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Zhang B, Zhang S, Sun L, Wu Y, Yang Y. Characteristics of preplan-based three-dimensional individual template-guided brachytherapy compared to freehand implantation. J Appl Clin Med Phys 2023; 24:e13840. [PMID: 36350283 PMCID: PMC10018671 DOI: 10.1002/acm2.13840] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/19/2022] [Accepted: 10/20/2020] [Indexed: 11/11/2022] Open
Abstract
Image-guided adaptive intracavitary/interstitial brachytherapy (IC/IS IGABT) has exhibited superior dosimetry advantage and local control for locally advanced cervical cancer (LACC). Our group designed a type of cylindrical three-dimensional (3D) printed vaginal template combining an intracavitary applicator with straight and oblique interstitial needles according to the preplan on computed tomography images. This work aimed to research the consistency of the preplan with the treatment plan at every fraction to verify the practical guiding significance of the preplan. We also investigated the difference between 3D-printed template-guided implantation compared with freehand implantation for LACC. Twenty-six patients were treated with 3D-printed individual templates (3D template group), and 20 patients were treated by using freehand insertion (freehand group). Patients in the 3D template group would take a preplan one week before treatment to design and print the individual template, while the freehand group did not. All patients accepted volumetric rotational intensity-modulated radiotherapy at a dose of 49.4 Gy in 26 fractions and subsequent brachytherapy at a dose of 26 Gy in four fractions. All analyses were performed by utilizing SPSS 26. The insertion depth was decreased in fractions 1 and 4 compared with the preplan. None of the dose volume histogram parameters of fractions 1-3, nor the D2cc of bladder and bowel at fraction 4 were barely changed compared with the preplan. The D90 and D98 of the high-risk clinical target volume in the 3D template group were statistically higher than those in the freehand group (p < 0.01). The D2cc of the rectum, bladder, bowel, and sigmoid in the 3D template group were all lower than those in the freehand group (p < 0.01). The preplan in this research is consistent with treatment plans, which is important to ensure the feasibility of applying a 3D-printed template in brachytherapy. The 3D-printed individual guidance template was an effective method in brachytherapy for locally advanced cervical cancer.
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Affiliation(s)
- Bin Zhang
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Siyu Zhang
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Li Sun
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yaqin Wu
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yongqin Yang
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
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Jahan D, Ahmad S, Thompson S, Schnell E. Dosimetric evaluation of the feasibility of utilizing a reduced number of interstitial needles in combined intracavitary and interstitial brachytherapy for cervical cancer. J Appl Clin Med Phys 2022; 24:e13833. [PMID: 36355039 PMCID: PMC9924101 DOI: 10.1002/acm2.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the ability of the Venezia advanced multichannel tandem and ring applicator to consistently produce dosimetrically comparable plans utilizing a reduced number of needle channels, to reduce the risk of secondary complications when boosting cervical cancer treatments with high dose rate (HDR) brachytherapy. METHODS We evaluated 26 fractions from 13 patients who were treated with HDR brachytherapy using the Venezia (Elekta) applicator. The original plans included a full load of 12-16 needles, including both parallel and 30-degree oblique needles. We replanned each original to nine new configurations, with a reduced number of two, three, four, or six needles. Comparisons included differences in percentage dose coverage to 90% of the high-risk clinical target volume, and percentage dose to 2 cm3 of the bladder, rectum, sigmoid, and bowel. We considered new plans "passing" if they remained within our standards (D90 > 100%; D2 cm3 < 85% bladder, <65% rectum, sigmoid, bowel) or did not perform worse than original. RESULTS Removing only the two most anterior or the two most posterior needles from both sides showed 80.8% and 61.5% overall passing rate. Removal of the most anterior and posterior four needles together showed 65.4% overall passing rate. Removing all oblique needles showed 19.2% overall passing rate. Removing only left-sided or only right-sided oblique needles showed 46.2% and 23.1% overall passing, respectively. Removing only right-sided or only left-sided parallel needles separately showed 19.2% and 34.6% overall passing, respectively. Removing all parallel needles showed 11.5% overall passing rate. CONCLUSIONS As only two replans required a full needle load to maintain dosimetric quality and 40 (76.9%), 36 (34.6%), 18 (69.2%), and 10 (19.2%) replans passed with 2, 3, 4, and 6 needles removed respectively, this indicates the potential for using a lesser number of interstitial needles during combined intracavitary and interstitial HDR brachytherapy while maintaining dosimetric quality.
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Affiliation(s)
- Dishary Jahan
- Departments of Radiation Oncology and Radiological SciencesThe University of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Salahuddin Ahmad
- Departments of Radiation Oncology and Radiological SciencesThe University of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Spencer Thompson
- Departments of Radiation Oncology and Radiological SciencesThe University of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Erich Schnell
- Departments of Radiation Oncology and Radiological SciencesThe University of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
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Muacevic A, Adler JR. GammaTile: Comprehensive Review of a Novel Radioactive Intraoperative Seed-Loading Device for the Treatment of Brain Tumors. Cureus 2022; 14:e29970. [PMID: 36225241 PMCID: PMC9541893 DOI: 10.7759/cureus.29970] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
GammaTile is a Food and Drug Administration (FDA)-licensed device consisting of four cesium-131 (Cs-131) radiation-emitting seeds in the collagen tile about the postage stamp size. The tiles are utilized to line the brain cavity immediately after tumor resection. GammaTile therapy is a surgically targeted radiation therapy (STaRT) that helps provide instant, dose-intense treatment after the completion of resection. The objective of this study is to explore the safety and efficacy of GammaTile surgically targeted radiation therapy for brain tumors. This study also reviews the differences between GammaTile surgically targeted radiation therapy (STaRT) and other traditional treatment options for brain tumors. The electronic database searches utilized in this study include PubMed, Google Scholar, and ScienceDirect. A total of 4,150 articles were identified based on the search strategy. Out of these articles, 900 articles were retrieved. A total of 650 articles were excluded for various reasons, thus retrieving 250 citations. We applied the exclusion and inclusion criteria to these retrieved articles by screening their full text and excluding 180 articles. Therefore, 70 citations were retrieved and included in this comprehensive literature review, as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Based on the findings of this study, GammaTile surgically targeted radiation therapy (STaRT) is safe and effective for treating brain tumors. Similarly, the findings have also shown that the efficacy of GammaTile therapy can be enhanced by combining it with other standard-of-care treatment options/external beam radiation therapy (EBRT). Also, the results show that patients diagnosed with recurrent glioblastoma (GBM) exhibit poor median overall survival because of the possibility of the tumor returning. Therefore, combining STaRT with other standard-of-care treatment options/EBRT can improve the patient's overall survival (OS). GammaTile therapy enhances access to care, guarantees 100% compliance, and eliminates patients' need to travel regularly to hospitals for radiation treatments. Its implementation requires collaboration from various specialties, such as radiation oncology, medical physics, and neurosurgery.
