eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2019
vol. 11
 
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abstract:
Original paper

Subdermal injection of hyaluronic acid to decrease skin toxicity from radiation delivered with low-dose-rate brachytherapy for cancer patients

Yuan Yuan, Zhang Ying, Dai Jianjian, Lin Qi, Xu Ruicai, Geng Baocheng, Han Mingyong

J Contemp Brachytherapy 2019; 11, 1: 14–20
Online publish date: 2019/02/06
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Purpose
To study the feasibility of hyaluronic acid (HA) injection to increase the distance between skin and radioactive sources, and dose reduction of skin during low-dose-rate (LDR) brachytherapy.

Material and methods
A total of 11 patients with subdermal malignant tumors were enrolled in this study. HA was injected after I-125 seed implantation, and dosimetric parameters were calculated by a brachytherapy treatment planning system (BTPS). The distance of the new space between radioactive sources and skin was measured on computed tomography (CT) and magnetic resonance imaging (MRI). Clinical signs were observed and followed up for every patient.

Results
After HA injection, the average of newly generated maximum distance was 1.0 cm along the entire length of the tumor. The D90 and V100 did not significantly change for tumors before or after injection (p = 0.39, p = 0.50, respectively). The maximum dose to a relatively small volume (0.1 cc) of the skin (OAR-Max) decreased from 100.66 Gy to 61.20 Gy (p < 0.05), and the mean skin dose (OAR-Mean) decreased from 49.20 Gy to 17.27 Gy (p < 0.05) after injection. On follow-up CT and MRI, HA was quite stable in shape and position for nearly 6 months.

Conclusions
Our study results showed that an additional 1.0 cm distance between the radioactive source and skin could be induced by HA injection in patients with subdermal tumor, and this distance could significantly decrease the skin dose in LDR brachytherapy. In addition, no obvious toxicity and side effects were produced by HA injection. Therefore, hyaluronic acid injection is a safe and effective technique.

keywords:

hyaluronic acid, low-dose-rate brachytherapy, subdermal malignant tumor

references:
Hinnen KA, Battermann JJ, van Roermund JG et al. Long-term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76: 1433-1438.
Taira AV, Merrick GS, Butler WM et al. Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2011; 79: 1336-1342.
Yan H, Mo Z, Xiang Z et al. CT-guided (125)I brachytherapy for locally recurrent nasopharyngeal carcinoma. J Cancer 2017; 8: 2104-2113.
Li W, Guan J, Yang L et al. Iodine-125 brachytherapy improved overall survival of patients with inoperable stage III/IV non-small cell lung cancer versus the conventional radiotherapy. Med Oncol 2015; 32: 395.
Timmerman R, McGarry R, Yiannoutsos C et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006; 24: 4833-4839.
Prada PJ, Jimenez I, Gonzalez-Suarez H et al. High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results. Brachytherapy 2012; 11: 105-110.
Prada PJ, Gonzalez H, Menéndez C et al. Transperineal injection of hyaluronic acid in the anterior perirectal fat to decrease rectal toxicity from radiation delivered with low-dose-rate brachytherapy for prostate cancer patients. Brachytherapy 2009; 8: 210-217.
Laliscia C, Delishaj D, Fabrini MG et al. Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit? J Contemp Brachytherapy 2016; 8: 512-517.
Kishi K, Sonomura T, Shirai S et al. Critical organ preservation in reirradiation brachytherapy by injectable spacer. Int J Radiat Oncol Biol Phys 2009; 75: 587-594.
Amirian J, Van TTT, Bae SH et al. Examination of in vitro and in vivo biocompatibility of alginate-hyaluronic acid microbeads as a promising method in cell delivery for kidney regeneration. Int J Biol Macromol 2017; 105: 143-153.
Iturriaga V, Bornhardt T, Manterola C et al. Effect of hyaluronic acid on the regulation of inflammatory mediators in osteoarthritis of the temporomandibular joint: a systematic review. Int J Oral Maxillofac Surg 2017; 46: 590-595.
Li R, Zhang Y, Yuan Y et al. Dosimetric comparison of CT-guided iodine-125 seed stereotactic brachytherapy and stereotactic body radiation therapy in the treatment of NSCLC. PLoS One 2017; 12: e0187390.
Li R, Ying Z, Yuan Y et al. Comparison of two iodine-125 brachytherapy implant techniques for the treatment of lung tumor: Preplanning and intraoperative planning. Brachytherapy 2018; 18: 87-94.
Huo X, Huo B, Wang H et al. Percutaneous computed tomography-guided permanent (125)I implantation as therapy for pulmonary metastasis. J Contemp Brachytherapy 2018; 10: 132-141.
Gifford KA, Pacha O, Hebert AA et al. A new paradigm for calculating skin dose. Brachytherapy 2013; 12: 114-119.
Bittner NH, Orio PF, 3rd, Merrick GS et al. The American College of Radiology and the American Brachytherapy Society practice parameter for transperineal permanent brachytherapy of prostate cancer. Brachytherapy 2017; 16: 59-67.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341-1346.
Bijlard E, Verduijn GM, Harmeling JX et al. Optimal high-dose-rate brachytherapy fractionation scheme after keloid excision: a retrospective multicenter comparison of recurrence rates and complications. Int J Radiat Oncol Biol Phys 2018; 100: 679-686.
Baliga S, Garg MK, Fox J et al. Fractionated stereotactic radiation therapy for brain metastases: a systematic review with tumour control probability modelling. Br J Radiol 2017; 90: 20160666.
Boissier R, Udrescu C, Rebillard X et al. Technique of injection of hyaluronic acid as a prostatic spacer and fiducials before hypofractionated external beam radiotherapy for prostate cancer. Urology 2017; 99: 265-269.
Pinkawa M. Current role of spacers for prostate cancer radiotherapy. World J Clin Oncol 2015; 6: 189-193.
Pinkawa M, Klotz J, Djukic V et al. Learning curve in the application of a hydrogel spacer to protect the rectal wall during radiotherapy of localized prostate cancer. Urology 2013; 82: 963-968.
Rao AD, Feng Z, Shin EJ et al. A novel absorbable radiopaque hydrogel spacer to separate the head of the pancreas and duodenum in radiation therapy for pancreatic cancer. Int J Radiat Oncol Biol Phys 2017; 99: 1111-1120.
Prada PJ, Fernandez J, Martinez AA et al. Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 2007; 69: 95-102.
 
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