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Portocarrero-Bonifaz A, Syed S, Kassel M, McKenzie GW, Shah VM, Forry BM, Gaskins JT, Sowards KT, Avula TB, Masters A, Silva SR. Dosimetric and toxicity comparison between Syed-Neblett and Fletcher-Suit-Delclos Tandem and Ovoid applicators in high dose rate cervix cancer brachytherapy. Brachytherapy 2024:S1538-4721(24)00045-X. [PMID: 38643046 DOI: 10.1016/j.brachy.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To compare patient and tumor characteristics, dosimetry, and toxicities between interstitial Syed-Neblett and intracavitary Fletcher-Suit-Delclos Tandem and Ovoid (T&O) applicators in high dose rate (HDR) cervical cancer brachytherapy. METHODS A retrospective analysis was performed for cervical cancer patients treated with 3D-based HDR brachytherapy from 2011 to 2023 at a single institution. Dosimetric parameters for high-risk clinical target volume and organs at risk were obtained. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS A total of 115 and 58 patients underwent Syed and T&O brachytherapy, respectively. Patients treated with Syed brachytherapy were more likely to have larger tumors and FIGO stage III or IV disease. The median D2cc values to the bladder, small bowel, and sigmoid colon were significantly lower for Syed brachytherapy. Patients treated with Syed brachytherapy were significantly more likely to be free of acute gastrointestinal (44% vs. 21%, p = 0.003), genitourinary (58% vs. 36%, p = 0.01), and vaginal toxicities (60% vs. 33%, p = 0.001) within 6 months following treatment compared to patients treated with T&O applicators. In contrast, Syed brachytherapy patients were more likely to experience late gastrointestinal (68% vs. 49%, p = 0.082), genitourinary (51% vs. 35%, p = 0.196), and vaginal toxicities (70% vs. 57%, p = 0.264). CONCLUSIONS Syed-Neblett and T&O applicators are suitable for HDR brachytherapy for cervical cancer in distinct patient populations. Acute toxicities are more prevalent with T&O applicators, while patients treated with Syed-Neblett applicators are more likely to develop late toxicities.
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Affiliation(s)
- Andres Portocarrero-Bonifaz
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; Physics Department, Pontificia Universidad Catolica del Peru, Lima, Peru.
| | - Salman Syed
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Maxwell Kassel
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Grant W McKenzie
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Vishwa M Shah
- Department of Gynecologic Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Bryce M Forry
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY
| | - Keith T Sowards
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Thulasi Babitha Avula
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Adrianna Masters
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Scott R Silva
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
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Parisi S, Sciacca M, Ferrantelli G, Chillari F, Critelli P, Venuti V, Lillo S, Arcieri M, Martinelli C, Pontoriero A, Minutoli F, Ercoli A, Pergolizzi S. Locally advanced squamous cervical carcinoma (M0): management and emerging therapeutic options in the precision radiotherapy era. Jpn J Radiol 2024; 42:354-366. [PMID: 37987880 DOI: 10.1007/s11604-023-01510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography-magnetic resonance imaging) PET-MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.
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Affiliation(s)
- S Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - M Sciacca
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - G Ferrantelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy.
| | - F Chillari
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - P Critelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - V Venuti
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - S Lillo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Arcieri
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - C Martinelli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - A Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - F Minutoli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - A Ercoli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - S Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
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Nakanishi K, Yamamoto S, Yabe T, Yogo K, Noguchi Y, Okudaira K, Kawachi N, Kataoka J. Estimating blurless and noise-free Ir-192 source images from gamma camera images for high-dose-rate brachytherapy using a deep-learning approach. Biomed Phys Eng Express 2023; 10:015006. [PMID: 37948761 DOI: 10.1088/2057-1976/ad0bb2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
Objective. Precise monitoring of the position and dwell time of iridium-192 (Ir-192) during high-dose-rate (HDR) brachytherapy is crucial to avoid serious damage to normal tissues. Source imaging using a compact gamma camera is a potential approach for monitoring. However, images from the gamma camera are affected by blurring and statistical noise, which impact the accuracy of source position monitoring. This study aimed to develop a deep-learning approach for estimating ideal source images that reduce the effect of blurring and statistical noise from experimental images captured using a compact gamma camera.Approach. A double pix2pix model was trained using the simulated gamma camera images of an Ir-192 source. The first model was responsible for denoising the Ir-192 images, whereas the second model performed super resolution. Trained models were then applied to the experimental images to estimate the ideal images.Main results. At a distance of 100 mm between the compact gamma camera and the Ir-192 source, the difference in full width at half maximum (FWHM) between the estimated and actual source sizes was approximately 0.5 mm for a measurement time of 1.5 s. This difference has been improved from approximately 2.7 mm without the use of DL. Even with a measurement time of 0.1 s, the ideal images could be estimated as accurately as in the 1.5 s measurements. This method consistently achieved accurate estimations of the source images at any position within the field of view; however, the difference increased with the distance between the Ir-192 source and the compact gamma camera.Significance. The proposed method successfully provided estimated images from the experimental images within errors smaller than 0.5 mm at 100 mm. This method is promising for reducing blurring and statistical noise from the experimental images, enabling precise real-time monitoring of Ir-192 sources during HDR brachytherapy.