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Comparative Analysis of 60Co and 192Ir Sources in High Dose Rate Brachytherapy for Cervical Cancer. Cancers (Basel) 2022; 14:cancers14194749. [PMID: 36230672 PMCID: PMC9563337 DOI: 10.3390/cancers14194749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
High-dose-rate (HDR) brachytherapy (BT) is an essential treatment for cervical cancer, one of the most prevalent gynecological malignant tumors. In HDR BT, high radiation doses can be delivered to the tumor target with the minimum radiation doses to organs at risk. Despite the wide use of the small HDR 192Ir source, as the technique has improved, the HDR 60Co source, which has the same miniaturized geometry, has also been produced and put into clinical practice. Compared with 192Ir (74 days), 60Co has a longer half-life (5.3 years), which gives it a great economic advantage for developing nations. The aim of the study was to compare 60Co and 192Ir sources for HDR BT in terms of both dosimetry and clinical treatment. The results of reports published on the use of HDR BT for cervical cancer over the past few years as well as our own research show that this treatment is safe and it is feasible to use 60Co as an alternative source.
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Yan XJ, Yang Y, Chen X, Wang SG, Niu SH, Niu HX, Liu H. A new technique for performing interstitial implants for gynecologic malignancies using transvaginal ultrasound guidance. Front Oncol 2022; 12:858620. [PMID: 36033491 PMCID: PMC9410761 DOI: 10.3389/fonc.2022.858620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study concerns a new technique that aims to achieve precise interstitial brachytherapy of pelvic recurrent tumors under transvaginal ultrasound (US) guidance, enhance the conformity index of the brachytherapy (BT), and improve the curative effect of radiotherapy for gynecological oncology patients with pelvic relapse. Methods A real-time transvaginal US-guided interstitial implant device was developed to assist in implant BT. Prior to implant brachytherapy, the size and location of the tumor in the pelvis and the interrelationship with adjacent organs were first assessed with intracavitary ultrasound. The transvaginal US-guided interstitial implant device was then placed on the endoluminal ultrasound probe, the probe was oriented intravaginally to determine a safe needle path, the implant needle was placed into the needle passage of the device, and the implant needle was inserted into the tumor tissue in the direction guided by the ultrasound puncture guide line. After the implant needle was placed in place, the cover of the transvaginal US-guided interstitial implant device was opened perpendicular to the ultrasound probe, and the needle was separated from the ultrasound probe smoothly, and then the cover was re-covered for subsequent implantation. Results In this study, 56 patients who underwent real-time transvaginal ultrasound-guided implantation for gynecologic oncology were enrolled, and insertion of 736 implant needles was completed. Among them, 13 patients had recurrent pelvic tumors after cervical cancer surgery and 6 patients had recurrent pelvic tumors after endometrial cancer surgery. Thirty-two patients who underwent radical radiation therapy for cervical cancer did not have adequate regression of parametrial invaded tissue after completion of standard EBRT treatment; and 5 patients had recurrent tumors in the radiation field after previous standard course of pelvic radiotherapy. The accuracy of the implant therapy was improved. The radiotherapy dose for recurrent pelvic masses was successfully increased, and the cumulative dose of external irradiation combined with BT was augmented to 80–100 Gy. The use of a new device for transvaginal implant for recurrent masses located in the lateral wall of the pelvic cavity was successful. Conclusion This intravascular US-guided interstitial implant device can realize interstitial implant with the shortest path under transvaginal US guidance. With convenient operation, high precision, and good security, the device not only improves the accuracy of implant therapy, but it also reduces the risks of anesthesia and organ injury, so it is suitable for widespread promotion and use.
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Affiliation(s)
- Xiao-Jing Yan
- Gynecology and Obstetrics Ultrasound Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Yang
- Gynecology and Obstetrics Ultrasound Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xi Chen
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Guang Wang
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shu-Huai Niu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Xian Niu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong Liu
- Department of Gynecologic Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Hong Liu,
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Jamora KE, Patricia A. Cañal J. Factors predictive of parametrial boost in patients with cervical cancer treated with definitive chemoradiation. Gynecol Oncol Rep 2022; 39:100919. [PMID: 35036508 PMCID: PMC8753115 DOI: 10.1016/j.gore.2021.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study is to identify demographic, clinical, and treatment-related characteristics associated with the prescription of parametrial boost (PMB) in cervical cancer patients undergoing definitive chemoradiation. MATERIALS/METHODS A retrospective chart review of 132 non-metastatic cervical cancer patients treated with definitive chemoradiation from May 2017 to December 2019 was performed. Demographic, clinical, and treatment characteristics were obtained and compared between those who received PMB and those who did not. Clinical outcomes (pelvic recurrence, tumor persistence, distant metastases, and median survival time) were also gathered and compared. Statistical software was used for analysis, with a p < 0.05 considered statistically significant. RESULTS Of the 132 patients included in the analysis, 74 (56%) received PMB of 10 Gy in five daily fractions and 58 (44%) did not. Patients who received PMB were more likely to have pelvic sidewall invasion at the time of diagnosis (OR 4.053, 95% CI 1.163-14.13, p < 0.05) and received more cycles of concurrent chemotherapy during whole pelvis irradiation (OR 2.149, 95% CI 1.370-3.371, p < 0.05). At a median follow-up of 24 months, there was no statistically significant difference in the crude rates of pelvic recurrence, tumor persistence, distant metastasis, and median survival between the two groups. CONCLUSION Presence of pelvic sidewall invasion at diagnosis and increased number of chemotherapy cycles were predictive of administering PMB after whole pelvis irradiation. There was no significant difference in treatment outcomes for those with and without PMB.
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Affiliation(s)
- Kurl E. Jamora
- Division of Radiation Oncology, Department of Radiology, University of the Philippines – Philippine General Hospital, Manila, Philippines
| | - Johanna Patricia A. Cañal
- Division of Radiation Oncology, Department of Radiology, University of the Philippines – Philippine General Hospital, Manila, Philippines
- Department of Radiology, University of the Philippines – College of Medicine, Manila, Philippines
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Qu HD, Han DM, Zhang N, Mao Z, Cheng GH. Intracavitary/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric Study. Front Oncol 2021; 10:621347. [PMID: 33680943 PMCID: PMC7930555 DOI: 10.3389/fonc.2020.621347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the dosimetric advantage of combining intracavitary/interstitial applicator with distal parametrial free needle interstitial brachytherapy (IC/IS+ISBT DP) based on MRI for locally advanced cervical cancer. Methods and Materials 77 IC/IS+ISBT DP treatment plans were developed for 34 patients with locally advanced cervical cancer from June 2016 to January 2020 in this study. We removed the free needles and devised a new IC/ISBT treatment plan based on the same principle. We then compared the dosimetric differences of D90, D98, V100, V150, V200 for HR-CTV (high-risk clinical target volume), D90 for IR-CTV (Intermediate risk-CTV) and D2cc for OARs (organs at risk) between the two groups of treatment plans for the same patient, and the paired T test was performed in parallel. Further, the dosage differences between the two group plans under different parametrial extension widths (the maximum distance of HR-CTV from the vertical direction of the uterine tandem at coronal position) were compared. The survival rate was calculated using the Kaplan-Meier method. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were determined by Cox regression method. RTOG/EORTC criteria were used to grade toxicities. Results A total of 297 free needles were used, with a weight ratio of 15.8% ± 0.11, and a mean insertion depth of 6.52cm ± 2.8cm. D90, D98, V100 for HR-CTV, and D90 for IR-CTV for IC/IS+ISBT DP were significantly higher than IC/ISBT for which free needles were removed (p<0.05). And the V200 for HR-CTV and D2cc for bladder, rectum and sigmoid were decreased (p<0.05). When the parametrial extension widths were greater than 3cm, the HR-CTV D90 and the D2CC for rectum, bladder and sigmoid colon for IC/IS-ISBT DP were advantageous compared to IC/ISBT (p<0.05). The 2-yr OS, PFS and local control rate (LC) were 82.3, 66.8, and 93.1%, respectively. Parametrial extension widths was the only statistically prognostic factors for PFS (p = 0.002) on univariate analysis. No grade 3 or 4 Treatment-related toxicities were observed. Conclusion Our institutional experiences showed that IC/IS+ISBT DP is an effective treatment for cervical cancer patients with distal parametrial extension. IC/IS-ISBT DP had dosage advantage and clinical feasibility in locally advanced cervical cancer with distal parametrial extension when the parametrial extension widths were greater than 3cm.
