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Adam Dickler - One of the best experts on this subject based on the ideXlab platform.
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xoft axxent electronic Brachytherapy a new device for delivering Brachytherapy to the breast
Nature Reviews Clinical Oncology, 2009Co-Authors: Adam DicklerAbstract:Balloon-based Brachytherapy was developed to simplify the bracytherapy technique to make it more accessible to breast cancer patients. Balloon-based Brachytherapy is associated with a more-convenient delivery of radiotherapy, improved quality of life and patient compliance. This Review discusses a new device called Xoft Axxent®electronic Brachytherapy, which uses a disposable electronic radiation source and avoids the need of a high-dose-rate afterloader unit, thereby enhancing the convenience for patients. Balloon-based Brachytherapy was developed to simplify the Brachytherapy technique and make accelerated partial breast irradiation more accessible to patients with breast cancer who are suitable candidates for this technique. Xoft Axxent® (Xoft, Inc., Sunnyvale, CA) electronic Brachytherapy is a novel method of accelerated partial breast irradiation that uses an electronic source to produce X-rays. Xoft Axxent® treatment does not require a high-dose-rate afterloader unit or a shielded vault, unlike other Brachytherapy techniques that use iridium-192, such as MammoSite® Brachytherapy. Xoft Axxent® is associated with the delivery of less radiation to normal tissues, and increased high radiation dose regions or 'hot spots' to the target volume compared with treatment with the MammoSite® device. Further research will be needed to determine subgroups of patients who might benefit from treatment with Xoft Axxent® electronic Brachytherapy.
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Xoft Axxent^® electronic Brachytherapy—a new device for delivering Brachytherapy to the breast
Nature Reviews Clinical Oncology, 2009Co-Authors: Adam DicklerAbstract:Balloon-based Brachytherapy was developed to simplify the Brachytherapy technique and make accelerated partial breast irradiation more accessible to patients with breast cancer who are suitable candidates for this technique. Xoft Axxent^® (Xoft, Inc., Sunnyvale, CA) electronic Brachytherapy is a novel method of accelerated partial breast irradiation that uses an electronic source to produce X-rays. Xoft Axxent^® treatment does not require a high-dose-rate afterloader unit or a shielded vault, unlike other Brachytherapy techniques that use iridium-192, such as MammoSite^® Brachytherapy. Xoft Axxent^® is associated with the delivery of less radiation to normal tissues, and increased high radiation dose regions or 'hot spots' to the target volume compared with treatment with the MammoSite^® device. Further research will be needed to determine subgroups of patients who might benefit from treatment with Xoft Axxent^® electronic Brachytherapy. Balloon-based Brachytherapy was developed to simplify the bracytherapy technique to make it more accessible to breast cancer patients. Balloon-based Brachytherapy is associated with a more-convenient delivery of radiotherapy, improved quality of life and patient compliance. This Review discusses a new device called Xoft Axxent^®electronic Brachytherapy, which uses a disposable electronic radiation source and avoids the need of a high-dose-rate afterloader unit, thereby enhancing the convenience for patients. Xoft Axxent^® electronic Brachytherapy is a form of partial breast irradiation that uses an electronic source rather than a radioisotope source Xoft Axxent^® electronic Brachytherapy does not require a high-dose rate afterloader unit or treatment in a shielded vault Xoft Axxent^® is associated with an increased volume of radiation 'hot spots' and less dose to normal tissues than other forms of balloon Brachytherapy Further clinical research is needed with Xoft Axxent^® electronic Brachytherapy
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Technology Insight: MammoSite^®—a new device for delivering Brachytherapy following breast-conserving therapy