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Affiliation(s)
- Kohei Nakanishi
- Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Yabe
- Takasaki Institute for Advanced Quantum Science, Foundational Quantum Technology Research Directorate, National Institutes for Quantum Science and Technology (QST), Japan
| | - Katsunori Yogo
- Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Japan
| | - Yumiko Noguchi
- Department of Radiological Technology, Nagoya University Hospital, Japan
| | - Kuniyasu Okudaira
- Department of Radiological Technology, Nagoya University Hospital, Japan
| | - Naoki Kawachi
- Takasaki Institute for Advanced Quantum Science, Foundational Quantum Technology Research Directorate, National Institutes for Quantum Science and Technology (QST), Japan
| | - Jun Kataoka
- Faculty of Science and Engineering, Waseda University, Japan
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Sagae S, Toita T, Matsuura M, Saito M, Matsuda T, Sato N, Shimizu A, Endo T, Fujii M, Gaffney DK, Small W. Improvement in radiation techniques for locally advanced cervical cancer during the last two decades. Int J Gynecol Cancer 2023; 33:1295-1303. [PMID: 37041022 PMCID: PMC10423558 DOI: 10.1136/ijgc-2022-004230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 04/13/2023] Open
Abstract
Since the National Cancer Institute (NCI) alert of concurrent chemoradiotherapy, radiotherapy has been changed from external beam radiotherapy plus brachytherapy to platinum-based concurrent chemoradiotherapy. Therefore, concurrent chemoradiotherapy plus brachytherapy has become a standard treatment for locally advanced cervical cancer. Simultaneously, definitive radiotherapy has been changed gradually from external beam radiotherapy plus low-dose-rate intracavitary brachytherapy to external beam radiotherapy plus high-dose-rate intracavitary brachytherapy. Cervix cancer is uncommon in developed countries; hence, international collaborations have been critical in large-scale clinical trials. The Cervical Cancer Research Network (CCRN), created from the Gynecologic Cancer InterGroup (GCIG), has investigated various concurrent chemotherapy regimens and sequential methods of radiation and chemotherapy. Most recently, many clinical trials of combining immune checkpoint inhibitors with radiotherapy have been ongoing for sequential or concurrent settings. During the last decade, the method of standard radiation therapy has changed from three-dimensional conformal radiation therapy to intensity-modulated radiation therapy for external beam radiotherapy and from two-dimensional to three-dimensional image-guided approaches for brachytherapy. Recent improvements include stereotactic ablative body radiotherapy and MRI-guided linear accelerator (MRI-LINAC) using adaptive radiotherapy. Here we review the current progress of radiation therapy during the last two decades.
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Affiliation(s)
- Satoru Sagae
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Manabu Saito
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takuma Matsuda
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Nanaka Sato
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Ayumi Shimizu
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Toshiaki Endo
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Miho Fujii
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois, USA
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Becerra-Bolaños Á, Jiménez-Gil M, Federico M, Domínguez-Díaz Y, Valencia L, Rodríguez-Pérez A. Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study. J Pers Med 2023; 13:1187. [PMID: 37623438 PMCID: PMC10456084 DOI: 10.3390/jpm13081187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.
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Affiliation(s)
- Ángel Becerra-Bolaños
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
| | - Miriam Jiménez-Gil
- Department of Anesthesiology, Complejo Hospitalario Universitario Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Yurena Domínguez-Díaz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Lucía Valencia
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
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DE Sanctis V, Facondo G, Vullo G, Anzellini D, Sanguineti G, Nardangeli A, Marmiroli L, Tortoreto F, Gentile P, Annessi I, Donato V, Chiostrini C, Tombolini V, DE Felice F, Valeriani M, Osti MF. Clinical Outcomes and Toxicity of CT-guided High Dose-rate Brachytherapy in Women With Locally-advanced Cervical Cancer. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:194-200. [PMID: 36875316 PMCID: PMC9949546 DOI: 10.21873/cdp.10201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND/AIM To evaluate the outcome and toxicities in patients with locally advanced cervical cancer (LACC) treated with radiochemotherapy and intracavitary brachytherapy. PATIENTS AND METHODS This study included 67 patients with LACC treated between 2010 and 2018. The most represented stage was FIGO IIB. The patients were treated with external beam radiotherapy (EBRT) to the pelvis and boost to the cervix and parametrials. Concomitant chemotherapy (CHT) with cisplatin (CDDP) 40 mg/mq was planned. Subsequently, the patients underwent CT-based endouterine brachytherapy (BT). The response was evaluated at 3 months with PET-CT and/or pelvic magnetic resonance imaging (MRI). Since then, the patients have been followed with clinical instrumental controls every 4 months for the first 2 years and every 6 months for the following 3 years. Local response was assessed with pelvic MRI and/or PET-CT scan at the end of intracavitary BT) according to RECIST 1.1 criteria. RESULTS The median duration of treatment was 55 days (range=40-73 days). The prescription dose to the planning target volume (PTV) was delivered in 25 to 30 (median 28) daily fractions. The EBRT median dose to the pelvis and gross tumor volume were 50.4 Gy (range=45-56.25) and 61.6 Gy (range=45-70.4), respectively. The 1-year, 2-year, 3-year, and 5-year overall survival rates were 92.44%, 80.81%, 78.84%, and 76.45% respectively. The actuarial 1-year, 2-year, 3-year, and 5-year disease-free survival rates were 89.5%, 83.6%, 81%, and 78.2% respectively. CONCLUSION This study analyzed acute and chronic toxicity, survival, and local control in cervical cancer patients treated with IMRT followed by CT-planned high dose rate-brachytherapy. Patients demonstrated satisfactory outcomes and incidence of acute and late toxicities.
