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Malignant obstructive jaundice Treated by Intraluminal Brachytherapy Combined With stent placement or Stent Implantation Alone
S82
Abstracts / Brachytherapy 15 (2016) S21eS204
Purpose: Tools for tumor heterogeneity quantitative analysis are in demand for clinical radiotherapy and treatment assessment. Texture analysis is a mathematical approach that quantifies intuitive qualities as a function of the nonrandom spatial patterns in pixel intensities. Texture features are of great potential value as quantitative biomarkers in radiotherapy assessment. The aim of this study is to investigate the clinical feasibility of using classic texture features as potential biomarkers which are supplementary to regional apparent diffusion coefficient in gynecological cancer radiotherapy response assessment. Materials and Methods: Twelve female patients recently treated with external beam radiotherapy (EBRT) combined with high dose rate (HDR) intracavitary brachytherapy were retrospectively studied. Each patient received EBRT with a total 45 Gy dose followed by five fractions of HDR treatment (5.5 Gy/fx, total dose 27.5 Gy). Diffusion Weighted MRI (DWI-MRI) and CT scans were conducted before EBRT and before each fraction of brachytherapy. The mean high-risk clinical target volume (HRCTV) size of all enrolled patients was 35 cm3 (20-95 cm3). DWI-MRI scans were acquired on a 1.5T clinical scanner (GE Healthcare, Milwaukee, WI) using a spin-echo EPI sequence. Diffusion-sensitized gradient encoding with weighting factors of b 5 500 s/mm2 and b 5 1000 s/mm2 was applied in six directions, one set of images of b 5 0 s/mm2 were also acquired. Apparent diffusion coefficient (ADC) maps were calculated using linear least-square fitting method. ADC maps were normalized to 32 gray levels. For ADC maps, 33 classic texture features were extracted utilizing the classic gray level run length matrix (GLRLM) and gray level co-occurrence matrix (GLCOM) from HR-CTV. For each texture feature, Wilcoxon signed-rank statistics test was conducted to determine the significance of the feature’s numerical value change after radiotherapy. And significance level was set to 0.05 with multicomparison correction if applicable. Results: After the EBRT treatment, the relative change of mean ADC (before 1st fx of HDR/before EBRT) of HR-CTV was 0.760.13 (p 5 0.002). For GLCOM of ADC maps, 18 out of 22 HR-CTV texture features demonstrated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. After HDR treatments, the relative change of mean ADC (before 5th fx of HDR/before 1st fx of HDR) of HR-CTV was 0.990.24 (p 5 0.814). For GLCOM of ADC maps, 18 out of 22 HRCTV texture features indicated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. The texture features that indicated significant changes after HDR treatments are the same as those after EBRT treatment. For the whole radiotherapy treatment process, the relative change of mean ADC (before 5th fx of HDR/before EBRT) of HR-CTV was 0.730.13 (p 5 0.002). For GLCOM of ADC maps, 18 out of 22 HR-CTV texture features demonstrated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. The texture features that indicated significant changes for the whole treatment process are the same as those after HDR treatments. Conclusions: Initial results indicate that certain classic texture features are sensitive to radiation-induced changes. Classic texture features with significant numerical changes can be used in monitoring radiotherapy effect. This might suggest that certain texture features might be used as biomarkers which are supplementary to ADC for assessment of radiotherapy response in gynecological cancer.
MISCELLANEOUS PROFFERED PAPERS II (INCLUDES SKIN, GI, THORACIC) Wednesday, June 29, 2016 1:15 PM - 2:45 PM PP70 Presentation Time: 1:15 PM Malignant obstructive jaundice Treated by Intraluminal Brachytherapy Combined With stent placement or Stent Implantation Alone Jingqin Ma, Doctor, Zhiping Yan, Doctor. Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China.
Purpose: To compare the safety and efficacy of intraluminal implantation of Iodine-125 (125I) seeds strand combined with stent versus stent placement alone for treatment of patients with malignant obstructive jaundice (MOJ). Materials and Methods: From January 2009 to December 2013, the data of 319 consecutive patients with MOJ treated with stent placement were retrospectively analyzed. 125I seeds strand was implanted in the obstructed bile duct of 107 patients (group A). No brachytherapy was performed in the remaining 212 patients (group B). Clinical outcomes, treatment related complications,stent patency period and overall survival were compared between two groups. Results: All 125I seeds strands and stents were successfully implanted without serious procedure-related adverse events. During a mean of 220 days follow-up,mean survival time in group A and B was 423.2 days (95% CI 344.5e501.8 days) and 344.4 days (95% CI 289.1e399.8 days), respectively (p50.033). Mean stent patency period in group A was 353.7 days (95% CI 293.0 -414.3 days) compared to 280.9 days (95% CI 243.7e318.2 days) in group B (p50.031). Conclusions: Compared to stent placement alone, the combination of 125I seeds strand and stent implantation appears to be more effective in treatment of patients with malignant obstructive jaundice.
