids.
Brachytherapy, 2016Co-Authors: Clara Ferreira, K Rasmussen, S Ahmad, Dan R. Johnson, Clinton Leinweber, Jae Won JungAbstract:Abstract Purpose To develop a novel conformal superficial Brachytherapy (CSBT) Device as a treatment option for the patient-specific radiation therapy of conditions including superficial lesions, postsurgical positive margins, Dupuytren's contractures, keloid scars, and complex anatomic sites (eyelids, nose, ears, etc.). Methods and Materials A preliminary CSBT Device prototype was designed, built, and tested using readily available radioactive seeds. Iodine-125 (125I) seeds were independently guided to the treatment surface to conform to the target. Treatment planning was performed via BrachyVision Planning System (BPS) and dose distributions measured with Gafchromic EBT3 film. Percent depth dose curves and profiles for Praseodymium-142 (142Pr), and Strontium-90/Yttrium-90 (90Sr–90Y) were also investigated as potential sources. Results achieved with 90Sr–90Y and electron external beam radiation therapy were compared and Monte Carlo N-Particle eXtended 2.6 simulations of 142Pr seeds were validated. Results BPS was able to predict clinical dose distributions for a multiple seeds matrix. Calculated and measured doses for the 125I seed matrix were 500 cGy and 473.5 cGy at 5 mm depth, and 171.0 cGy and 201.0 cGy at 10 mm depth, respectively. Results of 90Sr–90Y tests demonstrate a more conformal dose than electron EBRT (1.6 mm compared to 4.3 mm penumbra). Measured 142Pr doses were 500 cGy at surface and 17.4 cGy at 5 mm depth. Conclusions The CSBT Device provides a highly conformal dose to small surface areas. Commercially available BPS can be used for treatment planning, and Monte Carlo simulation can be used for plans using beta-emitting sources and complex anatomies. Various radionuclides may be used in this Device to suit prescription depths and treatment areas.
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SU‐G‐201‐12: Investigation of Beta‐Emitter 90Sr‐90Y Dose Distribution Using Gafchromic EBT3 Film for Application On Conformal Skin Brachytherapy Device
Medical Physics, 2016Co-Authors: Clara Ferreira, K Rasmussen, D Johnson, S Ahmad, Jae Won JungAbstract:Purpose: To investigate 90Sr-90Y as a high dose rate (HDR) source for application in a conformal skin Brachytherapy (CSBT) Device. The CSBT Device has been previously developed to provide patient specific treatment for small inoperable lesions and irregular surfaces. Methods: A popular beta emitter, 90Sr-90Y was tested for feasibility in a CSBT Device. A 1 cm diameter plaque was used to deliver dose to a solid water phantom containing EBT3 Gafchromic films arranged at the surface and perpendicular to it. Additionally, a 1 cm diameter 6 MeV electron beam was used to irradiate EBT3 film at 100 cm SSD with a 0.5 cm bolus. Films were digitized with an Epson Expression 10000 XL scanner and calibrated with a 6 MeV electron specific dose curve. Normalized percent depth doses (PDD) and dose profiles for both techniques were analyzed using ImageJ. Results: Dose distributions achieved with the 90Sr-90Y sources were compared with those of external electron beam radiation therapy (EBRT). Penumbra (20%- 80%) for EBRT and 90Sr-90Y were 4.3 mm and 1.6 mm, respectively. PDD values of 50% (normalized to 2 mm) were 10.1 mm and 2.8 mm for electron and 90Sr-90Y, respectively. Flatness (80% of the central beam profile) was 14.1% at a 5 mm depth for EBRT and 4.0% at surface for the 90Sr-90Y. Conclusion: As expected, the PDDs of 90Sr-90Y in water are shallower than that of external electron beams for the same field size. 90Sr-90Y can be used in CSBT to provide patient specific treatment where shallower depth doses than that provided by electron external beams may be required: e.g. eyelids, nose, lips, ears, etc. The customizability of EBRT could be replicated by using multiple adjacent 90Sr-90Y plaque placements.
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su g 201 12 investigation of beta emitter 90sr 90y dose distribution using gafchromic ebt3 film for application on conformal skin Brachytherapy Device
Medical Physics, 2016Co-Authors: Clara Ferreira, K Rasmussen, D Johnson, S Ahmad, J JungAbstract:Purpose: To investigate 90Sr-90Y as a high dose rate (HDR) source for application in a conformal skin Brachytherapy (CSBT) Device. The CSBT Device has been previously developed to provide patient specific treatment for small inoperable lesions and irregular surfaces. Methods: A popular beta emitter, 90Sr-90Y was tested for feasibility in a CSBT Device. A 1 cm diameter plaque was used to deliver dose to a solid water phantom containing EBT3 Gafchromic films arranged at the surface and perpendicular to it. Additionally, a 1 cm diameter 6 MeV electron beam was used to irradiate EBT3 film at 100 cm SSD with a 0.5 cm bolus. Films were digitized with an Epson Expression 10000 XL scanner and calibrated with a 6 MeV electron specific dose curve. Normalized percent depth doses (PDD) and dose profiles for both techniques were analyzed using ImageJ. Results: Dose distributions achieved with the 90Sr-90Y sources were compared with those of external electron beam radiation therapy (EBRT). Penumbra (20%- 80%) for EBRT and 90Sr-90Y were 4.3 mm and 1.6 mm, respectively. PDD values of 50% (normalized to 2 mm) were 10.1 mm and 2.8 mm for electron and 90Sr-90Y, respectively. Flatness (80% of the central beam profile) was 14.1% at a 5 mm depth for EBRT and 4.0% at surface for the 90Sr-90Y. Conclusion: As expected, the PDDs of 90Sr-90Y in water are shallower than that of external electron beams for the same field size. 90Sr-90Y can be used in CSBT to provide patient specific treatment where shallower depth doses than that provided by electron external beams may be required: e.g. eyelids, nose, lips, ears, etc. The customizability of EBRT could be replicated by using multiple adjacent 90Sr-90Y plaque placements.