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Affiliation(s)
- Vitaliana DE Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Facondo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Nardangeli
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Marmiroli
- U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy
| | - Francesca Tortoreto
- U.O.C. Radiotherapy, S. Giovanni Calibita Fatebenefratelli Hospital - Amethyst Radioterapia Italia, Rome, Italy
| | - Piercarlo Gentile
- Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Ivan Annessi
- Department of Radiation Oncology, San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Cinzia Chiostrini
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesca DE Felice
- Department of Radiotherapy, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maurizio Valeriani
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
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Kumar R, Patel SU, Mattes MD. Immunotherapy-Induced Rectovaginal Fistula After Prior Reirradiation for Recurrent Cervical Cancer in a Pelvic Lymph Node. Pract Radiat Oncol 2023; 13:13-17. [PMID: 36075550 DOI: 10.1016/j.prro.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
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McDaniels-Davidson C, Feng CH, Martinez ME, Canchola AJ, Gomez SL, Nodora JN, Patel SP, Mundt AJ, Mayadev JS. Improved survival in cervical cancer patients receiving care at National Cancer Institute-designated cancer centers. Cancer 2022; 128:3479-3486. [PMID: 35917201 PMCID: PMC9544648 DOI: 10.1002/cncr.34404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 12/02/2022]
Abstract
Background Locally advanced cervical cancer (CC) remains lethal in the United States. We investigate the effect of receiving care at an National Cancer Institute–designated cancer center (NCICC) on survival. Methods Data for women diagnosed with CC from 2004 to 2016 who received radiation treatment were extracted from the California Cancer Registry (n = 4250). Cox proportional hazards regression models assessed whether (1) receiving care at NCICCs was associated with risk of CC‐specific death, (2) this association remained after multivariable adjustment for age, race/ethnicity, and insurance status, and (3) this association was explained by receipt of guideline‐concordant treatment. Results Median age was 50 years (interquartile range [IQR] 41–61 years), with median follow‐up of 2.7 years (IQR 1.3–6.0 years). One‐third of patients were seen at an NCICC, and 29% died of CC. The hazard of CC‐specific death was reduced by 20% for those receiving care at NCICCs compared with patients receiving care elsewhere (HR = .80; 95% CI, 0.70–0.90). Adjustment for guideline‐concordant treatment and other covariates minimally attenuated the association to 0.83 (95% CI, 0.74–0.95), suggesting that the survival advantage associated with care at NCICCs may not be due to receipt of guideline‐concordant treatment. Conclusions This study demonstrates survival benefit for patients receiving care at NCICCs compared with those receiving care elsewhere that is not explained by differences in guideline‐concordant care. Structural, organizational, or provider characteristics and differences in patients receiving care at centers with and without NCI designation could explain observed associations. Further understanding of these factors will promote equality across oncology care facilities and survival equity for patients with CC. This study demonstrates survival benefit for patients receiving care for cervical cancer at National Cancer Institute–designated cancer centers that is not explained by receipt of guideline‐concordant treatment. Further understanding of these factors will promote equality across oncology care facilities resulting in survival equity for patients with cervical cancer.
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Affiliation(s)
| | - Christine H Feng
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Jesse N Nodora
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sandip P Patel
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Arno J Mundt
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Jyoti S Mayadev
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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9
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System-level capacity of high dose rate (HDR) brachytherapy for management of cervical cancer in an upper middle-income country: a case study from Brazil. Int J Radiat Oncol Biol Phys 2022; 114:545-553. [PMID: 35779808 DOI: 10.1016/j.ijrobp.2022.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ensuring optimal access to radiotherapy (RT) facilities is challenging for many countries. External beam RT and brachytherapy (BCT) are required to treat advanced cervical cancer. In this analysis, we evaluate the system-level capacity of brachytherapy in Brazil and its relationship with access to complete cervix cancer radiation treatment with both external beam radiotherapy and BCT. METHODOLOGY We used official government reports to compile data on BCT and Linear accelerator (LINAC) numbers, geographic distribution and coverage, cervical cancer annual incidence, and prevalence in Brazil. We also evaluated changes in national BCT capacity between 2001 and 2021. The 2020 relationship between cervical cancer cases for RT per BCT unit, LINAC per BCT unit, and the LINAC supply for each Brazilian state and region were evaluated. For comparison, the LINAC per BCT unit ratio in Brazil was compared with Europe using International Atomic Energy Agency data. RESULTS 85% (23/27) of Brazilian states have at least one brachytherapy unit; nationally, there are 117 cervical cancer cases for RT per BCT unit. Compared with the benchmark of 200 cervical cancer cases per BCT device per year, there are enough BCT units to fill capacity in Brazil nationally and regionally. The ratio of total cervix cancer cases per BCT unit decreased substantially over time from 142 in 2013 to 117 in 2021 (p<0.0001). Nationally, there are 252 LINAC units in the public system with a ratio of 1,985 new cancer cases/LINAC. Brazilian regions have a LINAC shortage ranging from 15 to 141 units. There were 2.55 LINACs per BCT unit in Brazil, compared with 3.25 in Europe (p=0.012). CONCLUSION Over 20 years, BCT capacity in Brazil has increased to meet the cervical cancer demand. However, the LINAC shortage has persisted over the decades, impacting the access to complete treatment and possibly the oncological outcomes. These data can help organize the patient treatment flow, avoid treatment delays, and improve survival.
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Tangkananan A, Thongkhao P, Janmunee N, Hanprasertpong J. Impact of chemotherapy cycles on oncological outcomes in elders with locally advanced cervical cancer treated with concurrent chemoradiotherapy. J Med Imaging Radiat Oncol 2022; 66:1014-1021. [PMID: 35695633 DOI: 10.1111/1754-9485.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To investigate the association between chemotherapy (CMT) cycles and oncological outcomes in elders with locally advanced cervical cancer (LACC) who treated with concurrent chemoradiotherapy (CCRT). METHODS We retrospective studied 498 elders with LACC who treated with radiotherapy (RT) or CCRT between 2002 and 2018. Patients were divided into three groups: RT, CCRT with 1-4 and CCRT with 5-6 cycles of CMT. We compared progression-free survival (PFS) and overall survival (OS) among the three groups and explored survival prognostic factors via multivariate analysis and time-varying analysis effect. RESULTS There were 453 eligible patients; 222, 119 and 112 patients who received RT, CCRT with 1-4 and CCRT with 5-6 cycles of CMT, respectively. Patients in the RT group had older age, poorer performance status, more treatment with conventional RT technique and earlier treatment year comparing with both CCRT groups. Patients who received 5-6 cycles of CMT were less to have underweight, comorbidities and anaemia compared with the RT group. There were patients with lower FIGO stage in 5-6 cycles than in 1-4 cycles of CMT and RT groups. The 5-year PFS and OS between RT, CCRT with 1-4 and CCRT with 5-6 cycles of the CMT group were significantly different. Performance status, comorbidity, histology, FIGO stage and total received 5-6 CMT cycles were significant prognostic factors of PFS and OS. However, the benefits of receiving 5-6 CMT cycles were evidenced only within the first 2.5 years. CONCLUSION Elders with LACC who received 5-6 cycles of CMT concurrently with RT can improve PFS and OS, but the benefit persisted only within the first 2.5 years.