PP71
Presentation Time: 1:24 PM
Initial Experience in High-Dose-Rate Brachytherapy Treatment of the Esophagus Using a Novel Esophageal Applicator Ivan M. Buzurovic, PhD, Mandar S. Bhagwat, PhD, Desmond A. O’Farrel, MS, Thomas C. Harris, PhD, Jorgen L. Hansen, MS, Robert A. Cormack, PhD, Phillip M. Devlin, MD. Radiation Oncology, DanaFarber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA. Purpose: The purpose of the study is to report the initial experience in the treatment of locally advanced esophageal carcinoma with high-dose-rate (HDR) brachytherapy using a novel transoral balloon centering esophageal applicator (E-APP, Ancer Medical). Materials and Methods: Initially, the patient underwent chemoradiotherapy preoperatively for locally advanced esophageal carcinoma. Esophagectomy and resection were performed. Recently, the patient was diagnosed with malignant neoplasm of the middle third of the esophagus. Imaging showed an avid lesion at the anastomosis. The patient received a total of 26 Gy in external beam radiation therapy, so the HDR brachytherapy was used in the second course. To decrease the dose to the organs at risk in the upper gastrointestinal region, we used a novel disposable esophageal brachytherapy applicator with five independently inflatable balloons. The applicator was designed to allow for treatment lengths greater than 10 cm. Prior to the treatment, the applicator was commissioned and tested for clinical implementations. We tested: a) the visibility of the radio-opaque markers in the computer tomography images to assure proper placement, b) the repeatability and consistency of the water inflatable balloons, c) the absolute and relative accuracy (sequencing) of the source positioning in the applicator using the source position simulator and the radiochromic film. In addition, we tested the usability and accuracy of twelve radiopaque markers on the exterior side of the catheters for the proper source placement in the clinical target. The prescription dose for the HDR treatments was 15 Gy in 3 fractions to the distal esophagus with a 5 cm offset from the end of the applicator. The treatment was delivered twice a day. The treatment length was 15 cm, which resulted in 31 dwell positions having a step size of 0.5 cm. The prescription dose was planned to be delivered to a diameter of 1 cm with respect to the central catheter with minimal optimization to avoid critical structures in the anatomy. Results: The commissioning showed sub-millimeter accuracy in the source positioning. The radiopaque markers of the applicators were visible in various windows and level setup configurations of the CT images. Distal position of the source (source extension) was 1270 mm for the microSelectron V.2. afterloader (Elekta Brachytherapy); the experimental setup is presented in Fig. 1a. The catheter reconstruction was uncomplicated due to the good visibility of the markers. The treatment
Abstracts / Brachytherapy 15 (2016) S21eS204
Purpose: Tools for tumor heterogeneity quantitative analysis are in demand for clinical radiotherapy and treatment assessment. Texture analysis is a mathematical approach that quantifies intuitive qualities as a function of the nonrandom spatial patterns in pixel intensities. Texture features are of great potential value as quantitative biomarkers in radiotherapy assessment. The aim of this study is to investigate the clinical feasibility of using classic texture features as potential biomarkers which are supplementary to regional apparent diffusion coefficient in gynecological cancer radiotherapy response assessment. Materials and Methods: Twelve female patients recently treated with external beam radiotherapy (EBRT) combined with high dose rate (HDR) intracavitary brachytherapy were retrospectively studied. Each patient received EBRT with a total 45 Gy dose followed by five fractions of HDR treatment (5.5 Gy/fx, total dose 27.5 Gy). Diffusion Weighted MRI (DWI-MRI) and CT scans were conducted before EBRT and before each fraction of brachytherapy. The mean high-risk clinical target volume (HRCTV) size of all enrolled patients was 35 cm3 (20-95 cm3). DWI-MRI scans were acquired on a 1.5T clinical scanner (GE Healthcare, Milwaukee, WI) using a spin-echo EPI sequence. Diffusion-sensitized gradient encoding with weighting factors of b 5 500 s/mm2 and b 5 1000 s/mm2 was applied in six directions, one set of images of b 5 0 s/mm2 were also acquired. Apparent diffusion coefficient (ADC) maps were calculated using linear least-square fitting method. ADC maps were normalized to 32 gray levels. For ADC maps, 33 classic texture features were extracted utilizing the classic gray level run length matrix (GLRLM) and gray level co-occurrence matrix (GLCOM) from HR-CTV. For each texture feature, Wilcoxon signed-rank statistics test was conducted to determine the significance of the feature’s numerical value change after radiotherapy. And significance level was set to 0.05 with multicomparison correction if applicable. Results: After the EBRT treatment, the relative change of mean ADC (before 1st fx of HDR/before EBRT) of HR-CTV was 0.760.13 (p 5 0.002). For GLCOM of ADC maps, 18 out of 22 HR-CTV texture features demonstrated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. After HDR treatments, the relative change of mean ADC (before 5th fx of HDR/before 1st fx of HDR) of HR-CTV was 0.990.24 (p 5 0.814). For GLCOM of ADC maps, 18 out of 22 HRCTV texture features indicated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. The texture features that indicated significant changes after HDR treatments are the same as those after EBRT treatment. For the whole radiotherapy treatment process, the relative change of mean ADC (before 5th fx of HDR/before EBRT) of HR-CTV was 0.730.13 (p 5 0.002). For GLCOM of ADC maps, 18 out of 22 HR-CTV texture features demonstrated significant changes after radiotherapy. For GLRLM of ADC maps, 10 out of 11 HR-CTV texture features showed significant changes after radiotherapy. The texture features that indicated significant changes for the whole treatment process are the same as those after HDR treatments. Conclusions: Initial results indicate that certain classic texture features are sensitive to radiation-induced changes. Classic texture features with significant numerical changes can be used in monitoring radiotherapy effect. This might suggest that certain texture features might be used as biomarkers which are supplementary to ADC for assessment of radiotherapy response in gynecological cancer.
