American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee Report on Electronic Brachytherapy

Park, Catherine C.; Yom, Sue S.; Podgorsak, Matthew B.; Harris, Eleanor; Price, Robert A.; Bevan, Alison; Pouliot, Jean; Konski, André; Wallner, Paul E.

doi:10.1016/j.ijrobp.2009.10.068

Cited by 48 publications

(36 citation statements)

References 12 publications

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“…Reserving WBRT for a later date potentially spares the remainder of the brain from a dose of radiation and may aid in preserving longterm neurocognition, an increasingly important aspect of the neurooncological care of patients with systemic cancer as newer therapies that increase systemic control and overall survival are developed. 5,21,29,45 This study had limitations. This was a prospective, nonrandomized, single-institution study.…”

Section: Discussionmentioning

confidence: 96%

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Weil

Mavinkurve

Chao

et al. 2015

JNS

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abbreviatioNs BrM = brain metastasis; GPA = Graded Prognostic Assessment; IORT = intraoperative radiotherapy; KPS = Karnofsky Performance Scale; LMD = leptomeningeal (metastatic) disease; NSCLCa = non-small cell lung cancer; RPA = recursive partitioning analysis; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy; XRS = radiation source. submitted January 30, 2014. accepted November 13, 2014. iNclude wheN citiNg Published online January 23, 2015; DOI: 10.3171/2014.11.JNS1449. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The authors assessed the feasibility of intraoperative radiotherapy (IORT) using a portable radiation source to treat newly diagnosed, surgically resected, solitary brain metastasis (BrM). methods In a nonrandomized prospective study, 23 patients with histologically confirmed BrM were treated with an Intrabeam device that delivered 14 Gy to a 2-mm depth to the resection cavity during surgery. results In a 5-year minimum follow-up period, progression-free survival from the time of surgery with simultaneous IORT averaged (± SD) 22 ± 33 months (range 1-96 months), with survival from the time of BrM treatment with surgery+IORT of 30 ± 32 months (range 1-96 months) and overall survival from the time of first cancer diagnosis of 71 ± 64 months (range 4-197 months). For the Graded Prognostic Assessment (GPA), patients with a score of 1.5-2.0 (n = 12) had an average posttreatment survival of 21 ± 26 months (range 1-96 months), those with a score of 2.5-3.0 (n = 7) had an average posttreatment survival of 52 ± 40 months (range 5-94 months), and those with a score of 3.5-4.0 (n = 4) had an average posttreatment survival of 17 ± 12 months (range 4-28 months). A BrM at the treatment site recurred in 7 patients 9 ± 6 months posttreatment, and 5 patients had new but distant BrM 17 ± 3 months after surgery+IORT. Six patients later received whole-brain radiation therapy, 7 patients received radiosurgery, and 2 patients received both treatments. The median Karnofsky Performance Scale scores before and 1 and 3 months after surgery were 80, 90, and 90, respectively; at the time of this writing, 3 patients remain alive with a CNS progression-free survival of > 90 months without additional BrM treatment. coNclusioNs The results of this study demonstrate the feasibility of resection combined with IORT at a dose of 14 Gy to a 2-mm peripheral margin to treat a solitary BrM. Local control, distant control, and long-term survival were comparable to those of other commonly used modalities. Surgery combined with IORT seems to be a potential adjunct to patient treatment for CNS involvement by systemic cancer. Clinical trial registration no.: NCT00107367 (clinicaltrials.gov)

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Section: Discussionmentioning

confidence: 96%

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Weil

Mavinkurve

Chao

et al. 2015

JNS

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“…Park et al [6] reported an exposure during treatment of the order of 12-15 mR h 21 at 2 m from the source, or 0.4-0.5 mGy h 21 at 1 m using the inverse square dependence on distance verified above. This is again in good agreement with the value measured in our centre of 0.6 mSv h 21 at 1 m. Differences between ambient dose equivalent and air kerma are close to unity for an effective energy of 30 keV [21].…”

mentioning

confidence: 82%

“…Electron-only linear accelerators have been used for this approach, and recent mobile devices can be used in unmodified theatres if the workload is limited or thick mobile shielding panels are used [2][3][4]. The Intrabeam system (Carl Zeiss Surgical, Oberkochen, Germany) is a compact X-ray unit used for intra-operative partial breast irradiation [5][6][7][8], currently in an international randomised controlled trial (Targit) [9,10]. It generates photons using an accelerating voltage of 50 kVp.…”