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Affiliation(s)
- Aimwarin Tangkananan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pitchaya Thongkhao
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Narumon Janmunee
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jitti Hanprasertpong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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11
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Knowledge-based three-dimensional dose prediction for tandem-and-ovoid brachytherapy. Brachytherapy 2022; 21:532-542. [PMID: 35562285 DOI: 10.1016/j.brachy.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this work was to develop a knowledge-based dose prediction system using a convolution neural network (CNN) for cervical brachytherapy treatments with a tandem-and-ovoid applicator. METHODS A 3D U-NET CNN was utilized to make voxel-wise dose predictions based on organ-at-risk (OAR), high-risk clinical target volume (HRCTV), and possible source location geometry. The model comprised 395 previously treated cases: training (273), validation (61), test (61). To assess voxel prediction accuracy, we evaluated dose differences in all cohorts across the dose range of 20-130% of prescription, mean(SD) and standard deviation (σ), as well as isodose dice similarity coefficients for clinical and/or predicted dose distributions. We examined discrete Dose-Volume Histogram(DVH) metrics utilized for brachytherapy plan quality assessment (HRCTV D90%, and bladder and/or rectum and/or sigmoid D2cc) with ΔDx=Dx,actual-Dx,predicted Pearson correlation coefficient, standard deviation, and mean further quantifying model performance. RESULTS Ranges of voxel-wise dose difference accuracy (δD¯±σ) for 20-130% dose interval in training (test) sets ranged from [-0.5% ± 2.0% to +2.0% ± 14.0%] ([-0.1% ± 4.0% to +4.0% ± 26.0%]) in all voxels, [-1.7% ± 5.1% to -3.5% ± 12.8%] ([-2.9% ± 4.8% to -2.6% ± 18.9%]) in HRCTV, [-0.02% ± 2.40% to +3.2% ± 12.0%] ([-2.5% ± 3.6% to +0.8% ± 12.7%]) in bladder, [-0.7% ± 2.4% to +15.5% ± 11.0%] ([-0.9% ± 3.2% to +27.8% ± 11.6%]) in rectum, and [-0.7% ± 2.3% to +10.7% ± 15.0%] ([-0.4% ± 3.0% to +18.4% ± 11.4%]) in sigmoid. Isodose dice similarity coefficients ranged from [0.96,0.91] for training and [0.94,0.87] for test cohorts. Relative DVH metric prediction in the training (test) set were HRCTV ΔD¯90±σΔD=-0.19 ± 0.55Gy(-0.09 ± 0.67 Gy), bladder ΔD¯2cc±σΔD= -0.06 ± 0.54Gy(-0.17 ± 0.67 Gy), rectum ΔD¯2cc±σΔD= -0.03 ± 0.36Gy(-0.04 ± 0.46 Gy), and sigmoid ΔD¯2cc±σΔD= -0.01 ± 0.34Gy(0.00 ± 0.44 Gy). CONCLUSIONS A 3D knowledge-based dose predictions provide voxel-level and DVH metric estimates that could be used for treatment plan quality control and data-driven plan guidance.
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12
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Kim H, Lee YC, Benedict SH, Dyer B, Price M, Rong Y, Ravi A, Leung E, Beriwal S, Bernard ME, Mayadev J, Leif JRL, Xiao Y. Dose Summation Strategies for External Beam Radiation Therapy and Brachytherapy in Gynecologic Malignancy: A Review from the NRG Oncology and NCTN Medical Physics Subcommittees. Int J Radiat Oncol Biol Phys 2021; 111:999-1010. [PMID: 34147581 PMCID: PMC8594937 DOI: 10.1016/j.ijrobp.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Definitive, nonsurgical management of gynecologic malignancies involves external beam radiation therapy (EBRT) and/or brachytherapy (BT). Summation of the cumulative dose is critical to assess the total biologic effective dose to targets and organs at risk. Cumulative dose calculation from EBRT and BT can be performed with or without image registration (IR) and biologic dose summation. Among these dose summation strategies, linear addition of dose-volume histogram (DVH) parameters without IR is the global standard for composite dose reporting. This approach stems from an era without image guidance and simple external beam and brachytherapy treatment approaches. With technological advances, EBRT and high-dose-rate BT have evolved to allow for volume-based treatment planning and delivery. Modern conformal therapeutic radiation involves volumetric or intensity modulated EBRT, capable of simultaneously treating multiple targets at different specified dose levels. Therefore, given the complexity of modern radiation treatment, the linear addition of DVH parameters from EBRT and high-dose-rate BT is challenging to represent the combined dose distribution. Deformable image registration (DIR) between EBRT and image guided brachytherapy (IGBT) data sets may provide a more nuanced calculation of multimodal dose accumulation. However, DIR is still nascent in this regard, and needs further development for accuracy and efficiency for clinical use. Biologic dose summation can combine physical dose maps from EBRT and each IGBT fraction, thereby generating a composite DVH from the biologic effective dose. However, accurate radiobiologic parameters are tissue-dependent and not well characterized. A combination of voxel-based DIR and biologic weighted dose maps may be the best approximation of dose accumulation but remains invalidated. The purpose of this report is to review dose summation strategies for EBRT and BT, including conventional equivalent dose in 2-Gy fractions dose summation without image registration, physical dose summation using 3-dimensional rigid IR and DIR, and biologic dose summation. We also provide general clinical workflows for IGBT with a focus on cervical cancer.