MISCELLANEOUS PROFFERED PAPERS II (INCLUDES SKIN, GI, THORACIC) Wednesday, June 29, 2016 1:15 PM - 2:45 PM PP70 Presentation Time: 1:15 PM Malignant obstructive jaundice Treated by Intraluminal Brachytherapy Combined With stent placement or Stent Implantation Alone Jingqin Ma, Doctor, Zhiping Yan, Doctor. Interventional Radiology, Zhongshan Hospital of Fudan University, Shanghai, China.
Purpose: To compare the safety and efficacy of intraluminal implantation of Iodine-125 (125I) seeds strand combined with stent versus stent placement alone for treatment of patients with malignant obstructive jaundice (MOJ). Materials and Methods: From January 2009 to December 2013, the data of 319 consecutive patients with MOJ treated with stent placement were retrospectively analyzed. 125I seeds strand was implanted in the obstructed bile duct of 107 patients (group A). No brachytherapy was performed in the remaining 212 patients (group B). Clinical outcomes, treatment related complications,stent patency period and overall survival were compared between two groups. Results: All 125I seeds strands and stents were successfully implanted without serious procedure-related adverse events. During a mean of 220 days follow-up,mean survival time in group A and B was 423.2 days (95% CI 344.5e501.8 days) and 344.4 days (95% CI 289.1e399.8 days), respectively (p50.033). Mean stent patency period in group A was 353.7 days (95% CI 293.0 -414.3 days) compared to 280.9 days (95% CI 243.7e318.2 days) in group B (p50.031). Conclusions: Compared to stent placement alone, the combination of 125I seeds strand and stent implantation appears to be more effective in treatment of patients with malignant obstructive jaundice.
PP71
Presentation Time: 1:24 PM
Initial Experience in High-Dose-Rate Brachytherapy Treatment of the Esophagus Using a Novel Esophageal Applicator Ivan M. Buzurovic, PhD, Mandar S. Bhagwat, PhD, Desmond A. O’Farrel, MS, Thomas C. Harris, PhD, Jorgen L. Hansen, MS, Robert A. Cormack, PhD, Phillip M. Devlin, MD. Radiation Oncology, DanaFarber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA. Purpose: The purpose of the study is to report the initial experience in the treatment of locally advanced esophageal carcinoma with high-dose-rate (HDR) brachytherapy using a novel transoral balloon centering esophageal applicator (E-APP, Ancer Medical). Materials and Methods: Initially, the patient underwent chemoradiotherapy preoperatively for locally advanced esophageal carcinoma. Esophagectomy and resection were performed. Recently, the patient was diagnosed with malignant neoplasm of the middle third of the esophagus. Imaging showed an avid lesion at the anastomosis. The patient received a total of 26 Gy in external beam radiation therapy, so the HDR brachytherapy was used in the second course. To decrease the dose to the organs at risk in the upper gastrointestinal region, we used a novel disposable esophageal brachytherapy applicator with five independently inflatable balloons. The applicator was designed to allow for treatment lengths greater than 10 cm. Prior to the treatment, the applicator was commissioned and tested for clinical implementations. We tested: a) the visibility of the radio-opaque markers in the computer tomography images to assure proper placement, b) the repeatability and consistency of the water inflatable balloons, c) the absolute and relative accuracy (sequencing) of the source positioning in the applicator using the source position simulator and the radiochromic film. In addition, we tested the usability and accuracy of twelve radiopaque markers on the exterior side of the catheters for the proper source placement in the clinical target. The prescription dose for the HDR treatments was 15 Gy in 3 fractions to the distal esophagus with a 5 cm offset from the end of the applicator. The treatment was delivered twice a day. The treatment length was 15 cm, which resulted in 31 dwell positions having a step size of 0.5 cm. The prescription dose was planned to be delivered to a diameter of 1 cm with respect to the central catheter with minimal optimization to avoid critical structures in the anatomy. Results: The commissioning showed sub-millimeter accuracy in the source positioning. The radiopaque markers of the applicators were visible in various windows and level setup configurations of the CT images. Distal position of the source (source extension) was 1270 mm for the microSelectron V.2. afterloader (Elekta Brachytherapy); the experimental setup is presented in Fig. 1a. The catheter reconstruction was uncomplicated due to the good visibility of the markers. The treatment