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Affiliation(s)
- Hong-Da Qu
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dong-Mei Han
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuang Mao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guang-Hui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
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Venezia applicator with oblique needles improves clinical target volume coverage in distal parametrial tumor residue compared to parallel needles only. J Contemp Brachytherapy 2021; 13:24-31. [PMID: 34025733 PMCID: PMC8117708 DOI: 10.5114/jcb.2021.103583] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Residual distal parametrial involvement after radiochemotherapy is a true challenge for brachytherapists since the width and asymmetry of high-risk clinical target volume (HR-CTV) are difficult to cover properly with a standard implant. Material and methods Dosimetric plans of five patients treated with Venezia advanced gynecological applicator at our institution were reviewed. For each patient, we compared the original plan with a new plan where oblique needles were removed and re-optimized manually. Optimization process was halted when EQD210 D90 HR-CTV reached 90 Gy, when one hard constraint to organs at risk (OARs) was reached according to the EMBRACE II protocol, or when dose-rate of one of OARs exceeded 0.6 Gy/h. Results Tumors were large; median HR-CTV volume was 64 cc and median distance between tandem and outer contour of HR-CTV was 40 mm. For the five patients, HR-CTV EQD210 D90 was superior in the plan using oblique needles, with a median difference of 6.5 Gy (range, 1.7-8.5 Gy). Median D90 HR-CTV and intermediate-risk CTV (IR-CTV) were significantly increased with oblique needles: 85.9 Gy (range, 83.2-90.3 Gy) vs. 81.5 Gy (range, 77.4-84 Gy), and 68.7 Gy (range, 66.3-72.3 Gy) vs. 67 Gy (range, 64.3-69.1 Gy), p = 0.006 for both. There were no significant differences in the dose to OARs. Plans with only parallel needles had less favorable dose distribution, with cold spots on the outer parametria and higher vaginal activation to compensate parametrial coverage in its inferior part. Conclusions VeneziaTM applicator permits reproducible application to increase CTV coverage in patients with distal parametrial tumor residue during brachytherapy, while maintaining acceptable dose to OARs.
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Tanderup K, Nesvacil N, Kirchheiner K, Serban M, Spampinato S, Jensen NBK, Schmid M, Smet S, Westerveld H, Ecker S, Mahantshetty U, Swamidas J, Chopra S, Nout R, Tan LT, Fokdal L, Sturdza A, Jürgenliemk-Schulz I, de Leeuw A, Lindegaard JC, Kirisits C, Pötter R. Evidence-Based Dose Planning Aims and Dose Prescription in Image-Guided Brachytherapy Combined With Radiochemotherapy in Locally Advanced Cervical Cancer. Semin Radiat Oncol 2020; 30:311-327. [DOI: 10.1016/j.semradonc.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Individually customised parametrial boost for locally advanced cervical cancer: is 2D planned external beam radiotherapy useful? JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s146039691900058x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:Pelvic wall control and toxicity was retrospectively assessed in patients who received individually customised parametrial boost (PMB) for locally advanced cervical cancer with 2D planned external beam radiotherapy. Outcomes of a dose-escalated combined boost were also evaluated.Materials and methods:Toxicity and pelvic wall recurrence was evaluated over a median period of 24 months between two groups who received different pelvic wall doses. One group was randomised to receive either intracavitary brachytherapy (ICRT) with an external beam PMB using a customised midline shield, or a dose-escalated combined boost with interstitial brachytherapy (ISBT) and PMB. The comparator group received no PMB.Results:At 24 months, pelvic wall recurrence occurred in 2/112 and 40/130 with and without PMB, respectively (p < 0·000001). No significant difference in toxicity was noted between boost versus no-boost groups (p = 0·56). Combined ISBT/PMB dose escalation showed no significant difference in pelvic wall recurrence compared with PMB alone (p = 0·49).Findings:Individually customised 2D PMBs with 3D image-based ICRT was safe and improved pelvic wall control in locally advanced cervix cancer. Dose-escalated combined boosts offered no significant benefit over standard boost doses.
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Swamidas J, Kirisits C, De Brabandere M, Hellebust TP, Siebert FA, Tanderup K. Image registration, contour propagation and dose accumulation of external beam and brachytherapy in gynecological radiotherapy. Radiother Oncol 2020; 143:1-11. [DOI: 10.1016/j.radonc.2019.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
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Gangopadhyay A, Saha S. Pelvic side wall recurrence in locally advanced cervical carcinoma treated with definitive chemoradiation-clinical impact of pelvic wall dose. Br J Radiol 2019; 92:20180841. [PMID: 31322915 DOI: 10.1259/bjr.20180841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Pelvic side wall dose in locally advanced cervical carcinoma treated with definitive chemoradiation has been debated. The present study investigated relationship of disease recurrence with dose for the pelvic side wall. It also attempted to identify minimal dose that significantly reduced recurrence. METHODS Pelvic side wall recurrence at median 24 months was assessed clinically and radiologically across three groups of patients receiving variable pelvic wall doses using no parametrial boost, external beam or interstitial boost, or dose escalated combined external beam with interstitial boost. RESULTS At 24 months, recurrence occurred in 3/155 boost vs 40/130 no boost patients. (p < 0.0001). Receiver operating characteristic curve analysis demonstrated cut-off pelvic wall dose to be 58.9 Gy (p < 0.0001). Dose escalated combined boost showed no significant benefit compared to single modality parametrial boost (p = 0. 0.553). CONCLUSION Mean pelvic wall dose of at least 58.9 Gy offers clinically significant benefit in pelvic wall control. Doses recommended by guidelines should be adhered to in the patients' best interests. ADVANCES IN KNOWLEDGE This preliminary study determined a relationship between recurrence rates and dose to the pelvic side wall and also a cut-off dose that significantly improved pelvic wall control in locally advanced cervical cancer.
