Dosimetric and Economic Comparison of Interstitial High-Dose-Rate Brachytherapy to Stereotactic Body Radiation Therapy for Liver Lesions
2015; Elsevier BV; Volume: 14; Linguagem: Inglês
10.1016/j.brachy.2015.02.376
ISSN1873-1449
AutoresBrian Hrycushko, Jeffrey Meyer, Patrick D. Sutphin, Anil K. Pillai, Sanjeeva P. Kalva, Robert Timmerman, Michael R. Folkert,
Tópico(s)Cholangiocarcinoma and Gallbladder Cancer Studies
ResumoPurposePrimary liver malignancies (hepatocellular carcinoma and cholangiocarcinoma) are increasing in incidence and mortality in the US. Additionally, the liver is a common site for metastasis, with >50% direct mortality. Aggressive management of liver lesions may improve patient quality of life and survival, but optimal treatment has not been established. Stereotactic body radiation therapy (SBRT) has been shown to be a safe and effective treatment for liver lesions and its use is increasing in the US. Interstitial high-dose-rate brachytherapy (HDR-BT) has also been shown to be safe and effective in prior studies but has not been broadly implemented in the US. In this study, we compare the economics and common radiation dosimetry metrics of HDR-BT and SBRT treatment of liver lesions.Materials and MethodsBetween January 2012 and June 2014, 10 liver lesions in 8 patients treated with SBRT were randomly selected for analysis. Lesions were treated to a median dose of 46.5 Gy (range 40-60 Gy) with a median dose of 10 Gy per fraction (range 8-15.5 Gy) in 3-5 fractions. These patients were replanned for optimal "virtual" HDR-BT treatment, and target D95, Dmin, and conformality index values, and normal tissue dosimetric values for liver (D700cc), spinal cord (Dmax, D0.35cc, D1.2cc), esophagus (D<5cc), stomach (D<10cc), heart (D<15cc), bowel (D<2cc), portal vein (PV) + 2cm (D<10cc), skin (D<10cc), and kidney (D33%, Dmean) were determined and compared to dosimetric values from SBRT treatment plans in terms of % prescription dose using two-tailed paired-sample t-tests. For economic comparison, Medicare charges were compared for similar fractionation schedules of HDR-BT and SBRT.ResultsMedian lesion diameter was 4.9 cm (range 3.1-7cm). "Virtual" HDR-BT plans utilized a median number of 4 needles (range 3-5). HDR-BT and SBRT achieved similar PTV/GTV D95 (99% vs. 99.3%, P=.835) coverage. (Figure 1) As expected, Dmin (83.4% vs. 90.2%, P=.004) and dose conformality (1.41 vs 1.1, P<.001) were significantly better with SBRT.Most normal structure doses were significantly lower with HDR-BT; liver D700cc (5.4% vs. 11.2%, P=.010); spinal cord Dmax D0.35cc, and D1.2cc (4.7% vs. 17.3%, 4.5% vs. 15.9%, and 4.74% vs. 14.4%, respectively, all P=.001); esophagus D<5cc (7.1% vs. 12.1%, P=.022); stomach D<10cc (6.2% vs. 19.4%, P=.005); PV+2cm D<10cc (21% vs. 40.2%, P=.013); skin D<10cc (5.5% vs. 21.8%, P<.001).Similar dosimetric values included heart D<15cc (5.1% vs. 7.5%, P=.117), bowel D 50% direct mortality. Aggressive management of liver lesions may improve patient quality of life and survival, but optimal treatment has not been established. Stereotactic body radiation therapy (SBRT) has been shown to be a safe and effective treatment for liver lesions and its use is increasing in the US. Interstitial high-dose-rate brachytherapy (HDR-BT) has also been shown to be safe and effective in prior studies but has not been broadly implemented in the US. In this study, we compare the economics and common radiation dosimetry metrics of HDR-BT and SBRT treatment of liver lesions. Primary liver malignancies (hepatocellular carcinoma and cholangiocarcinoma) are increasing in incidence and mortality in the US. Additionally, the liver is a common site for metastasis, with >50% direct mortality. Aggressive management of liver lesions may improve patient quality of life and survival, but optimal treatment has not been established. Stereotactic body radiation therapy (SBRT) has been shown to be a safe and effective treatment for liver lesions and its use is increasing in the US. Interstitial high-dose-rate brachytherapy (HDR-BT) has also been shown to be safe and effective in prior studies but has not been broadly implemented in the US. In this study, we compare the economics and common radiation dosimetry metrics