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TU‐AB‐201‐10: Novel Conformal Skin Brachytherapy Device
Medical Physics, 2015Co-Authors: C Ferreira, K Rasmussen, D Johnson, S Ahmad, Jae Won JungAbstract:Purpose: A novel conformal skin Brachytherapy (CSBT) Device was developed to provide patient specific treatment for small inoperable lesions and irregular surfaces that are not good candidates for electron external beam, e.g. eyelids, nose, lips, ears, etc. Methods: A prototype was built and tested using radioactive seeds spaced by 1.5 mm attached to a 3D printed template. Seeds were allowed to move independently at treatment surface to conform to target geometry. Beta-emitter Praseodymium-142 (half-life: 19.12 h, average beta energy: 809 keV) and Iodine-125 Model 6711 (half-life: 59.4 days, average gamma energy: 28 keV) seeds were used to test the feasibility of the Device in solid water phantom for different prescription depths and surface areas. Percent depth doses and dose profiles were analyzed. MCNPX2.6 Monte Carlo Simulation and Gafchromic EBT3 film measurements were performed for a single Pr-142 seed. Treatment with nineteen I-125 seeds was planned in BrachyVision and measured experimentally for a total dose of 500 cGy at 5.0 mm depth. Results: For a single Pr-142 seed, dose was 500.0 cGy at surface and 17.4 cGy at 5.00 mm. BrachyVision planned and film doses for I-125 seed matrix were 500 cGy and 473.5 cGy at 5 mm depth and 171.0 cGy and 201.0 cGy at 10 mm depth. Total covered surface area for Pr-142 and I-125 were 2.35 mm2 and 88.24 mm2 respectively. Profile dose fall-off showed to be very conformal to contact area with 50% of the total surface dose from a single Pr-142 and array of I-125 seeds being deposited at 0.72 mm and 0.65 mm respectively from the central axis. Conclusion: CSBT Device provides a high conformal dose to small surfaces. BrachyVision can be used to predict clinical dose distributions for multiple seeds matrix. Different radioactive seeds can be used to suit prescription depth and treatment area.
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tu ab 201 10 novel conformal skin Brachytherapy Device
Medical Physics, 2015Co-Authors: C Ferreira, K Rasmussen, D Johnson, S Ahmad, J JungAbstract:Purpose: A novel conformal skin Brachytherapy (CSBT) Device was developed to provide patient specific treatment for small inoperable lesions and irregular surfaces that are not good candidates for electron external beam, e.g. eyelids, nose, lips, ears, etc. Methods: A prototype was built and tested using radioactive seeds spaced by 1.5 mm attached to a 3D printed template. Seeds were allowed to move independently at treatment surface to conform to target geometry. Beta-emitter Praseodymium-142 (half-life: 19.12 h, average beta energy: 809 keV) and Iodine-125 Model 6711 (half-life: 59.4 days, average gamma energy: 28 keV) seeds were used to test the feasibility of the Device in solid water phantom for different prescription depths and surface areas. Percent depth doses and dose profiles were analyzed. MCNPX2.6 Monte Carlo Simulation and Gafchromic EBT3 film measurements were performed for a single Pr-142 seed. Treatment with nineteen I-125 seeds was planned in BrachyVision and measured experimentally for a total dose of 500 cGy at 5.0 mm depth. Results: For a single Pr-142 seed, dose was 500.0 cGy at surface and 17.4 cGy at 5.00 mm. BrachyVision planned and film doses for I-125 seed matrix were 500 cGy and 473.5 cGy at 5 mm depth and 171.0 cGy and 201.0 cGy at 10 mm depth. Total covered surface area for Pr-142 and I-125 were 2.35 mm2 and 88.24 mm2 respectively. Profile dose fall-off showed to be very conformal to contact area with 50% of the total surface dose from a single Pr-142 and array of I-125 seeds being deposited at 0.72 mm and 0.65 mm respectively from the central axis. Conclusion: CSBT Device provides a high conformal dose to small surfaces. BrachyVision can be used to predict clinical dose distributions for multiple seeds matrix. Different radioactive seeds can be used to suit prescription depth and treatment area.