Nature Clinical Practice Oncology, 2007Co-Authors: Adam DicklerAbstract:The MammoSite^® breast Brachytherapy applicator was designed to simplify the Brachytherapy procedure and make partial-breast irradiation more accessible The MammoSite^® catheter treats a volume of breast tissue comparable to that treated by multicatheter-based interstitial Brachytherapy The MammoSite^® applicator can be placed at the time of lumpectomy or post-lumpectomy using ultrasound guidance Initial results show that treatment with the MammoSite^® applicator is well-tolerated and associated with favorable cosmetic results The NSABP/RTOG trial has broad eligibility criteria compared with the selection criteria recommendations of the American Brachytherapy Society and American Society of Breast Surgeons for partial-breast irradiation The MammoSite^®breast Brachytherapy applicator was designed to simplify the Brachytherapy procedure and make it more accessible to patients who are suitable candidates for partial-breast irradiation (PBI). Dickler highlights the advantages of this technique such as low rates of serious complications and favorable cosmetic outcome and also summarizes ongoing trials that should provide a definitive answer regarding the benefits of PBI. The MammoSite^® (Cytyc Corporation, Marlborough, MA) breast Brachytherapy applicator was designed to overcome the logistic problems created by external-beam radiation therapy (EBRT) and the technical difficulties associated with multicatheter-based interstitial Brachytherapy. The MammoSite^® catheter has been shown to treat a volume of tissue equivalent to that treated by multicatheter-based Brachytherapy. Using ultrasound guidance, the MammoSite^® applicator can be placed using an open technique at the time of lumpectomy or post-lumpectomy. Initial results have shown favorable cosmesis and few significant side effects. NSABP B-39/RTOG 0413 randomizes patients between EBRT and partial-breast irradiation (PBI). The PBI arm consists of interstitial Brachytherapy, MammoSite^® Brachytherapy, or 3D conformal EBRT. This trial has the potential to provide a definitive answer regarding the benefits of PBI for certain subgroups of patients, and hence lead to more women undergoing breast conservation therapy.
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the mammosite breast Brachytherapy device targeted delivery of breast Brachytherapy
Future Oncology, 2005Co-Authors: Adam DicklerAbstract:The MammoSite® breast Brachytherapy device was designed to overcome the logistic difficulties presented by external beam radiation therapy and the technical difficulties of multicatheter-based interstitial Brachytherapy. The device consists of a silicone balloon connected to a catheter which contains an inflation channel and a port for passage of a high-dose-rate Brachytherapy source. The American Brachytherapy Society and American Society of Breast Surgeons have published partial breast irradiation patient selection guidelines. Initial reports have shown a favorable cosmetic outcome in the majority of patients. The MammoSite applicator has also been associated with minimal side effects. The NSABP B-39/RTOG 0413 trial will randomize patients to either whole breast irradiation or partial-breast irradiation consisting of interstitial Brachytherapy, MammoSite Brachytherapy, or 3D conformal radiation. This national randomized trial has the potential to provide a definitive answer regarding the benefits of par...
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The MammoSite ® breast Brachytherapy device: targeted delivery of breast Brachytherapy
Future oncology (London England), 2005Co-Authors: Adam DicklerAbstract:The MammoSite® breast Brachytherapy device was designed to overcome the logistic difficulties presented by external beam radiation therapy and the technical difficulties of multicatheter-based interstitial Brachytherapy. The device consists of a silicone balloon connected to a catheter which contains an inflation channel and a port for passage of a high-dose-rate Brachytherapy source. The American Brachytherapy Society and American Society of Breast Surgeons have published partial breast irradiation patient selection guidelines. Initial reports have shown a favorable cosmetic outcome in the majority of patients. The MammoSite applicator has also been associated with minimal side effects. The NSABP B-39/RTOG 0413 trial will randomize patients to either whole breast irradiation or partial-breast irradiation consisting of interstitial Brachytherapy, MammoSite Brachytherapy, or 3D conformal radiation. This national randomized trial has the potential to provide a definitive answer regarding the benefits of par...
Subir Nag - One of the best experts on this subject based on the ideXlab platform.
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Intraoperative high-dose-rate Brachytherapy: An American Brachytherapy Society consensus report.