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Affiliation(s)
- Aparna Gangopadhyay
- Department of Radiotherapy, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, India
| | - Subrata Saha
- Department of Radiotherapy, Medical College Hospitals, Kolkata 88, College Street, Kolkata, India
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Development and assessment of 3D-printed individual applicators in gynecological MRI-guided brachytherapy. J Contemp Brachytherapy 2019; 11:128-136. [PMID: 31139221 PMCID: PMC6536148 DOI: 10.5114/jcb.2019.84741] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/29/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate the clinical use of 3D printing technology for the modelling of individual applicators for advanced gynecological tumors in magnetic resonance imaging (MRI)-based brachytherapy (BT). Material and methods We tested individually designed 3D-printed applicators in nine patients with advanced gynecological cancer. Before BT was performed, all patients were treated with external beam radiotherapy (EBRT). The most common indication for individualized BT was advanced gynecological tumors where the use of standard BT applicators was not feasible. Other indications were suboptimal dose-volume histogram (DVH) parameters for high-risk clinical target volume (CTV-THR) at the first BT (V100 ≤ 90% of CTV-THR volume and D98 ≤ 80%, D90 ≤ 100%, and D100 ≤ 60% of dose aim). The EQD2 dose aim to the target volume D90 CTV-THR per one BT fraction was 20 Gy for cervical or recurrent endometrial cancer and 16 Gy for vaginal cancer patient. The first BT with the standard applicator in situ was used as the virtual plan for designing a 3D-printed applicator. The next BT was performed with a 3D-printed applicator in situ. The primary endpoint was to improve CTV-THR DVH parameters without exceeding the dose to the organs at risk (OARs). Results All DVH parameters for CTV-THR were significantly higher with the use of an individually designed applicator. Mean D90 CTV-THR improved from 14.1 ±5.4 Gy to 22.0 ±2.5 Gy and from 7.1 Gy to 16.2 Gy for cervical/recurrent endometrial and vaginal cancer, respectively (p < 0.001). The mean D2cm3 bladder, rectum, sigmoid, and bowel dose was within institutional dose constraints, and increased from 13.0 ±1.5 Gy to 13.6 ±1.5 Gy (p = 0.045), 10.8 ±1.2 Gy to 11.7 ±1.3 Gy (p = 0.004), 8.9 ±3.2 Gy to 10.3 ±3.3 Gy (p = 0.008), and 8.7 ±3.8 Gy to 9.2 ±3.1 Gy (p = 0.2). Conclusions With the use of individual 3D-printed applicators, all DVH parameters for CTV-THR significantly improved without compromising the dose constraints for the OARs.
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彭 清, 彭 应, 朱 金, 蔡 明, 周 凌. [Accuracy of different image registration methods in image-guided adaptive brachytherapy for cervical cancer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1344-1348. [PMID: 30514683 PMCID: PMC6744129 DOI: 10.12122/j.issn.1673-4254.2018.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the accuracy of different methods for image registration in image-guided adaptive brachytherapy (IGABT) for cervical cancer. METHODS The last treatment planning CT images (CT1) and the first treatment planning CT images (CT2) were acquired from 15 patients with cervical cancer and registered with different match image qualities (retained/removed catheter source in images) and different match regions [target only (S Group)/ interested organ structure (M Group)/body (L Group)] in Velocity3.2 software. The dice similarity coefficient (DSC) between the clinical target volumes (CTV) of the CT1 and CT2 images (CTVCT1 and CTVCT2, respectively) and between the organs-at-risk (OAR) of the two imaging datasets (OARCT1 and OARCT2, respectively) were used to evaluate the image registration accuracy. RESULTS The auto-segmentation volume of the catheter source using Velocity software based on the CT threshold was the closest to the actual volume within the CT value range of 1700-1800 HU. In the retained group, the DSC for the OARs of was better than or equal to that of the removed group, and the DSC value of the rectum was significantly improved (P < 0.05). For comparison of different match regions, the high-risk target volume (HRCTV) and the low-risk target volume (IRCTV) had the best precision for registration of the target area, which was significantly greater than that of M group and L group (P < 0.05). The M group had better registration accuracy of the target area and the best accuracy for the OARs. The DSC values of the bladder and rectum were significantly better than those of the other two groups (P < 0.05). CONCLUSIONS The CT value range of 1700-1800 HU is optimal for automatic image segmentation using Velocity software. Automatic segmentation and shielding the volume of the catheter source can improve the image quality. We recommend the use of interested organ structures regions for image registration in image-guided adaptive brachytherapy for cervical cancer.
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Affiliation(s)
- 清河 彭
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 应林 彭
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 金汉 朱
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 明章 蔡
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 凌宏 周
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
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Percutaneous parametrial dose escalation in women with advanced cervical cancer: feasibility and efficacy in relation to long-term quality of life. Radiol Oncol 2018; 52:320-328. [PMID: 30210042 PMCID: PMC6137362 DOI: 10.2478/raon-2018-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background We analyzed long-term quality of life (QoL) and prognostic factors for QoL as well as clinical outcome in patients with advanced cervical cancer (ACC) treated with primary radiochemotherapy (RChT) consisting of external beam radiotherapy (EBRT) with or without sequential or simultaneous integrated boost (SIB) to the parametria, intracavitary brachytherapy and concomitant chemotherapy (ChT). Patients and methods Eighty-three women were treated with primary RChT between 2008 and 2014. Survival of all patients was calculated and prognostic factors for survival were assessed in univariate and multivariate analysis. In 31 patients QoL was assessed in median 3 years (range 2–8 years) after treatment. QoL was compared to published normative data and the influence of age, tumour stage, treatment and observed acute toxicities was analyzed. Results Thirty-six patients (43.4%) died, 18 (21.7%) had a local recurrence and 24 (28.9%) had a distant progression. Parametrial boost (p = 0.027) and ChT (p = 0.041) were independent prognostic factors for overall survival in multivariate analysis. Specifically, a parametrial equivalent doses in 2-Gy fractions (EQD2) > 50 Gy was associated with an improved overall survival (OS) (p = 0.020), but an EQD2 > 53 Gy did not further improve OS (p = 0.194). Tumour size was the only independent prognostic factor for local control (p = 0.034). Lymph node status (p = 0.038) and distant metastases other than in paraaortic lymph nodes (p = 0.002) were independent prognostic factors for distant progressionfree survival. QoL was generally inferior to the reference population. Age only correlated with menopausal symptoms (p = 0.003). The degree of acute gastrointestinal (p = 0.038) and genitourinary (p = 0.041) toxicities correlated with the extent of chronic symptom experience. Sexual/vaginal functioning was reduced in patients with larger tumours (p = 0.012). Parametrial EQD2 > 53 Gy correlated with reduced sexual/vaginal functioning (p = 0.009) and increased sexual worry (p = 0.009). Whether parametrial dose escalation was achieved by sequential boost or SIB, did not affect survival or QoL. Conclusions Primary RChT is an effective treatment, but long-term QoL is reduced. The degree of acute side effects of RChT correlates with the extent of chronic symptoms. Patients benefit from parametrial SIB or sequential boost, but an EQD2 > 53 Gy does not further improve survival and negatively affects QoL.
