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• W2021805438 abstract "To analyse the dosimetric data from our first 45 interstitial multi-catheter HDR breast brachytherapy patients in conjunction with implant geometries to observe the effect of the learning curve and any trends indicating optimal implant techniques. At St George Hospital we are conducting a Phase II study of accelerated partial breast irradiation using multi-catheter HDR brachytherapy. Our first patient was treated in November 2011, and we recruited 45 patients by October 2014. Our implant technique involved the use of OncoSmart Comfort Catheters. On day 1, the patient was implanted, CT scanned, a treatment plan was generated and the first treatment was delivered. Bi-daily treatments were subsequently given and in all cases, the implant was removed on or before Day 7. A total of 34 Gy in 10 fractions was delivered to the PTV. Oncentra Brachy (Nucletron Pty Ltd) was used for treatment planning and the Flexitron afterloader (Nucletron Pty Ltd) with an Ir-192 source was used for treatment delivery. We defined the skin to be a 5mm rind limited by the external contour. As most studies use a maximum of 3mm for skin depth, we have chosen 5mm as a conservative approach initially, and attempt to keep maximum skin dose below 70% of the prescribed dose. The chest wall structure is generated as a 5mm expansion of the lung. This tends to correlate reasonably well across the region of interest. Data collected and analysed includes:• Number of catheters used for treatment• PTV volume (cc)• V100 (cc)• V150 (cc)• V200 (cc)• D90 (Gy)• Chest wall V100 (cc)• Chest wall V130 (cc)• Lung D0.1cc (Gy)• Lung D1.0cc (Gy)• Skin D0.1cc (Gy)• Skin D1.0cc (Gy) From this data, we can extrapolate dosimetric parameters such as the DHI and COIN. An analysis of the number of catheters used can be manipulated to show some interesting results. By calculating the ratio of number of catheters divided by the PTV volume, we can plot dosimetric parameters against the number of catheters per cubic centimetre of PTV. Using these plots we can establish if there is an optimal number of catheters to implant for expected PTVs. There was no significant learning curve evident in any of the dosimetric data. Analysis of all dosimetric parameters showed no time-based trends. Based on the best-fit lines on the plots of catheters used per cc vs dosimetric data, there is a clear trend that by using more catheters per cubic centimetre, we can achieve better coverage with less hot spots. Our protocol suggests that we should be achieving D90 >90% for our patients. If possible, we prefer to keep D90 >100%. By observing the point at which the trend line crosses the 100% dose line in Figure 1 below, we can establish a suggested minimum number of catheters for each implant. Based on our first 45 cases, this appears to be around 0.25 catheters per cc of PTV. From our pre-implant CT study used to assess patient suitability and assuming that this correlates reasonably well with the PTV size at the time of implant, we can use the treatment planning system to delineate the seroma cavity, and use the pathology results to define margins for the PTV. We can then multiply the PTV volume by 0.25 to determine the minimum number of catheters to be implanted. For example if the PTV is 40cc, we would use 40 × 0.25 = 10 catheters as a minimum to expect reasonable coverage. There was no significant learning curve evident in any of the dosimetric data. This is thought to be a result of collaboration between Oncologists, Surgeons, Physicists and Radiation Therapists, as well as careful planning to obtain appropriate implant geometries and select appropriate patients for this treatment. Our extensive experience in HDR prostate brachytherapy (>300 patients) has also given us a strong background in brachytherapy treatment planning to extrapolate to different techniques." @default.
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• W2021805438 date "2015-05-01" @default.
• W2021805438 modified "2023-09-25" @default.
• W2021805438 title "Multi-Catheter Interstitial Breast Brachytherapy - An Australian Perspective - Lessons Learned From Our First 45 Patients" @default.
• W2021805438 doi "https://doi.org/10.1016/j.brachy.2015.02.387" @default.
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