Brachytherapy, 2017Co-Authors: Shane Lloyd, Subir Nag, Kaled M. Alektiar, Y.j. Huang, Christopher L. Deufel, Firas Mourtada, David K. GaffneyAbstract:Abstract Purpose This report presents recommendations from the American Brachytherapy Society for the use of intraoperative high-dose-rate (IOHDR) Brachytherapy. Methods and Materials Members of the American Brachytherapy Society with expertise in IOHDR formulated this document based on their clinical experience and a review of the literature. This report covers the use of IOHDR in colorectal cancer, soft tissue sarcoma, gynecologic cancers, head and neck cancers, and pediatric cancers. This report does not cover intraoperative Brachytherapy for breast cancer. Details about treatment planning and delivery are emphasized so this document can serve as a guide to practices implementing this technique. Results IOHDR Brachytherapy is generally most beneficial for patients with either close or positive margins and/or recurrent disease in a previous resection bed or previously irradiated area. IOHDR Brachytherapy requires a well-coordinated multidisciplinary team. IOHDR Brachytherapy is recommended in the treatment of both recurrent and primary locally advanced disease for colorectal and gynecologic malignancies, soft tissue sarcoma, and selected head and neck and pediatric malignancies. Other techniques such as perioperative fractionated Brachytherapy are also acceptable in many cases with some advantages and disadvantages compared to IOHDR. Conclusions IOHDR Brachytherapy is a specialized technique in radiation therapy with unique properties and advantages in cancer control. Special considerations for treatment planning and delivery are outlined herein.
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Controversies and new developments in gynecologic Brachytherapy: image-based intracavitary Brachytherapy for cervical carcinoma.
Seminars in radiation oncology, 2006Co-Authors: Subir NagAbstract:The current clinical practice for cervical cancer intracavitary Brachytherapy in most centers is to prescribe the dose to point A. However, this is an empirical point and does not necessarily reflect dose to the tumor. Although 3-dimensional image-based treatment planning is extensively used in prostate Brachytherapy, only a few institutions have used it to shape the dose distribution in cervical Brachytherapy. To facilitate and standardize image-based dosimetry for cervical cancer Brachytherapy, the American Image-guided Brachytherapy Working Group and the European Gynecological GEC-ESTRO Working Group have recently proposed nomenclature for volume definition and recommendations for image-based intracavitary Brachytherapy for cervical cancer. The recommendations of the 2 groups are very similar and are discussed together in this article. Proposals are made for research in image-based Brachytherapy for cervical cancer. At a recent transatlantic image-based cervical cancer Brachytherapy workshop (Chicago, IL, July 28, 2005), it was suggested that because the recommendations are so similar and to prevent confusion, the nomenclature suggested by the European Group be adopted and future joint contouring workshops be organized to facilitate image-based cervical cancer Brachytherapy.
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The American Brachytherapy Society recommendations for low-dose-rate Brachytherapy for carcinoma of the cervix.
International journal of radiation oncology biology physics, 2002Co-Authors: Subir Nag, Alvaro Martinez, Clifford K.s. Chao, Beth Erickson, Jeffery M. Fowler, Nilendu Gupta, Bruce R. ThomadsenAbstract:Abstract Purpose: This report presents guidelines for using low-dose-rate (LDR) Brachytherapy in the management of patients with cervical cancer. Methods: Members of the American Brachytherapy Society (ABS) with expertise in LDR Brachytherapy for cervical cancer performed a literature review, supplemented by their clinical experience, to formulate guidelines for LDR Brachytherapy of cervical cancer. Results: The ABS strongly recommends that radiation treatment for cervical carcinoma (with or without chemotherapy) should include Brachytherapy as a component. Precise applicator placement is essential for improved local control and reduced morbidity. The outcome of Brachytherapy depends, in part, on the skill of the brachytherapist. Doses given by external beam radiotherapy and Brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional practice. The ABS recognizes that intracavitary Brachytherapy is the standard technique for Brachytherapy for cervical carcinoma. Interstitial Brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary Brachytherapy. The ABS recommends completion of treatment within 8 weeks, when possible. Prolonging total treatment duration can adversely affect local control and survival. Recommendations are made for definitive and postoperative therapy after hysterectomy. Although recognizing that many efficacious LDR dose schedules exist, the ABS presents suggested dose and fractionation schemes for combining external beam radiotherapy with LDR Brachytherapy for each stage of disease. The dose prescription point (point A) is defined for intracavitary insertions. Dose rates of 0.50 to 0.65 Gy/h are suggested for intracavitary Brachytherapy. Dose rates of 0.50 to 0.70 Gy/h to the periphery of the implant are suggested for interstitial implant. Use of differential source activity or loading minimizes excessive central dose rates. These recommendations are intended only as guidelines. The responsibility for medical decisions ultimately rests with the treating radiation oncologist. Conclusion: Guidelines are suggested for LDR Brachytherapy for cervical cancer. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies.