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Affiliation(s)
- Hayeon Kim
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yongsook C Lee
- Department of Radiation Oncology, Miami Cancer Institute | Baptist Health South Florida, Miami, Florida
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California at Davis Cancer Center, Sacramento, California.
| | - Brandon Dyer
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Michael Price
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Ananth Ravi
- Molli Surgical INC, Department of Radiation Oncology, University of Toronto, Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, Ontario
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mark E Bernard
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Jyoti Mayadev
- Department of Radiation Oncology, University of California at San Diego, San Diego, La Jolla, California
| | - Jessica R L Leif
- Department of Radiation Physics, IROC Houston QA Center, MD Anderson Cancer Center, Houston, Texas
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Kallis K, Mayadev J, Covele B, Brown D, Scanderbeg D, Simon A, Frisbie-Firsching H, Yashar CM, Einck JP, Mell LK, Moore KL, Meyers SM. Evaluation of dose differences between intracavitary applicators for cervical brachytherapy using knowledge-based models. Brachytherapy 2021; 20:1323-1333. [PMID: 34607771 DOI: 10.1016/j.brachy.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Currently, there is a lack of patient-specific tools to guide brachytherapy planning and applicator choice for cervical cancer. The purpose of this study is to evaluate the accuracy of organ-at-risk (OAR) dose predictions using knowledge-based intracavitary models, and the use of these models and clinical data to determine the dosimetric differences of tandem-and-ring (T&R) and tandem-and-ovoids (T&O) applicators. MATERIALS AND METHODS Knowledge-based models, which predict organ D2cc, were trained on 77/75 cases and validated on 32/38 for T&R/T&O applicators. Model performance was quantified using ΔD2cc=D2cc,actual-D2cc,predicted, with standard deviation (σ(ΔD2cc)) representing precision. Model-predicted applicator dose differences were determined by applying T&O models to T&R cases, and vice versa, and compared to clinically-achieved D2cc differences. Applicator differences were assessed using a Student's t-test (p < 0.05 significant). RESULTS Validation T&O/T&R model precision was 0.65/0.55 Gy, 0.55/0.38 Gy, and 0.43/0.60 Gy for bladder, rectum and sigmoid, respectively, and similar to training. When applying T&O/T&R models to T&R/T&O cases, bladder, rectum and sigmoid D2cc values in EQD2 were on average 5.69/2.62 Gy, 7.31/6.15 Gy and 3.65/0.69 Gy lower for T&R, with similar HRCTV volume and coverage. Clinical data also showed lower T&R OAR doses, with mean EQD2 D2cc deviations of 0.61 Gy, 7.96 Gy (p < 0.01) and 5.86 Gy (p < 0.01) for bladder, rectum and sigmoid. CONCLUSIONS Accurate knowledge-based dose prediction models were developed for two common intracavitary applicators. These models could be beneficial for standardizing and improving the quality of brachytherapy plans. Both models and clinical data suggest that significant OAR sparing can be achieved with T&R over T&O applicators, particularly for the rectum.
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Affiliation(s)
- Karoline Kallis
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Brent Covele
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Derek Brown
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Aaron Simon
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Helena Frisbie-Firsching
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Catheryn M Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Kevin L Moore
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Sandra M Meyers
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA.
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14
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Yusufaly TI, Meyers SM, Mell LK, Moore KL. Knowledge-Based Planning for Intact Cervical Cancer. Semin Radiat Oncol 2021; 30:328-339. [PMID: 32828388 DOI: 10.1016/j.semradonc.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cervical cancer radiotherapy is often complicated by significant variability in the quality and consistency of treatment plans. Knowledge-based planning (KBP), which utilizes prior patient data to correlated achievable optimal dosimetry with patient-specific anatomy, has demonstrated promise as a quality control tool for controlling this variability, with consequences for patient outcomes, as well as for the reliability of data from multi-institutional clinical trials. In this article we highlight the application of KBP-based quality control to cervical cancer radiotherapy. We discuss the potential impact of KBP on multi-institutional clinical trials to standardize cervical cancer treatment planning across diverse clinics, and discuss challenges and progress in the implementation of KBP for brachytherapy treatment planning. Additionally, we briefly discuss secondary applications of KBP for cervical cancer. The emerging picture from these studies indicates several exciting opportunities for increasing the utilization of KBP in day-to-day cervical cancer radiotherapy.
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Affiliation(s)
- Tahir I Yusufaly
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA
| | - Sandra M Meyers
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA
| | - Kevin L Moore
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA.
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15
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Neibart SS, Smith TA, Fang JH, Anderson T, Kulkarni A, Tsui J, Hudson SV, Peck GL, Hanna JS, Beer NL, Einstein MH. Assessment of Cervical Cancer Prevention and Treatment Infrastructure in Belize. JCO Glob Oncol 2021; 7:1251-1259. [PMID: 34351814 PMCID: PMC8389877 DOI: 10.1200/go.21.00138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Belize has one of the highest cervical cancer burdens among Latin American and Caribbean countries, despite the implementation of national policies to increase access to prevention and treatment services. This study evaluates the policies, infrastructure, and workforce of the cervical cancer management system in Belize to inform capacity building efforts. METHODS In 2018, health facility assessments were conducted across all six districts of Belize at the national pathology facility and 12 public facilities identified as critical to cervical cancer control. Human and infrastructure resource availability and existing policies related to cervical cancer screening and treatment services were assessed through a structured instrument. RESULTS The public cervical cancer screening workforce in Belize consists of 75 primary care nurses and physicians—one per 1,076 screening-eligible women, with 44% conducting rural outreach. All districts have at least one screening facility, but 50% perform screening services only once per week. Colposcopy and loop electrical excision procedures are available in three and four districts, respectively; radical hysterectomy and chemotherapy are available in two districts; and radiation therapy is unavailable. Of essential pathology equipment, 38.5% were present and functional, 23% were present but nonfunctional, and 38.5% were unavailable. Additionally, 35% of supplies were unavailable at the time of assessment, and 75% were unavailable at least once in the 12 months before assessment. CONCLUSION Public-sector cervical cancer management services differ among districts of Belize, with tertiary service availability concentrated in the largest district. Screening, outreach, and pathology are limited mostly by resource availability. This study characterizes the current capacity of services in Belize and pinpoints health system components for future investment and capacity-building efforts.