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Improving dose delivery by adding interstitial catheters to fixed geometry applicators in high-dose-rate brachytherapy for cervical cancer. Brachytherapy 2018; 17:580-586. [DOI: 10.1016/j.brachy.2018.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/21/2022]
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Laan JJ, van Lonkhuijzen LRCW, van Os RM, Tytgat KM, Dávila Fajardo R, Pieters BR, Stalpers LJA, Westerveld GH. Socioeconomic status as an independent risk factor for severe late bowel toxicity after primary radiotherapy for cervical cancer. Gynecol Oncol 2017; 147:684-689. [PMID: 29074259 DOI: 10.1016/j.ygyno.2017.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the frequency of and risk factors for severe late bowel toxicity after curative radiotherapy in women treated for locally advanced cervical cancer. METHODS Included were 515 women treated for locally advanced cervical cancer with primary radiotherapy with curative intent from 1992 to 2013. Bowel toxicity was graded according to the Common Terminology Criteria for Adverse Events. Associations between risk factors and severe late bowel toxicity were assessed using Cox proportional hazards regression models. RESULTS Median follow-up was 78months. Fifty-nine patients developed severe late bowel toxicity. The actuarial 3-year and 5-year severe late bowel toxicity rates were both 13%. In the multivariable analysis, factors significantly associated with severe late bowel toxicity were: smoking (HR 2.59 [1.48-4.55]), severe acute bowel toxicity (HR 2.46 [1.24-4.49]), previous major abdominal surgery (HR 2.35 [1.20-4.60]), hypertension (HR 2.33 [1.23-4.40]), parametrial boost (HR 2.18 [1.10-4.33]), low socioeconomic status (HR 2.05 [1.17-3.59]) and low BMI (HR 0.93 [0.88-0.99]). First symptoms of severe late bowel toxicity were reported after a median follow-up of 9months, but occurred up to 10years after end of treatment. Only one third of the patients with severe late bowel toxicity were referred to a gastroenterologist. CONCLUSIONS Severe late bowel toxicity is a frequent complication of definitive radiotherapy for cervical cancer. Several independent risk factors were found which warrant further research. A standardized and structured approach in the early diagnostics and management of bowel toxicity is needed.
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Affiliation(s)
- J J Laan
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - L R C W van Lonkhuijzen
- Department of Gynecology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R M van Os
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - K M Tytgat
- Department of Gastroenterology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R Dávila Fajardo
- Department of Radiotherapy/Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B R Pieters
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - L J A Stalpers
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - G H Westerveld
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Otter S, Franklin A, Ajaz M, Stewart A. Improving the efficiency of image guided brachytherapy in cervical cancer. J Contemp Brachytherapy 2016; 8:557-565. [PMID: 28115963 PMCID: PMC5241377 DOI: 10.5114/jcb.2016.64452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/16/2016] [Indexed: 11/21/2022] Open
Abstract
Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. Traditionally, cervical brachytherapy was prescribed to point A but since the GEC-ESTRO guidelines were published in 2005, there has been a move towards prescribing the dose to a 3D volume. Image guided brachytherapy has been shown to reduce local recurrence, and improve survival and is optimally predicated on magnetic resonance imaging. Radiological studies, patient workflow, operative parameters, and intensive therapy planning can represent a challenge to clinical resources. This article explores the ways, in which 3D conformal brachytherapy can be implemented and draws findings from recent literature and a well-developed hospital practice in order to suggest ways to improve the efficiency and efficacy of a brachytherapy service. Finally, we discuss relatively underexploited translational research opportunities.
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Affiliation(s)
- Sophie Otter
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Adrian Franklin
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Mazhar Ajaz
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
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Rodríguez Villalba S, Richart Sancho J, Otal Palacín A, Perez-Calatayud J, Santos Ortega M. Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience. J Contemp Brachytherapy 2016; 8:404-414. [PMID: 27895682 PMCID: PMC5116450 DOI: 10.5114/jcb.2016.63187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/22/2016] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To study outcome and toxicity in 59 patients with locally advanced cervix carcinoma treated with computed tomography (CT)-based Martinez universal perineal interstitial template (MUPIT) and the new magnetic resonance imaging (MRI)-compatible template Benidorm (TB). MATERIAL AND METHODS From December 2005 to October 2015, we retrospectively analyzed 34 patients treated with MUPIT and 25 treated with the TB. Six 4 Gy fractions were prescribed to the clinical target volume (CTV) combined with external beam radiotherapy (EBRT). The organs at risk (OARs) and the CTV were delineated by CT scan in the MUPIT implants and by MRI in the TB implants. Dosimetry was CT-based for MUPIT and exclusively MRI-based for TB. Dose values were biologically normalized to equivalent doses in 2 Gy fractions (EQD2). RESULTS Median CTV volumes were 163.5 cm3 for CT-based MUPIT (range 81.8-329.4 cm3) and 91.9 cm3 for MRI-based TB (range 26.2-161 cm3). Median D90 CTV (EBRT + BT) was 75.8 Gy for CT-based MUPIT (range 69-82 Gy) and 78.6 Gy for MRI-based TB (range 62.5-84.2 Gy). Median D2cm3 for the rectum was 75.3 Gy for CT-based MUPIT (range 69.8-132.1 Gy) and 69.9 Gy for MRI-based TB (range 58.3-83.7 Gy). Median D2cm3 for the bladder was 79.8 Gy for CT-based MUPIT (range 71.2-121.1 Gy) and 77.1 Gy for MRI-based TB (range 60.5-90.8 Gy). Local control (LC) was 88%. Overall survival (OS), disease free survival (DFS), and LC were not statistically significant in either group. Patients treated with CT-based MUPIT had a significantly higher percentage of rectal bleeding G3 (p = 0.040) than those treated with MRI-based TB, 13% vs. 2%. CONCLUSIONS Template Benidorm treatment using MRI-based dosimetry provides advantages of MRI volume definition, and allows definition of smaller volumes that result in statistically significant decreased rectal toxicity compared to that seen with CT-based MUPIT treatment.
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Affiliation(s)
| | | | | | - Jose Perez-Calatayud
- Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante; Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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Fokdal L, Sturdza A, Mazeron R, Haie-Meder C, Tan LT, Gillham C, Šegedin B, Jürgenliemk-Schultz I, Kirisits C, Hoskin P, Pötter R, Lindegaard JC, Tanderup K. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol 2016; 120:434-440. [DOI: 10.1016/j.radonc.2016.03.020] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/08/2016] [Accepted: 03/27/2016] [Indexed: 11/30/2022]
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Dosimetric study for cervix carcinoma treatment using intensity modulated radiation therapy (IMRT) compensation based on 3D intracavitary brachytherapy technique. J Contemp Brachytherapy 2016; 8:221-32. [PMID: 27504132 PMCID: PMC4965499 DOI: 10.5114/jcb.2016.60590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Intensity modulated radiation therapy (IMRT) compensation based on 3D high-dose-rate (HDR) intracavitary brachytherapy (ICBT) boost technique (ICBT + IMRT) has been used in our hospital for advanced cervix carcinoma patients. The purpose of this study was to compare the dosimetric results of the four different boost techniques (the conventional 2D HDR intracavitary brachytherapy [CICBT], 3D optimized HDR intracavitary brachytherapy [OICBT], and IMRT-alone with the applicator in situ). Material and methods For 30 patients with locally advanced cervical carcinoma, after the completion of external beam radiotherapy (EBRT) for whole pelvic irradiation 45 Gy/25 fractions, five fractions of ICBT + IMRT boost with 6 Gy/fractions for high risk clinical target volume (HRCTV), and 5 Gy/fractions for intermediate risk clinical target volume (IRCTV) were applied. Computed tomography (CT) and magnetic resonance imaging (MRI) scans were acquired using an in situ CT/MRI-compatible applicator. The gross tumor volume (GTV), the high/intermediate-risk clinical target volume (HRCTV/IRCTV), bladder, rectum, and sigmoid were contoured by CT scans. Results For ICBT + IMRT plan, values of D90, D100 of HRCTV, D90, D100, and V100 of IRCTV significantly increased (p < 0.05) in comparison to OICBT and CICBT. The D2cc values for bladder, rectum, and sigmoid were significantly lower than that of CICBT and IMRT alone. In all patients, the mean rectum V60 Gy values generated from ICBT + IMRT and OICBT techniques were very similar but for bladder and sigmoid, the V60 Gy values generated from ICBT + IMRT were higher than that of OICBT. For the ICBT + IMRT plan, the standard deviations (SD) of D90 and D2cc were found to be lower than other three treatment plans. Conclusions The ICBT + IMRT technique not only provides good target coverage but also maintains low doses (D2cc) to the OAR. ICBT + IMRT is an optional technique to boost parametrial region or tumor of large size and irregular shape when intracavitary/interstitial brachytherapy cannot be used.