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The American Brachytherapy Society recommendations for Brachytherapy of soft tissue sarcomas
International journal of radiation oncology biology physics, 2001Co-Authors: Subir Nag, Daniel Shasha, Nora A. Janjan, Ivy A. Petersen, Marco ZaiderAbstract:Abstract Purpose: This report presents the American Brachytherapy Society (ABS) guidelines for the use of Brachytherapy for patients with soft tissue sarcoma. Methods and Materials: Members of the ABS with expertise in soft tissue sarcoma formulated Brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. Results: Brachytherapy used alone or in combination with external beam irradiation is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas in adults and in children. Brachytherapy options include low dose rate techniques with iridium 192 or iodine 125, fractionated high dose rate Brachytherapy, or intraoperative high dose rate therapy. Recommendations are made for patient selection, techniques, dose rates, and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed. Conclusion: Brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biologic and dosimetric advantage in the treatment of patients with soft tissue sarcoma. The treatment approach used depends upon the institution, physician expertise, and the clinical situation. Guidelines are established for the use of Brachytherapy in the treatment of soft tissue sarcomas in adults and in children. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified, as further clinical results become available.
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The American Brachytherapy Society recommendations for high-dose-rate Brachytherapy for carcinoma of the cervix
International journal of radiation oncology biology physics, 2000Co-Authors: Subir Nag, Beth Erickson, Bruce R. Thomadsen, Colin G. Orton, Jeffrey D. Demanes, Daniel G PetereitAbstract:Abstract Purpose: This report presents guidelines for using high-dose-rate (HDR) Brachytherapy in the management of patients with cervical cancer, taking into consideration the current availability of resources in most institutions. Methods: Members of the American Brachytherapy Society (ABS) with expertise in HDR Brachytherapy for cervical cancer performed a literature review, supplemented their clinical experience to formulate guidelines for HDR Brachytherapy of cervical cancer. Results: The ABS strongly recommends that definitive irradiation for cervical carcinoma must include Brachytherapy as a component. Each institution should follow a consistent treatment policy when performing HDR Brachytherapy, including complete documentation of treatment parameters and correlation with clinical outcome, such as pelvic control, survival, and complications. The goals are to treat Point A to at least a total low-dose-rate (LDR) equivalent of 80–85 Gy for early stage disease and 85–90 Gy for advanced stage. The pelvic sidewall dose recommendations are 50–55 Gy for early lesions and 55–65 Gy for advanced ones. The relative doses given by external beam radiation therapy (EBRT) vs. Brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional preference. As with LDR Brachytherapy, every attempt should be made to keep the bladder and rectal doses below 80 Gy and 75 Gy LDR equivalent doses, respectively. Interstitial Brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary Brachytherapy. While recognizing that many efficacious HDR fractionation schedules exist, some suggested dose and fractionation schemes for combining the EBRT with HDR Brachytherapy for each stage of disease are presented. These recommendations are intended only as guidelines, and the suggested fractionation schemes have not been thoroughly tested. The responsibility for the medical decisions ultimately rests with the treating radiation oncologist. Conclusion: Guidelines are established for HDR Brachytherapy for cervical cancer. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified, as image-based treatment becomes more widely available.
