Critical Organ Preservation in Reirradiation Brachytherapy by Injectable Spacer

Kishi, Kazushi; Sonomura, Tetsuo; Shirai, Shintaro; Sato, Morio; Tanaka, K

doi:10.1016/j.ijrobp.2009.03.072

Cited by 23 publications

(23 citation statements)

References 22 publications

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“…In our previous report of reirradiation with a total accumulated target dose of 125.6 Gy (median) [Kishi, 2009], the actual incidence of complications was very low (0% directly related to the radiotherapy) than expected (16.1%) over a 19.5-month observation period. This may have occurred because we had created a sufficient safety margin in the gel spacing procedure, and because of the time interval from the previous radiation effect.…”

Section: Occurrence Of Complicationsmentioning

confidence: 66%

“…There is a remarkable decrease in FDG accumulation 2 months after the brachytherapy (d). This photograph has been published previously [Kishi, 2009]. …”

Section: Head and Neck Reirradiationmentioning

confidence: 99%

“…We previously reported a series of 30 patients who were treated with reirradiation [Kishi, 2009]. The patients had received previous irradiation with a median dose of 60 Gy (range, 44-70 Gy) in 2-Gy fractions.…”

Section: Summary Of Clinical Effects In the First 30 Patientsmentioning

confidence: 99%

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Safe and Curative Brachytherapy Reirradiation with Organ-Sparing Hyaluronate Gel Injection

Kishi¹,

Noda²,

Sato³

2012

Brachytherapy

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Section: Occurrence Of Complicationsmentioning

confidence: 66%

“…There is a remarkable decrease in FDG accumulation 2 months after the brachytherapy (d). This photograph has been published previously [Kishi, 2009]. …”

Section: Head and Neck Reirradiationmentioning

confidence: 99%

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Safe and Curative Brachytherapy Reirradiation with Organ-Sparing Hyaluronate Gel Injection

Kishi¹,

Noda²,

Sato³

2012

Brachytherapy

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“…However, reirradiation is often limited by normal organs, especially closely surrounding organs such as skin. Skin protection during intensive brachytherapy was achieved by injectable spacers such as hyaluronate [4,5] . This spacing technique can be used to protect the intestines [12,31] , and rectum [11,32] , as well as other organs [33] .…”

Section: Reirradiation Brachytherapymentioning

confidence: 99%

“…Recently, high-dose eradicative radiotherapy using various spacers has been developed [4][5][6][7][8][9] . Of these spacers, high-molecular-weight hyaluronate is a safe intrinsic substance in the human body and when used as an injectable spacer is temporarily successful during high dose rate brachytherapy (HDRBT) [5,9,[10][11][12] . HDRBT with a spacer may facilitate safe and effective dose delivery to IMLNM.…”

Section: Introductionmentioning

confidence: 99%

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

Kishi

Tanino²,

Sonomura³

et al. 2012

WJR

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AIM:To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS:We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS:All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10: EQ�2, α/β = 10, cumulative total was 101.9 Gy EQ�10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQ�2, α/β = 3 which was 98.7 Gy EQ�2, α/β = 3 without spacer. No procedure related-or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION:We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.

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Normal Tissue Tolerance to Reirradiation

Langendijk¹

2010

Re-Irradiation: New Frontiers

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As a result of longer survival times, even among patients with incurable malignancies, the prevalence of patients at risk of developing second primary tumours and/or locoregional recurrences in previously irradiated areas might increase. Consequently, the need for additional therapeutic measures providing local control and/or symptom palliation along different lines of treatment has emerged. This has resulted in increasing requests for delivering a second and sometimes even third course of radiation to target volumes within or close to previously irradiated anatomical areas. On the one hand, improved imaging and delivery techniques including image-guided and intensity-modulated radiotherapy might facilitate reirradiation of previously exposed regions of the body. On the other hand, late toxicity is of concern because it often causes serious impact on health-related quality of life. Therefore, knowledge about longterm recovery of occult radiation injury is of utmost importance. This chapter summarises available experimental and clinical data on the effects of reirradiation to various organs.

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Critical Organ Preservation in Reirradiation Brachytherapy by Injectable Spacer

Cited by 23 publications

References 22 publications

Safe and Curative Brachytherapy Reirradiation with Organ-Sparing Hyaluronate Gel Injection

Safe and Curative Brachytherapy Reirradiation with Organ-Sparing Hyaluronate Gel Injection

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

Normal Tissue Tolerance to Reirradiation

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