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Chargari C, Mazeron R, Escande A, Maroun P, Dumas I, Martinetti F, Tafo-Guemnie A, Deutsch E, Morice P, Haie-Meder C. Image-guided adaptive brachytherapy in cervical cancer: Patterns of relapse by brachytherapy planning parameters. Brachytherapy 2016; 15:456-462. [PMID: 27180129 DOI: 10.1016/j.brachy.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Cervical cancer patients with a bulky high-risk clinical target volume (HR-CTV) get the largest benefit of dose escalation in terms of local control. However, the expected survival benefit could be lessened by a higher metastatic risk. We examined the patterns of relapse according to major prognostic factors: the HR-CTV volume and to the D90 HR-CTV. METHODS AND MATERIALS The clinical records of patients treated with pulsed-dose-rate image-guided adaptive brachytherapy after concurrent pelvic chemoradiation were reviewed. All patients had an optimal workup before treatment comprising a 18-fluorodeoxyglucose positron emission tomography/computed tomography and a para-aortic lymph node dissection. Patients with initial extrapelvic disease were excluded. RESULTS A total of 109 patients fulfilled inclusion criteria. Median followup was 39 months. An HR-CTV volume ≥40 cm(3) was associated with a poorer local failure-free survival. There was a strong inverse correlation between the HR-CTV volume and the D90 of the HR-CTV (correlation coefficient r = -0.696; p < 0.001) with increasing HR-CTV volume being associated with a decreasing D90 HR-CTV. A D90 HR-CTV <85 Gy and an HR-CTV volume ≥40 cm(3) were significant univariate factors for experiencing nonlocal failure (p = 0.002 and 0.035, respectively), even after exclusion of local relapses. CONCLUSION A lower ability to reach the target D90 HR-CTV planning and an HR-CTV volume ≥ 40 cm(3) correlated with a high propensity of relapsing at distance, these factors being interrelated. Next step of treatment personalization should design strategies integrating this risk, which is now the main cause of failure.
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Affiliation(s)
- Cyrus Chargari
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; Department of Surgery, Gustave Roussy, Villejuif, France.
| | - Renaud Mazeron
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Alexandre Escande
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Pierre Maroun
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Isabelle Dumas
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Florent Martinetti
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Alain Tafo-Guemnie
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy, Villejuif, France; University Paris-Sud, SIRIC SOCRATES, Faculte de Médecine, Le Kremlin-Bicêtre, France
| | - Christine Haie-Meder
- Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France
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Image guided radiation therapy boost in combination with high-dose-rate intracavitary brachytherapy for the treatment of cervical cancer. J Contemp Brachytherapy 2016; 8:122-7. [PMID: 27257416 PMCID: PMC4873551 DOI: 10.5114/jcb.2016.59282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/15/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to demonstrate the dosimetric and clinical feasibility of image guided radiation therapy (IGRT) combined with high-dose-rate (HDR) intracavitary brachytherapy (ICBT) to improve dose distribution in cervical cancer treatment. Material and methods For 42 cervical cancer patients, magnetic resonance imaging (MRI) scans were acquired after completion of whole pelvic irradiation 45-46 Gy and 5 fractions of B + I (ICBT + IGRT) treatment were subsequently received. The high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV), bladder, rectum, and sigmoid were contoured on the computed tomography (CT) scans. The total planning aim doses for HRCTV was D90% > 85 Gy, whilst constraints for rectum and sigmoid were D2cc < 75 Gy and D2cc < 90 Gy for bladder in terms of an equivalent dose in 2 Gy (EQD2) for external beam radiotherapy (EBRT) and brachytherapy boost. The IGRT plan was optimized on top of the ICBT dose distribution. A dosimetric comparison was made between B + I and optimized ICBT (O-ICBT) only. Results The mean D90% of HRCTV was comparable for B + I and O-ICBT (p = 0.82). For B + I plan, HRCTV D100%, IRCTV D100%, and IRCTV D90% were significantly increased by a mean of 10.52 Gy, 5.61 Gy, and 2.70 Gy, respectively (p < 0.01). The D2cc for bladder, rectum, and sigmoid were lower by a mean of 21.36, 6.78, and 10.65 Gy, respectively (p < 0.01). The mean rectum V60 Gy value over 42 patients was almost the same for both techniques but for bladder and sigmoid B + I had higher V60 Gy mean values as compared with the O-ICBT. Conclusions B + I can improve dose distribution in cervical cancer treatment; it could be useful for tumors extended beyond the reach of intracavitary/interstitial brachytherapy (IC/ISBT) or for centers that are inexperienced or ill-equipped with IC/ISBT techniques. Additional confirmatory prospective studies with larger numbers of patients and longer follow-up are required to validate the durability.
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Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer. J Contemp Brachytherapy 2016; 8:23-31. [PMID: 26985194 PMCID: PMC4793065 DOI: 10.5114/jcb.2016.57535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/06/2016] [Indexed: 01/03/2023] Open
Abstract
Purpose There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transperineal parametrial high-dose-rate brachytherapy (HDRB) boost for locally advanced cervical cancer. Material and methods From 01.2011 to 12.2014, 33 patients (pts) presenting a locally advanced cervical cancer with parametrial invasion were treated. After the first course of external beam radiation therapy with cisplatinum, HDRB was performed combining endocavitary and interstitial technique for cervical and parametrial disease. Post-operative delineation (CTV, bladder, rectum, sigmoid) and planification were based on CT-scan/MRI. HDRB was delivered in 3-5 fractions over 2-3 consecutive days. Acute toxicities occurring within 6 months after HDRB were retrospectively reviewed. Results Median age was 56.4 years (27-79). Clinical stages were: T2b = 23 pts (69.7%), T3a = 1 pt (3%), T3b = 6 pts (18.2%), and T4a = 3 pts (9.1%). Median HDRB prescribed dose was 21 Gy (21-27). Median CTVCT (16 pts) and HR-CTVMRI (17 pts) were 52.6 cc (28.5-74.3), 31.9 cc (17.1-58), respectively. Median EQD2αβ10 for D90CTV and D90HR-CTV were 82.9 Gy (78.2-96.5), 84.8 Gy (80.6-91.4), respectively. Median EQD2αβ3 (CT/MRI) for D2cc bladder, rectum and sigmoid were 75.5 Gy (66.6-90.9), 64.4 Gy (51.9-77.4), and 60.4 Gy (50.9-81.1), respectively. Median follow-up was 14 months (ranged 6-51). Among the 24 pts with MFU = 24 months, 2-year LRFS rate, RRFS, and OS were 86.8%, 88.8%, and 94.1%, respectively. The rates of acute genitourinary and gastrointestinal toxicities were 36% (G1 dysuria = 8 pts, G2 infection = 2 pts, G3 infection = 2 pts), and 27% (G1 diarrhea = 9 pts), respectively. One patient presented vaginal bleeding at the time of applicator withdrawal (G3-blood transfusion); no bleeding was observed due to the parametrial implant. Conclusions Concomitant cervical and transperineal parametrial HDRB boost for locally advanced cervical cancer appears feasible and safe with no specific acute toxicity compare to cervical HDRB alone. Longer follow-up and larger patient cohort will be needed.