Mitchell Kamrava - One of the best experts on this subject based on the ideXlab platform.
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The American Brachytherapy society consensus statement for skin Brachytherapy.
Brachytherapy, 2020Co-Authors: Chirag Shah, Zoubir Ouhib, Mitchell Kamrava, Shlomo A. Koyfman, Shauna R. Campbell, Ajay Bhatnagar, Joycelin F. Canavan, Zain A. Husain, Christopher A. Barker, Gil'ad N. CohenAbstract:Abstract Purpose Keratinocyte carcinoma (KC, previously nonmelanoma skin cancer) represents the most common cancer worldwide. While surgical treatment is commonly utilized, various radiation therapy techniques are available including external beam and Brachytherapy. As such, the American Brachytherapy Society has created an updated consensus statement regarding the use of Brachytherapy in the treatment of KCs. Methods Physicians and physicists with expertise in skin cancer and Brachytherapy created a consensus statement for appropriate patient selection, data, dosimetry, and utilization of skin Brachytherapy and techniques based on a literature search and clinical experience. Results Guidelines for patient selection, evaluation, and dose/fractionation schedules to optimize outcomes for patients with KC undergoing Brachytherapy are presented. Studies of electronic Brachytherapy are emerging, although limited long-term data or comparative data are available. Radionuclide-based Brachytherapy represents an appropriate option for patients with small KCs with multiple techniques available. Conclusions Skin Brachytherapy represents a standard of care option for appropriately selected patients with KC. Radionuclide-based Brachytherapy represents a well-established technique; however, the current recommendation is that electronic Brachytherapy be used for KC on prospective clinical trial or registry because of a paucity of mature data.
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Brachytherapy training survey of radiation oncology residents
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: Samuel Marcrom, Catheryn M Yashar, Jenna Kahn, Lauren E Colbert, Christopher Freese, Kaleigh Doke, Joanna C Yang, Michael Luu, Mitchell KamravaAbstract:Purpose As Brachytherapy utilization rates decline, we sought to evaluate the state of Brachytherapy training during radiation oncology residency. Methods and Materials US radiation oncology residents in the Association of Residents in Radiation Oncology database were sent an online questionnaire regarding Brachytherapy training. Survey questions addressed a wide array of topics, and responses were often given on a 1 to 5 Likert-type scale that reflected strength of opinion. Postgraduate year (PGY) 4/5 respondents' answers were analyzed. Descriptive statistics were generated, and rank correlation analyses (Kendall's τ coefficient and Wilcoxon signed-rank test) were used for comparisons. Results The survey was completed by 145 of 567 residents (62% being PGY4/5). Of PGY4/5 respondents, 96% (86 of 90) believed learning Brachytherapy during residency was important, and 72% (65 of 90) felt their program valued Brachytherapy training. Resident Brachytherapy comfort varied by site, decreasing as follows: gynecologic, prostate, breast, skin. The current intracavitary 15-case minimum was believed adequate by most, but only a minority believed the 5-case interstitial minimum was adequate. Most respondents (59%) believed that caseload was the greatest barrier to achieving independence in Brachytherapy. Significant support exists for American Brachytherapy Society training courses and on-the-job education to enhance training, but enthusiasm about pursuing Brachytherapy fellowship training was low. Most respondents expressed confidence in developing a Brachytherapy practice (54%); however, this was significantly lower than the rate of those confident in developing a stereotactic body radiation therapy/stereotactic radiosurgery program (97%) (P Conclusions Brachytherapy is an important component of residency training that is valued by residents and programs. Because caseload was the greatest perceived barrier in Brachytherapy training, with confidence correlated with case volume, attempts should be made to expand opportunities for training experiences that are feasible to complete during residency.
Akila N. Viswanathan - One of the best experts on this subject based on the ideXlab platform.
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The ABS Brachytherapy schools.