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confidence: 99%

Radiation protection for an intra-operative X-ray device

Eaton

Gonzalez²,

Duck³

et al. 2011

BJR

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Objectives: Therapeutic partial breast irradiation can be delivered intra-operatively using the Intrabeam 50 kVp compact X-ray device. Spherical applicators are added to the source to give an isotropic radiation dose. The low energy of this unit leads to rapid attenuation with distance, but dose rates are much greater than for diagnostic procedures. Methods: To investigate the shielding requirements for this unit, attenuation measurements were carried out with manufacturer-provided tungsten-rubber sheets, lead, plasterboard and bricks. A prospective environmental dose rate survey was also conducted in the designated theatre. Results: As a result of isotropic geometry, the scattered dose around shielding can be 1% of primary and thus often dominates measured dose rates compared with transmission. The absorbed dose rate of the unshielded source at 1 m was 11.6 mGy h 21 but this was reduced by 95% with the shielding sheets. Measured values for the common shielding materials were similar to reference data for the attenuation of a 50 kVp diagnostic X-ray beam. Two lead screens were constructed to shield operators remaining in the theatre and an air vent into a service corridor. A lead apron would also provide suitable attenuation, although a screen allows greater flexibility for treatment operators. With these measures, staff doses were reduced to negligible quantities. Survey measurements taken during patient treatments confirmed no additional measures were required, but the theatre should be a controlled area and access restricted.

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“…The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology (ASTRO) appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for (or are already in) clinical use [16]. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft Inc. (San Jose, CA, USA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany).…”

Section: Purposementioning

confidence: 99%

Dosimetric Characteristics of a New Unit for Electronic Skin Brachytherapy

et al. 2014

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Purpose: Brachytherapy with radioactive high dose rate (HDR) 192 Ir source is applied to small skin cancer lesions, using surface applicators, i.e. Leipzig or Valencia type. New developments in the field of radiotherapy for skin cancer include electronic brachytherapy. This technique involves the placement of an HDR X-ray source close to the skin, therefore combining the benefits of brachytherapy with the reduced shielding requirements and targeted energy of low energy X-rays. Recently, the Esteya ® Electronic Brachytherapy System (Esteya EBS, Elekta AB-Nucletron, Stockholm, Sweden) has been developed specifically for HDR brachytherapy treatment of surface lesions. The system provides radionuclide free HDR brachytherapy by means of a small 69.5 kV X-ray source. The purpose of this study is to obtain the dosimetric characterization required for clinical implementation, providing the detailed methodology to perform the commissioning.Material and methods: Flatness, symmetry and penumbra, percentage of depth dose (PDD), kV stability, HVL, output, spectrum, linearity, and leakage have been evaluated for a set of applicators (from 10 mm to 30 mm in diameter).Results: Flatness and symmetry resulted better than 5% with around 1 mm of penumbra. The depth dose gradient is about 7%/mm. A kV value of 68.4 ± 1.0 kV (k = 1) was obtained, in good agreement with manufacturer data (69.5 kV). HVL was 1.85 mm Al. Dose rate for a typical 6 Gy to 7 Gy prescription resulted about 3.3 Gy/min and the leakage value was < 100 µGy/min. Conclusions:The new Esteya ® Electronic Brachytherapy System presents excellent flatness and penumbra as with the Valencia applicator case, combined with an improved PDD, allowing treatment of lesions of up to a depth of 5 mm in combination with reduced treatment duration. The Esteya unit allows HDR brachytherapy superficial treatment within a minimally shielded environment due its low energy.

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American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee Report on Electronic Brachytherapy

Cited by 48 publications

References 12 publications

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes

Radiation protection for an intra-operative X-ray device

Dosimetric Characteristics of a New Unit for Electronic Skin Brachytherapy

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