skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: TU-AB-201-07: Image Guided Endorectal HDR Brachytherapy Using a Compliant Balloon Applicator

Abstract

Purpose: High dose rate endorectal brachytherapy is an option to deliver a focal, high-dose radiotherapy to rectal tumors for patients undergoing non-operative management. We investigate a new multichannel, MR compatible applicator with a novel balloon-based design to provide improved treatment geometry. We report on the initial clinical experience using this applicator. Methods: Patients were enrolled on an IRB-approved, dose-escalation protocol evaluating the use of the anorectal (AR-1) applicator (Ancer Medical, Hialeah, FL), a multichannel applicator with two concentric balloons. The inner balloon supports 8 source lumens; the compliant outer balloon expands to separate the normal rectal wall and the source lumens, yet deforms around a firm, exophytic rectal mass, leading to dose escalation to tumor while sparing normal rectum. Under general anesthesia, gold fiducial markers were inserted above and below the tumor, and the AR applicator was placed in the rectum. MRI-based treatment plans were prepared to deliver 15 Gy in 3 weekly fractions to the target volume while sparing healthy rectal tissue, bladder, bowel and anal muscles. Prior to each treatment, CBCT/Fluoroscopy were used to place the applicator in the treatment position and confirm the treatment geometry using rigid registration of the CBCT and planning MRI. After registration ofmore » the applicator images, positioning was evaluated based on the match of the gold markers. Results: Highly conformal treatment plans were achieved. MR compatibility of the applicator enabled good tumor visualization. In spite of the non-rigid nature of the applicators and the fact that a new applicator was used at each treatment session, treatment geometry was reproducible to within 2.5 mm. Conclusions: This is the first report on using the AR applicator in patients. Highly conformal plans, confidence in MRI target delineation, in combination with reproducible treatment geometry provide encouraging feedback for continuation with dose escalation in these patients.« less

Authors:
;  [1]
  1. Memorial Sloan Kettering Cancer Center, New York, NY (United States)
Publication Date:
OSTI Identifier:
22563018
Resource Type:
Journal Article
Journal Name:
Medical Physics
Additional Journal Information:
Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0094-2405
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ANESTHESIA; BLADDER; BRACHYTHERAPY; COMPUTERIZED TOMOGRAPHY; DOSE RATES; FIDUCIAL MARKERS; FLUOROSCOPY; IMAGES; MUSCLES; NEOPLASMS; NMR IMAGING; PATIENTS; RADIATION DOSES; RECTUM

Citation Formats

Cohen, G, and Goodman, K. TU-AB-201-07: Image Guided Endorectal HDR Brachytherapy Using a Compliant Balloon Applicator. United States: N. p., 2015. Web. doi:10.1118/1.4925545.
Cohen, G, & Goodman, K. TU-AB-201-07: Image Guided Endorectal HDR Brachytherapy Using a Compliant Balloon Applicator. United States. https://doi.org/10.1118/1.4925545
Cohen, G, and Goodman, K. 2015. "TU-AB-201-07: Image Guided Endorectal HDR Brachytherapy Using a Compliant Balloon Applicator". United States. https://doi.org/10.1118/1.4925545.
@article{osti_22563018,
title = {TU-AB-201-07: Image Guided Endorectal HDR Brachytherapy Using a Compliant Balloon Applicator},
author = {Cohen, G and Goodman, K},
abstractNote = {Purpose: High dose rate endorectal brachytherapy is an option to deliver a focal, high-dose radiotherapy to rectal tumors for patients undergoing non-operative management. We investigate a new multichannel, MR compatible applicator with a novel balloon-based design to provide improved treatment geometry. We report on the initial clinical experience using this applicator. Methods: Patients were enrolled on an IRB-approved, dose-escalation protocol evaluating the use of the anorectal (AR-1) applicator (Ancer Medical, Hialeah, FL), a multichannel applicator with two concentric balloons. The inner balloon supports 8 source lumens; the compliant outer balloon expands to separate the normal rectal wall and the source lumens, yet deforms around a firm, exophytic rectal mass, leading to dose escalation to tumor while sparing normal rectum. Under general anesthesia, gold fiducial markers were inserted above and below the tumor, and the AR applicator was placed in the rectum. MRI-based treatment plans were prepared to deliver 15 Gy in 3 weekly fractions to the target volume while sparing healthy rectal tissue, bladder, bowel and anal muscles. Prior to each treatment, CBCT/Fluoroscopy were used to place the applicator in the treatment position and confirm the treatment geometry using rigid registration of the CBCT and planning MRI. After registration of the applicator images, positioning was evaluated based on the match of the gold markers. Results: Highly conformal treatment plans were achieved. MR compatibility of the applicator enabled good tumor visualization. In spite of the non-rigid nature of the applicators and the fact that a new applicator was used at each treatment session, treatment geometry was reproducible to within 2.5 mm. Conclusions: This is the first report on using the AR applicator in patients. Highly conformal plans, confidence in MRI target delineation, in combination with reproducible treatment geometry provide encouraging feedback for continuation with dose escalation in these patients.},
doi = {10.1118/1.4925545},
url = {https://www.osti.gov/biblio/22563018}, journal = {Medical Physics},
issn = {0094-2405},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}