Brachytherapy, 2020Co-Authors: Beth Erickson, Wayne M. Butler, Zoubir Ouhib, Daniel G Petereit, Frank A. Vicini, Bruce R. Thomadsen, Juanita Crook, Douglas W. Arthur, William S. Bice, Akila N. ViswanathanAbstract:Abstract The American Brachytherapy Society Brachytherapy schools have been pivotal in teaching and evolving the art of Brachytherapy over the past decades. Founded in 1995, the schools have consistently provided content for the major disease sites including gynecologic, prostate, and breast with ocular, vascular, head and neck, pediatric, intraluminal, systemic, and intraoperative approaches more selectively addressed. In addition, Physics schools, either coupled with clinical schools or as stand-alone venues, have provided an essential educational component for practicing physicists, a pivotal part of the Brachytherapy team. Celebrating 25 years in existence, this historical overview of the American Brachytherapy Society Brachytherapy schools is a tribute to the many teachers who have shared their expertise, to the many students who have been enthusiastic and interactive participants, and the staff who have made it all possible, with the reward of perpetuating the important and timely art of Brachytherapy.
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Brachytherapy in Gynecologic Cancers: Why Is It Underused?
Current oncology reports, 2016Co-Authors: Kathy Han, Akila N. ViswanathanAbstract:Despite its established efficacy, Brachytherapy is underused in the management of cervical and vaginal cancers in some parts of the world. Possible reasons for the underutilization of Brachytherapy include the adoption of less invasive techniques, such as intensity-modulated radiotherapy; reimbursement policies favoring these techniques over Brachytherapy; poor physician or patient access to Brachytherapy; inadequate maintenance of Brachytherapy skills among practicing radiation oncologists; transitioning to high-dose-rate (HDR) Brachytherapy with increased time requirements; and insufficient training of radiation oncology residents.
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trends in the utilization of Brachytherapy in cervical cancer in the united states
International Journal of Radiation Oncology Biology Physics, 2013Co-Authors: Kathy Han, Michael Milosevic, Anthony Fyles, Melania Pintilie, Akila N. ViswanathanAbstract:Purpose To determine the trends in Brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with Brachytherapy treatment. Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received Brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results Sixty-three percent of the 7359 women received Brachytherapy in combination with EBRT, and 37% received EBRT alone. The Brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 ( P .001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of Brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, Brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P .001) and overall survival (OS; 58.2% vs 46.2%, P .001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74). Conclusions This population-based analysis reveals a concerning decline in Brachytherapy utilization and significant geographic disparities in the delivery of Brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.
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american Brachytherapy society consensus guidelines for locally advanced carcinoma of the cervix part ii high dose rate Brachytherapy
Brachytherapy, 2012Co-Authors: Akila N. Viswanathan, Bruce R. Thomadsen, David K. Gaffney, Jeffrey D. Demanes, Sushil Beriwal, Jennifer F De Los Santos, Jorgen L Hansen, Ellen L Jones, Christian Kirisits, Beth EricksonAbstract:Abstract Purpose This report presents an update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) Brachytherapy guidelines for locally advanced cervical cancer. Methods Members of the ABS with expertise in cervical cancer formulated updated guidelines for HDR Brachytherapy using tandem and ring, ovoids, cylinder, or interstitial applicators for locally advanced cervical cancer. These guidelines were written based on medical evidence in the literature and input of clinical experts in gynecologic Brachytherapy. Results The ABS affirms the essential curative role of tandem-based Brachytherapy in the management of locally advanced cervical cancer. Proper applicator selection, insertion, and imaging are fundamental aspects of the procedure. Three-dimensional imaging with magnetic resonance or computed tomography or radiographic imaging may be used for treatment planning. Dosimetry must be performed after each insertion before treatment delivery. Applicator placement, dose specification, and dose fractionation must be documented, quality assurance measures must be performed, and followup information must be obtained. A variety of dose/fractionation schedules and methods for integrating Brachytherapy with external-beam radiation exist. The recommended tumor dose in 2-Gray (Gy) per fraction radiobiologic equivalence (normalized therapy dose) is 80–90 Gy, depending on tumor size at the time of Brachytherapy. Dose limits for normal tissues are discussed. Conclusion These guidelines update those of 2000 and provide a comprehensive description of HDR cervical cancer Brachytherapy in 2011.