of HDR-BT and SBRT treatment of liver lesions. Materials and MethodsBetween January 2012 and June 2014, 10 liver lesions in 8 patients treated with SBRT were randomly selected for analysis. Lesions were treated to a median dose of 46.5 Gy (range 40-60 Gy) with a median dose of 10 Gy per fraction (range 8-15.5 Gy) in 3-5 fractions. These patients were replanned for optimal "virtual" HDR-BT treatment, and target D95, Dmin, and conformality index values, and normal tissue dosimetric values for liver (D700cc), spinal cord (Dmax, D0.35cc, D1.2cc), esophagus (D<5cc), stomach (D<10cc), heart (D<15cc), bowel (D<2cc), portal vein (PV) + 2cm (D<10cc), skin (D<10cc), and kidney (D33%, Dmean) were determined and compared to dosimetric values from SBRT treatment plans in terms of % prescription dose using two-tailed paired-sample t-tests. For economic comparison, Medicare charges were compared for similar fractionation schedules of HDR-BT and SBRT. Between January 2012 and June 2014, 10 liver lesions in 8 patients treated with SBRT were randomly selected for analysis. Lesions were treated to a median dose of 46.5 Gy (range 40-60 Gy) with a median dose of 10 Gy per fraction (range 8-15.5 Gy) in 3-5 fractions. These patients were replanned for optimal "virtual" HDR-BT treatment, and target D95, Dmin, and conformality index values, and normal tissue dosimetric values for liver (D700cc), spinal cord (Dmax, D0.35cc, D1.2cc), esophagus (D<5cc), stomach (D<10cc), heart (D<15cc), bowel (D<2cc), portal vein (PV) + 2cm (D<10cc), skin (D<10cc), and kidney (D33%, Dmean) were determined and compared to dosimetric values from SBRT treatment plans in terms of % prescription dose using two-tailed paired-sample t-tests. For economic comparison, Medicare charges were compared for similar fractionation schedules of HDR-BT and SBRT. ResultsMedian lesion diameter was 4.9 cm (range 3.1-7cm). "Virtual" HDR-BT plans utilized a median number of 4 needles (range 3-5). HDR-BT and SBRT achieved similar PTV/GTV D95 (99% vs. 99.3%, P=.835) coverage. (Figure 1) As expected, Dmin (83.4% vs. 90.2%, P=.004) and dose conformality (1.41 vs 1.1, P<.001) were significantly better with SBRT.Most normal structure doses were significantly lower with HDR-BT; liver D700cc (5.4% vs. 11.2%, P=.010); spinal cord Dmax D0.35cc, and D1.2cc (4.7% vs. 17.3%, 4.5% vs. 15.9%, and 4.74% vs. 14.4%, respectively, all P=.001); esophagus D<5cc (7.1% vs. 12.1%, P=.022); stomach D<10cc (6.2% vs. 19.4%, P=.005); PV+2cm D<10cc (21% vs. 40.2%, P=.013); skin D<10cc (5.5% vs. 21.8%, P<.001).Similar dosimetric values included heart D<15cc (5.1% vs. 7.5%, P=.117), bowel D<2cc (6.2% vs. 6%, P=.826), and kidney D33% and Dmean (5.9% vs. 8.5%, P=.560, and 5.5% vs. 7%, P=.525, respectively).Medicare charges for a 3 fraction plan include $4,535 for professional fees and $37,182 for technical fees for a total of $41,717 for SBRT. For 3-fraction HDR-BT, charges include $14,531 for professional fees and $18,640 for technical fees, for a total of $33,171. Median lesion diameter was 4.9 cm (range 3.1-7cm). "Virtual" HDR-BT plans utilized a median number of 4 needles (range 3-5). HDR-BT and SBRT achieved similar PTV/GTV D95 (99% vs. 99.3%, P=.835) coverage. (Figure 1) As expected, Dmin (83.4% vs. 90.2%, P=.004) and dose conformality (1.41 vs 1.1, P<.001) were significantly better with SBRT. Most normal structure doses were significantly lower with HDR-BT; liver D700cc (5.4% vs. 11.2%, P=.010); spinal cord Dmax D0.35cc, and D1.2cc (4.7% vs. 17.3%, 4.5% vs. 15.9%, and 4.74% vs. 14.4%, respectively, all P=.001); esophagus D<5cc (7.1% vs. 12.1%, P=.022); stomach D<10cc (6.2% vs. 19.4%, P=.005); PV+2cm D<10cc (21% vs. 40.2%, P=.013); skin D<10cc (5.5% vs. 21.8%, P<.001). Similar dosimetric values included heart D<15cc (5.1% vs. 7.5%, P=.117), bowel D<2cc (6.2% vs. 6%, P=.826), and kidney D33% and Dmean (5.9% vs. 8.5%, P=.560, and 5.5% vs. 7%, P=.525, respectively). Medicare charges for a 3 fraction plan include $4,535 for professional fees and $37,182 for technical fees for a total of $41,717 for SBRT. For 3-fraction HDR-BT, charges include $14,531 for professional fees and $18,640 for technical fees, for a total of $33,171. Conclusions
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