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Zhou YC, Zhao LN, Wang N, Hu J, Sun XH, Zhang Y, Li JP, Li WW, Liu JY, Wei LC, Shi M. Late rectal toxicity determined by dose-volume parameters in computed tomography-based brachytherapy for locally advanced cervical cancer. Cancer Med 2016; 5:434-41. [PMID: 26806114 PMCID: PMC4799942 DOI: 10.1002/cam4.603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/07/2015] [Accepted: 11/10/2015] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to observe the relationship between dose–volume histogram (DVH) parameters and rectal late side effects (LSE) in computed tomography (CT)‐based brachytherapy (BT) for patients with locally advanced cervical cancer. In total, 144 cervical cancer patients received external beam radiotherapy and CT‐based BT. The data from 111 survival cases with pelvic local control (LC) were used to analyze the relationship between DVH parameters and rectal LSE. The total doses, manifesting 2, 1, and 0.1 cm3 (D2cc, D1cc, and D0.1cc) of the rectum, and D90 for high‐risk clinical target volume (HR CTV) were computed and normalized to 2 Gy fractions (EQD2) using a linear‐quadratic model. The rectal LSE were evaluated by the late effects in normal tissues‐subjective, objective, management, and analytic (LENT‐SOMA) scale. A dose–response relationship was evaluated by probit analyses. For all patients, the total rate of rectal LSE was 56%, and the rate of ≥Grade 2 LSE was 27.4%. For the 111 survival cases with pelvic LC, the total mean for D2cc was 71.23 ± 5.54 Gy for the rectum, and the D2cc, D1cc, and D0.1cc values for Grades 2 and 3 were higher than those for Grades 0 and 1. In addition, the number of complications increased, and the complications became more severe as the dose increased, with a dose of 73.5 Gy resulting in a 10% probability of ≥Grade 3 LSE. In conclusion, DVH parameters could predict the incidence and grades of rectal LSE in CT‐based BT. D2cc showed an excellent predictive value, and 73.5 Gy for D2cc of the rectum might be considered as an alternative dose limit.
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Affiliation(s)
- Yong-Chun Zhou
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Li-Na Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Ning Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jing Hu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao-Huan Sun
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Ying Zhang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jian-Ping Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Wei-Wei Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jun-Yue Liu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Li-Chun Wei
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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Yoshida K, Yamazaki H, Kotsuma T, Takenaka T, Ueda MM, Miyake S, Tsujimoto Y, Masui K, Yoshioka Y, Sumida I, Uesugi Y, Shimbo T, Yoshikawa N, Yoshioka H, Tanaka E, Narumi Y. Simulation analysis of optimized brachytherapy for uterine cervical cancer: Can we select the best brachytherapy modality depending on tumor size? Brachytherapy 2015; 15:57-64. [PMID: 26612700 DOI: 10.1016/j.brachy.2015.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To choose the optimal brachytherapeutic modality for uterine cervical cancer, we performed simulation analysis. METHODS AND MATERIALS For each high-risk clinical target volume (HR CTV), we compared four modalities [classical conventional intracavitary brachytherapy (ConvICBT), Image-guided ICBT (IGICBT), intracavitary/interstitial brachytherapy (ICISBT), and interstitial brachytherapy (ISBT) with perineal approach] using dose-volume histograms using eight sizes of HR CTV (2 × 2 × 2 cm to 7 × 4 × 4 cm) and organs at risk model. RESULTS In ConvICBT, the doses covered 90% of the HR CTV [D90(HR CTV)] decreased from 197% prescribed dose (PD) for the HR CTV size (2 × 2 × 2 cm) to 73% PD for 5 × 4 × 4 cm, whereas the other three modalities could achieve 100% PD for all HR CTV sizes. The minimum doses received by the maximally irradiated 2-cm(3) volumes for organs at risks of IGICBT demonstrated lower values than those of ConvICBT for the HR CTV size of 4 × 3 × 3 cm or smaller. ICISBT demonstrated lower values than those of IGICBT for 4 × 3 × 3 cm or larger. ISBT demonstrated lowest values for 5 × 4 × 4 cm or larger. CONCLUSIONS HR CTV size of 4 × 3 × 3 cm seems to be a threshold volume in this simulation analysis, and IGICBT is a better choice for smaller HR CTV than the threshold volume. On larger HR CTV, ICISBT or ISBT is the better choice.
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Affiliation(s)
- Ken Yoshida
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Tadayuki Kotsuma
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Tadashi Takenaka
- Department of Radiology, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Mari Mikami Ueda
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Shunsuke Miyake
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Yutaka Tsujimoto
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuo Uesugi
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Taiju Shimbo
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Nobuhiko Yoshikawa
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroto Yoshioka
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Eiichi Tanaka
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
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Lakosi F, de Cuypere M, Viet Nguyen P, Jansen N, Warlimont B, Gulyban A, Gennigens C, Seidel L, Delbecque K, Coucke P, Hermesse J, Kridelka F. Clinical efficacy and toxicity of radio-chemotherapy and magnetic resonance imaging-guided brachytherapy for locally advanced cervical cancer patients: A mono-institutional experience. Acta Oncol 2015; 54:1558-66. [PMID: 26406152 DOI: 10.3109/0284186x.2015.1062542] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To evaluate efficacy and toxicity of radio-chemotherapy (RCT) and MR-guided pulsed-dose-rate (PDR) adaptive brachytherapy (IGABT) for locally advanced cervical cancer (LACC). MATERIAL AND METHODS Between 2007 and 2014 85 patients with FIGO stage 1B1 N+ or ≥ 1B2 cervical cancer were treated with RCT+ IGABT. The treatment consisted of a pelvic± paraaortic external beam radiotherapy (EBRT) (45-50.4 Gy ± 10 Gy boost to primary tumor and/or to pathologic lymph nodes) with concurrent cisplatin followed by 25-35 Gy of PDR IGABT in 30-50 pulses. The ratio of 3D-CFRT/IMRT was 61/24 patients. Dose-volume parameters of high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV) and D2cm(3) organs at risk (OARs) were reported. Local control (LC), cancer-specific survival (CCS) and overall survival (OS) were analyzed actuarially and morbidity crude rates were scored using CTCAEv4.0. RESULTS Mean follow-up was 36 months (range 6-94). The mean D90 and D98 for HR-CTV was 84.4 ± 9 Gy and 77 ± 8.1 Gy, while for IR-CTV was 69.1 ± 4.3 Gy and 64.8 ± 4.3 Gy, respectively. The mean D2cm(3) for OARs was the following: bladder: 77.3 ± 10.5 Gy, rectum: 65 ± 6.8 Gy, sigmoid: 63 ± 7.9 Gy and intestine: 64.0 ± 9.1 Gy. Three year LC, CSS and OS were: 94%, 85% and 81%. The three-year regional- and distant control rates were 95% and 74%. Node negative patients had significantly higher three-year CSS (100 vs. 72%, p = 0.016) and OS (92 vs. 72%, p = 0.001) compared to node positive ones. Three-year actuarial late Grade ≥ 3 morbidity was the following: GI: 8%, GU: 5%, Vaginal: 8%. The frequency of Grade ≥ 3 hematological toxicities including anemia/leukopenia/neutropenia/thrombocytopenia were 8.6%/34.7%/24.3%/24.3%, respectively. CONCLUSION This large mono-institutional experience builds up further evidences that IGABT in conjunction with RCT should be the standard of care for patients suffering LACC.