Beth Erickson - One of the best experts on this subject based on the ideXlab platform.
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The ABS Brachytherapy schools.
Brachytherapy, 2020Co-Authors: Beth Erickson, Wayne M. Butler, Zoubir Ouhib, Daniel G Petereit, Frank A. Vicini, Bruce R. Thomadsen, Juanita Crook, Douglas W. Arthur, William S. Bice, Akila N. ViswanathanAbstract:Abstract The American Brachytherapy Society Brachytherapy schools have been pivotal in teaching and evolving the art of Brachytherapy over the past decades. Founded in 1995, the schools have consistently provided content for the major disease sites including gynecologic, prostate, and breast with ocular, vascular, head and neck, pediatric, intraluminal, systemic, and intraoperative approaches more selectively addressed. In addition, Physics schools, either coupled with clinical schools or as stand-alone venues, have provided an essential educational component for practicing physicists, a pivotal part of the Brachytherapy team. Celebrating 25 years in existence, this historical overview of the American Brachytherapy Society Brachytherapy schools is a tribute to the many teachers who have shared their expertise, to the many students who have been enthusiastic and interactive participants, and the staff who have made it all possible, with the reward of perpetuating the important and timely art of Brachytherapy.
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american Brachytherapy society consensus guidelines for locally advanced carcinoma of the cervix part ii high dose rate Brachytherapy
Brachytherapy, 2012Co-Authors: Akila N. Viswanathan, Bruce R. Thomadsen, David K. Gaffney, Jeffrey D. Demanes, Sushil Beriwal, Jennifer F De Los Santos, Jorgen L Hansen, Ellen L Jones, Christian Kirisits, Beth EricksonAbstract:Abstract Purpose This report presents an update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) Brachytherapy guidelines for locally advanced cervical cancer. Methods Members of the ABS with expertise in cervical cancer formulated updated guidelines for HDR Brachytherapy using tandem and ring, ovoids, cylinder, or interstitial applicators for locally advanced cervical cancer. These guidelines were written based on medical evidence in the literature and input of clinical experts in gynecologic Brachytherapy. Results The ABS affirms the essential curative role of tandem-based Brachytherapy in the management of locally advanced cervical cancer. Proper applicator selection, insertion, and imaging are fundamental aspects of the procedure. Three-dimensional imaging with magnetic resonance or computed tomography or radiographic imaging may be used for treatment planning. Dosimetry must be performed after each insertion before treatment delivery. Applicator placement, dose specification, and dose fractionation must be documented, quality assurance measures must be performed, and followup information must be obtained. A variety of dose/fractionation schedules and methods for integrating Brachytherapy with external-beam radiation exist. The recommended tumor dose in 2-Gray (Gy) per fraction radiobiologic equivalence (normalized therapy dose) is 80–90 Gy, depending on tumor size at the time of Brachytherapy. Dose limits for normal tissues are discussed. Conclusion These guidelines update those of 2000 and provide a comprehensive description of HDR cervical cancer Brachytherapy in 2011.
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The American Brachytherapy Society recommendations for low-dose-rate Brachytherapy for carcinoma of the cervix.