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Affiliation(s)
- Shane S Neibart
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tiffany A Smith
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer H Fang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Taylor Anderson
- University of Queensland Ochsner Clinical School, Brisbane, QLD, Australia
| | - Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Tsui
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Gregory L Peck
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.,Rutgers School of Public Health, Piscataway, NJ
| | - Joseph S Hanna
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Mark H Einstein
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.,Rutgers New Jersey Medical School, Newark, NJ
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16
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Zhou P, Li X, Zhou H, Fu X, Liu B, Zhang Y, Lin S, Pang H. Support Vector Machine Model Predicts Dose for Organs at Risk in High-Dose Rate Brachytherapy of Cervical Cancer. Front Oncol 2021; 11:619384. [PMID: 34336640 PMCID: PMC8319952 DOI: 10.3389/fonc.2021.619384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to establish a support vector machine (SVM) model to predict the dose for organs at risk (OARs) in intracavitary brachytherapy planning for cervical cancer with tandem and ovoid treatments. Methods Fifty patients with loco-regionally advanced cervical cancer treated with 200 CT-based tandem and ovoid brachytherapy plans were included. The brachytherapy plans were randomly divided into the training (N = 160) and verification groups (N = 40). The bladder, rectum, sigmoid colon, and small intestine were divided into sub-OARs. The SVM model was established using MATLAB software based on the sub-OAR volume to predict the bladder, rectum, sigmoid colon, and small intestine D 2 c m 3 . Model performance was quantified by mean squared error (MSE) and δ ( δ = | D 2 c m 3 / D prescription ( actual ) - D 2 c m 3 / D prescription ( predicted ) | ) . The goodness of fit of the model was quantified by the coefficient of determination (R2). The accuracy and validity of the SVM model were verified using the validation group. Results The D 2 c m 3 value of the bladder, rectum, sigmoid colon, and small intestine correlated with the volume of the corresponding sub-OARs in the training group. The mean squared error (MSE) in the SVM model training group was <0.05; the R2 of each OAR was >0.9. There was no significant difference between the D 2 c m 3 -predicted and actual values in the validation group (all P > 0.05): bladder δ = 0.024 ± 0.022, rectum δ = 0.026 ± 0.014, sigmoid colon δ = 0.035 ± 0.023, and small intestine δ = 0.032 ± 0.025. Conclusion The SVM model established in this study can effectively predict the D 2 c m 3 for the bladder, rectum, sigmoid colon, and small intestine in cervical cancer brachytherapy.
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Affiliation(s)
- Ping Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaojie Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhou
- Department of Nursing College, Southwest Medical University, Luzhou, China
| | - Xiao Fu
- Department of Nursing College, Southwest Medical University, Luzhou, China
| | - Bo Liu
- Department of Nursing College, Southwest Medical University, Luzhou, China
| | - Yu Zhang
- Department of Nursing College, Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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17
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Fan J, Xing L, Yang Y. Independent verification of brachytherapy treatment plan by using deep learning inference modeling. Phys Med Biol 2021; 66. [PMID: 34132651 DOI: 10.1088/1361-6560/ac067f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/28/2021] [Indexed: 11/12/2022]
Abstract
This study aims to develop a deep learning-based strategy for treatment plan check and verification of high-dose rate (HDR) brachytherapy. A deep neural network was trained to verify the dwell positions and times for a given input brachytherapy isodose distribution. In our modeling, each dwell position is represented by a Gaussian heatmap located in the vicinity of the dwell positions. A deep inception network based architecture was established to learn the mapping between CT, dose distribution and the heatmap volume. The dwell position coordinates were obtained from the predicted heatmap volume by finding the location of the Gaussian peak using non-maximum suppression. An encoder network was employed to predict dwell time by using the same input. 110 HDR brachytherapy cervical patients were used to train the proposed network. Additional 10 patients were employed to evaluate the accuracy of the proposed method through comparing the dwell position coordinates and dwell times with the results from a treatment planning system. The proposed deep learning-based dwell positions and times verification method achieved excellent predictive performance. For the tested patients, the deviation of the deep learning predicted dwell position coordinates was around one pixel from the planned positions (on average, a pixel is ∼0.5 mm), and the relative deviations of the predicted dwell times were within 2%. A deep learning-based plan check and verification method was established for brachytherapy. Our study showed that the model is capable of predicting the dwell positions and times reliably and promises to provide an efficient and accurate tool for independent verification of HDR brachytherapy treatment plan.
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Affiliation(s)
- Jiawei Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College Fudan University, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, People's Republic of China.,Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, United States of America
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, United States of America
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, United States of America
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Ahmed HZ, Vijayakumar S, Duggar WN, Allbright R. MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States. Cureus 2021; 13:e15495. [PMID: 34113529 PMCID: PMC8186450 DOI: 10.7759/cureus.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting. The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.
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Affiliation(s)
- Hiba Z Ahmed
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Robert Allbright
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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19
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Cereno RE, Yap B, Chavez L, Germar MJ, Eala MAB, Fragante EJ. Toxicities and Recurrences after Co-60 High-Dose-Rate Brachytherapy for Cervical Cancer in a Tertiary Government Hospital in the Philippines. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1729344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Despite the rising popularity of high-dose-rate (HDR) brachytherapy and use of Co-60 in the country, local data on brachytherapy outcomes are lacking. The study reviewed the incidence of toxicities and recurrences in patients with cervical cancer treated with Co-60 intracavitary HDR brachytherapy in a tertiary government hospital in the Philippines.
Methods Records of patients with cervical cancer who completed external beam radiotherapy (EBRT) and brachytherapy from 2016 to 2018 were reviewed. Patient-related (age, smoking history, body mass index, histology, stage, mass size) and treatment-related (overall treatment time [OTT], EBRT machine used, brachytherapy fractionation, dose prior to midline shielding/central tumor dose [CTD]) parameters were analyzed for possible associations with the incidence of toxicities and recurrences.
Results One hundred and sixty-three patients were identified and reviewed for baseline characteristics. Patients who had inadequate follow-up (<90 days) were excluded in the analysis of outcomes. Among the remaining 132 patients, median follow-up duration was 389 days. Gastrointestinal (GI) and genitourinary (GU) toxicities were present in 19.7% (n = 26) and 1.5% (n = 2), respectively. Recurrence was noted in 31.8% (n = 42). The most commonly involved sites of locoregional and distant recurrence was the uterocervix (n = 16, 59.3%) and para-aortics (n = 42, 31.8%), respectively. CTD was significantly associated with toxicities (p = 0.03), while OTT was borderline significantly associated with recurrence (p = 0.06).