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Affiliation(s)
- Ferenc Lakosi
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | | | - Paul Viet Nguyen
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Nicolas Jansen
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Bernard Warlimont
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Akos Gulyban
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Christine Gennigens
- c Department of Clinical Oncology , University Hospital of Liège , Liège , Belgium
| | - Laurence Seidel
- d Department of Biostatistics , University Hospital of Liège , Liège , Belgium
| | - Katty Delbecque
- e Department of Pathology , University Hospital of Liège , Liège , Belgium
| | - Philippe Coucke
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Johanne Hermesse
- a Department of Radiation Oncology , University Hospital of Liège , Liège , Belgium
| | - Frederic Kridelka
- b Department of Gynecology , University Hospital of Liège , Liège , Belgium
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28
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Villalba SR, Sancho JR, Palacin AO, Calatayud JP, Ortega MS. A new template for MRI-based intracavitary/interstitial gynecologic brachytherapy: design and clinical implementation. J Contemp Brachytherapy 2015; 7:265-72. [PMID: 26622229 PMCID: PMC4643734 DOI: 10.5114/jcb.2015.54051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/05/2015] [Accepted: 08/10/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To describe the potential clinical use of a new brachytherapy applicator for gynecological tumors, with special attention to locally advanced cervical carcinoma. This device allows the combination of intracavitary radiotherapy and MRI-compatible transperineal interstitial needles. The design of this template addresses the disadvantages of currently commercially available templates: the inability of the intracavitary component to reach deep into the cervix (MUPIT), and the MRI-incompatibility of these templates (MUPIT and Syed), which necessitates use of CT imaging for the dosimetry. MATERIAL AND METHODS The newly developed Benidorm Template applicator allows titanium needles in a template with straight and angled holes to provide different angles of divergence to be used with currently existing MRI-compatible intrauterine tubes. It can provide total coverage of the craniocaudal and lateral extension of the tumor (intrautherus, parametrial, and paravaginal). This method is mainly indicated in advanced cervical carcinoma with bulky parametrial invasion (medial or distal), with bulky primary disease that responds poorly to external beam radiotherapy extensive paravaginal involvement (tumor thickness greater than 0.5 cm) extending to the middle or lower third of the vagina, or for disease that has invaded the bladder or rectum (stage IVA). RESULTS Between April 2013 until December 2014, we treated 15 patients with locally advanced cervical carcinoma employing the Benidorm Template. The median dose at D90 for the CTV was 79.8 Gy (71.5-89.9 Gy), at D2cc for the bladder it was 77.6 Gy (69.8-90.8 Gy), and at D2cc for the rectum it was 71.9 Gy (58.3-83.7 Gy). Values expressed in EQD2, assuming α/β of 10 for CTV and 3 for OAR. CONCLUSIONS This new applicator allows the use of MRI-based dosimetry, thus providing the advantages of MRI volume definition. As such, it facilitates determination of complete intracavitary and interstitial CTV coverage and the sparing of normal tissues.
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Affiliation(s)
| | | | | | - Jose Perez Calatayud
- Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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29
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Viswanathan AN, Erickson BA. Seeing is saving: The benefit of 3D imaging in gynecologic brachytherapy. Gynecol Oncol 2015; 138:207-15. [DOI: 10.1016/j.ygyno.2015.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/26/2015] [Indexed: 12/18/2022]
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30
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Outpatient combined intracavitary and interstitial cervical brachytherapy: barriers and solutions to implementation of a successful programme - a single institutional experience. J Contemp Brachytherapy 2015. [PMID: 26207117 PMCID: PMC4499522 DOI: 10.5114/jcb.2015.52625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Involvement of parametrial disease in locally advanced cervical patients poses a challenge for women undergoing brachytherapy. Current use of the Fletcher suit applicator may not adequately cover the high risk clinical target volume (HR CTV), especially in the parametrial region due to the physical qualities of brachytherapy from the inverse square law and the need to respect organs at risk (OAR) constraints, and leads to lower local control rates. Combined intracavitary and interstitial brachytherapy with the use of 1 or 2 interstitial needles allows adequate coverage of the HR CTV and the clinical evidence have demonstrated a correlation with better clinical results. This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning. In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy. This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.
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31
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Sun B, Yang D, Esthappan J, Garcia-Ramirez J, Price S, Mutic S, Schwarz JK, Grigsby PW, Tanderup K. Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer. Brachytherapy 2015; 14:481-9. [PMID: 25958039 DOI: 10.1016/j.brachy.2015.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Dose accumulation of split-field external beam radiotherapy (EBRT) and brachytherapy (BT) is challenging because of significant EBRT and BT dose gradients in the central pelvic region. We developed a method to determine biologically effective dose parameters for combined split-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. METHODS AND MATERIALS Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were computed on the 3D combined EQD2 dose based on rigid image registration. The dose accumulation uncertainty introduced by organ deformations between IMRT and BT was evaluated. RESULTS According to International Commission on Radiation Unit and Measurement and GEC European Society for Therapeutic Radiology and Oncology recommendations, D98, D90, D50, and D2cm3 EQD2 dose-volume histogram parameters were computed. GTV D98 was 84.0 ± 26.5 Gy and D2cc was 99.6 ± 13.9 Gy, 67.4 ± 12.2 Gy, 75.0 ± 10.1 Gy, for bladder, rectum, and sigmoid, respectively. The uncertainties induced by organ deformation were estimated to be -1 ± 4 Gy, -3 ± 5 Gy, 2 ± 3 Gy, and -3 ± 5 Gy for bladder, rectum, sigmoid, and GTV, respectively. CONCLUSIONS It is feasible to perform 3D EQD2 dose accumulation to assess high and intermediate dose regions for combined split-field IMRT and BT.
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Affiliation(s)
- Baozhou Sun
- Department of Radiation Oncology, Washington University Saint Louis, MO.
| | - Deshan Yang
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Jackie Esthappan
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | | | - Samantha Price
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Kari Tanderup
- Department of Radiation Oncology, Washington University Saint Louis, MO
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