International journal of radiation oncology biology physics, 2002Co-Authors: Subir Nag, Alvaro Martinez, Clifford K.s. Chao, Beth Erickson, Jeffery M. Fowler, Nilendu Gupta, Bruce R. ThomadsenAbstract:Abstract Purpose: This report presents guidelines for using low-dose-rate (LDR) Brachytherapy in the management of patients with cervical cancer. Methods: Members of the American Brachytherapy Society (ABS) with expertise in LDR Brachytherapy for cervical cancer performed a literature review, supplemented by their clinical experience, to formulate guidelines for LDR Brachytherapy of cervical cancer. Results: The ABS strongly recommends that radiation treatment for cervical carcinoma (with or without chemotherapy) should include Brachytherapy as a component. Precise applicator placement is essential for improved local control and reduced morbidity. The outcome of Brachytherapy depends, in part, on the skill of the brachytherapist. Doses given by external beam radiotherapy and Brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional practice. The ABS recognizes that intracavitary Brachytherapy is the standard technique for Brachytherapy for cervical carcinoma. Interstitial Brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary Brachytherapy. The ABS recommends completion of treatment within 8 weeks, when possible. Prolonging total treatment duration can adversely affect local control and survival. Recommendations are made for definitive and postoperative therapy after hysterectomy. Although recognizing that many efficacious LDR dose schedules exist, the ABS presents suggested dose and fractionation schemes for combining external beam radiotherapy with LDR Brachytherapy for each stage of disease. The dose prescription point (point A) is defined for intracavitary insertions. Dose rates of 0.50 to 0.65 Gy/h are suggested for intracavitary Brachytherapy. Dose rates of 0.50 to 0.70 Gy/h to the periphery of the implant are suggested for interstitial implant. Use of differential source activity or loading minimizes excessive central dose rates. These recommendations are intended only as guidelines. The responsibility for medical decisions ultimately rests with the treating radiation oncologist. Conclusion: Guidelines are suggested for LDR Brachytherapy for cervical cancer. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies.
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The American Brachytherapy Society recommendations for high-dose-rate Brachytherapy for carcinoma of the cervix
International journal of radiation oncology biology physics, 2000Co-Authors: Subir Nag, Beth Erickson, Bruce R. Thomadsen, Colin G. Orton, Jeffrey D. Demanes, Daniel G PetereitAbstract:Abstract Purpose: This report presents guidelines for using high-dose-rate (HDR) Brachytherapy in the management of patients with cervical cancer, taking into consideration the current availability of resources in most institutions. Methods: Members of the American Brachytherapy Society (ABS) with expertise in HDR Brachytherapy for cervical cancer performed a literature review, supplemented their clinical experience to formulate guidelines for HDR Brachytherapy of cervical cancer. Results: The ABS strongly recommends that definitive irradiation for cervical carcinoma must include Brachytherapy as a component. Each institution should follow a consistent treatment policy when performing HDR Brachytherapy, including complete documentation of treatment parameters and correlation with clinical outcome, such as pelvic control, survival, and complications. The goals are to treat Point A to at least a total low-dose-rate (LDR) equivalent of 80–85 Gy for early stage disease and 85–90 Gy for advanced stage. The pelvic sidewall dose recommendations are 50–55 Gy for early lesions and 55–65 Gy for advanced ones. The relative doses given by external beam radiation therapy (EBRT) vs. Brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional preference. As with LDR Brachytherapy, every attempt should be made to keep the bladder and rectal doses below 80 Gy and 75 Gy LDR equivalent doses, respectively. Interstitial Brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary Brachytherapy. While recognizing that many efficacious HDR fractionation schedules exist, some suggested dose and fractionation schemes for combining the EBRT with HDR Brachytherapy for each stage of disease are presented. These recommendations are intended only as guidelines, and the suggested fractionation schemes have not been thoroughly tested. The responsibility for the medical decisions ultimately rests with the treating radiation oncologist. Conclusion: Guidelines are established for HDR Brachytherapy for cervical cancer. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified, as image-based treatment becomes more widely available.
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Clinical indications for Brachytherapy
Journal of surgical oncology, 1997Co-Authors: Beth Erickson, J. Frank WilsonAbstract:Brachytherapy, or placing radioactive sources either temporarily or permanently into or near a malignant tumor, is a long-established cancer treatment method. During the past 25 years, Brachytherapy has become safer and more versatile than earlier radium therapy, and its indications have increased dramatically during this period. One estimate is that at least 5-10% of all patients needing radiation therapy require Brachytherapy. The site-specific clinical indications and methods for Brachytherapy implementation are described.