Conclusion We present outcomes of GI and GU toxicities, and locoregional and distant recurrences after chemoradiation and Co-60 HDR brachytherapy in a tertiary government hospital in the Philippines. Our study suggests that CTD was significantly associated with incidence of toxicities, while OTT was weakly associated with recurrence. Interventions should be made to control these factors, especially in high-volume, low-resource cancer centers.
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Affiliation(s)
- Reno Eufemon Cereno
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Ermita, Manila, The Philippines
| | - Bernadette Yap
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of the Philippines-Philippine General Hospital, Ermita, Manila, The Philippines
| | - Lorelei Chavez
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Ermita, Manila, The Philippines
| | - Maria Julieta Germar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of the Philippines-Philippine General Hospital, Ermita, Manila, The Philippines
| | | | - Edilberto Joaquin Fragante
- Division of Radiation Oncology, Department of Radiology, University of the Philippines-Philippine General Hospital, Ermita, Manila, The Philippines
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20
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Dyer BA, Yuan Z, Qiu J, Shi L, Wright C, Benedict SH, Valicenti R, Mayadev JS, Rong Y. Clinical feasibility of MR-assisted CT-based cervical brachytherapy using MR-to-CT deformable image registration. Brachytherapy 2020; 19:447-456. [DOI: 10.1016/j.brachy.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 12/21/2022]
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21
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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:220-234. [DOI: 10.1016/j.prro.2020.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
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Valakh V, Coopey BC. Factors Associated with Duration of Overall Treatment Time for Cervical Cancer Treated with Definitive Chemoradiotherapy. Cureus 2019; 11:e5951. [PMID: 31799092 PMCID: PMC6863584 DOI: 10.7759/cureus.5951] [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] [Indexed: 01/26/2023] Open
Abstract
Introduction For women with intact cervical cancer treated by definitive chemoradiotherapy, the adverse impact of treatment prolongation is well-established. We aimed to identify potentially modifiable factors associated with the unwanted increase in the time required to complete the prescribed course of therapy. Methods We retrospectively examined treatment records of 104 consecutive cervical cancer patients receiving chemoradiation for cervical cancer, which included cervical high-dose-rate intracavitary brachytherapy performed at a single referral center. Association of factors, including distance to care, driving time, and income level with overall treatment time, was explored. Results Guideline-concordant treatment duration was achieved in 34% of cases. There was no significant correlation between treatment duration and any of the patient-related characteristics assessed in this study. Transitioning of the radiation oncology physician staffing at the brachytherapy center from a private practice non-integrated group to a large integrated group was associated with a decrease in mean overall treatment time, 61 vs. 68 days, p = 0.007. Conclusions We did not identify a modifiable patient-related factor amenable to a financial intervention. Administration of brachytherapy within an integrated system resulted in a shortened duration of the entire course of therapy for intact cervical cancer.
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Affiliation(s)
- Vladimir Valakh
- Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA
| | - Bryan C Coopey
- Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA
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23
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An evaluation of gender diversity in the American Brachytherapy Society. Brachytherapy 2019; 18:835-840. [PMID: 31402211 DOI: 10.1016/j.brachy.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/29/2019] [Accepted: 07/01/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Recent evaluation of female representation in major radiation oncology organizations was published by Knoll et al. (IJROBP, 2018) but did not include information about the American Brachytherapy Society (ABS). The objective of this study is to assess trends in gender diversity in the ABS. MATERIALS AND METHODS Publicly available information from the ABS and American Society for Radiation Oncology (ASTRO) websites were used to determine the proportion of women in various leadership positions and receiving awards and honors. The data were organized by comparing female representation up until 2004 and then from 2005 until current as was done in the article of Knoll et al. to facilitate comparisons with ASTRO. RESULTS Of the 579 US physician members of the ABS, 155 (27%) are women. There has been an increase in the proportion of female ABS presidents and female Hensche Award recipients between 1978-2004 and 2005-2018. There was a significant difference in the female makeup of the editorial board of the main journals for the ABS (18%) and ASTRO (43%) (p = 0.02). Two other prominent differences between the ABS and ASTRO, however not statistically significant, were the female representation of 2018 fellows (10% vs. 26%, respectively) and recipients of each organization's highest honor between 2005 and 2017 (25% vs. 6%, respectively). CONCLUSIONS Over the past decade, there has been an increase in women representation in the ABS presidency and Henschke awardees. Representation still remains low, relative to ASTRO, in other areas suggesting room for further improvement. Exploring these trends is imperative in developing potential solutions to improve gender diversity in the field of brachytherapy.
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Hrinivich WT, Morcos M, Viswanathan A, Lee J. Automatic tandem and ring reconstruction using MRI for cervical cancer brachytherapy. Med Phys 2019; 46:4324-4332. [PMID: 31329302 DOI: 10.1002/mp.13730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/19/2019] [Accepted: 07/06/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The MRI-guided cervical cancer brachytherapy provides unparalleled soft-tissue contrast for target and normal tissue contouring, but eliminates the ability to use conventional metallic fiducials for radiation source path reconstruction as required for treatment planning. Instead, the source path is reconstructed by manually aligning a library model to the signal void produced by the applicator, which takes time intraoperatively and precludes fully automated treatment planning. The purpose of this study is to present and validate an algorithm to automatically reconstruct tandem and ring applicators using MRI for cervical cancer brachytherapy treatment planning. METHODS Applicators were reconstructed using T2-weighted MR images acquired at 1.5 T from 33 brachytherapy fractions including 10 patients using a model-to-image registration algorithm. The algorithm involves (a) image filtering and maximum intensity projection to highlight the applicator, (b) ring center identification using the circular Hough transform, and (c) three-dimensional surface model registration, optimized by maximizing the image intensity gradient normal to the model surface. Two independent observers manually reconstructed all applicators, enabling the calculation of interobserver variability and establishing a ground truth. Algorithm variability was calculated by comparing algorithm results to each individual observer, and algorithm accuracy was calculated by comparing algorithm results to the ground truth. The algorithm variability and accuracy were compared to the interobserver variability using paired t-tests. RESULTS Mean ± SD interobserver variability was 0.83 ± 0.31 mm and 0.78 ± 0.29 mm for the ring and tandem, respectively. The algorithm had mean ± SD variability and accuracy of 0.72 ± 0.32 mm (P = 0.02) and 0.60 ± 0.24 mm (P = 0.0005) for the ring, and 0.70 ± 0.29 mm (P = 0.11) and 0.58 ± 0.24 mm (P = 0.004) for the tandem, respectively. CONCLUSIONS The algorithm variability and accuracy were within the interobserver variability measured in this study. The algorithm accuracy and mean execution time of 10.0 s are sufficient for clinical tandem and ring reconstruction, and are a step toward fully automated tandem and ring brachytherapy treatment planning.
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Affiliation(s)
- William T Hrinivich
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Marc Morcos
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Akila Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
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Sethi R, Mayadev J, Sethi S, Rash D, Chen LM, Brooks R, Ueda S, Hsu IC. Patterns of Recurrence in Node-Positive Cervical Cancer Patients Treated With Contemporary Chemoradiation and Dose Escalation: A Multi-Institutional Study. Pract Radiat Oncol 2019; 9:e180-e186. [DOI: 10.1016/j.prro.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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26
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Cho O, Chun M. Management for locally advanced cervical cancer: new trends and controversial issues. Radiat Oncol J 2018; 36:254-264. [PMID: 30630264 PMCID: PMC6361251 DOI: 10.3857/roj.2018.00500] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/17/2018] [Indexed: 01/21/2023] Open
Abstract
This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.
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Affiliation(s)
- Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
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27
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Comparison of impact of target delineation of computed tomography- and magnetic resonance imaging-guided brachytherapy on dose distribution in cervical cancer. J Contemp Brachytherapy 2018; 10:418-424. [PMID: 30479618 PMCID: PMC6251453 DOI: 10.5114/jcb.2018.78993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The dose distributions obtained from three imaging approaches for target delineation in cervical cancer using high-dose-rate (HDR) brachytherapy were investigated. Material and methods Ten cervical cancer patients receiving four fractions of HDR brachytherapy were enrolled. Based on different imaging approaches, three brachytherapy plans were developed for each patient: with the high-risk clinical target volume (HRCTV) delineated on magnetic resonance (MRI) images for every fraction (approach A; MRI-only); on MRI for the first fraction and computed tomography (CT) images for the subsequent fractions (approach B; MRI1st/CT); and on CT images for all fractions (approach C; CT-only). The volume, height, width at point A, width at maximum level, and dosimetric parameters (D100, D98, D95, and D90 of the HRCTV; and D0.1cc, D1cc, and D2cc of all organs at risk, or organ at risk – OAR: bladder, rectum, sigmoid colon, and bowel) provided by each approach were compared. Results The mean HRCTV volume, width, and height obtained from approach C (CT-only) were overestimated compared to those from approaches A (MRI-only) and B (MRI1st/CT). The doses to the HRCTV for approaches A and B were similar. However, the HRCTV doses for approach C were significantly lower than those for approaches A and B for all parameters (D95-D100). As to the OAR, the three approaches showed no differences. Conclusions A combination of MRI and CT is a safe alternative approach for cervical cancer HDR brachytherapy. The technique provides comparable dosimetric outcomes to MRI-based planning, while being more cost-effective.
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28
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Romano KD, Hill C, Trifiletti DM, Peach MS, Horton BJ, Shah N, Campbell D, Libby B, Showalter TN. High dose-rate tandem and ovoid brachytherapy in cervical cancer: dosimetric predictors of adverse events. Radiat Oncol 2018; 13:129. [PMID: 30012164 PMCID: PMC6048838 DOI: 10.1186/s13014-018-1074-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/10/2018] [Indexed: 12/02/2022] Open
Abstract
Background Brachytherapy (BT) is a vital component of the curative treatment of locally advanced cervical cancer. The American Brachytherapy Society has published guidelines for high dose rate (HDR) BT with recommended dose limits. However, recent reports suggest lower doses may be needed to avoid toxicity. The purpose of this study is to investigate incidence and predictive factors influencing gastrointestinal (GI) and genitourinary (GU) toxicity following HDR intracavitary brachytherapy for locally advanced cervical cancer. Methods We retrospectively evaluated a cohort of patients with locally advanced cervical cancer who received CT-based HDR BT. Cumulative doses were calculated using the linear-quadratic model. Statistical analyses were used to investigate clinical and dosimetric predictors of GI and GU toxicity following HDR brachytherapy according to CTCAE v4.0 grading criteria. Results Fifty-six women with FIGO IB1 – IVA cervical cancer were included. The overall rate of any GU adverse event (Grade 1+) was 23.3% (n = 13) and severe adverse events (Grade 3+) was 7.1% (n = 4). Of those, the bladder equivalent dose in 2- Gray (Gy) fractions (EQD2) D2cc was ≥80 for three of the four patients. The overall rate of any GI adverse event was 26.8% (n = 15) and the rate of severe adverse events was 14.3% (n = 8). Of those, six of the eight patients had a rectal EQD2 D2cc ≥ 65 Gy and seven patients had a sigmoid D2cc ≥ 65 Gy. Amongst clinically meaningful factors for development of adverse events (i.e. diabetes, smoking status, ovoid size, and treatment duration), there were no statistically significant prognostic factors identified. Conclusions Severe adverse events are observed even with adherence to current ABS guidelines. In the era of recent multi-institutional study results, our data also supports more stringent dosimetric goals. We suggest cumulative D2cc dose limits of: less than 80 Gy for the bladder and less than 65 Gy for the rectum and sigmoid.
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Affiliation(s)
- Kara D Romano
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Colin Hill
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - M Sean Peach
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Bethany J Horton
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Neil Shah
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Dylan Campbell
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA.
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Ko HC, Huang JY, Miller JR, Das RK, Wallace CR, De Costa AMA, Francis DM, Straub MR, Anderson BM, Bradley KA. Novel use of ViewRay MRI guidance for high-dose-rate brachytherapy in the treatment of cervical cancer. Brachytherapy 2018; 17:680-688. [DOI: 10.1016/j.brachy.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 10/14/2022]
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Workflow and efficiency in MRI-based high-dose-rate brachytherapy for cervical cancer in a high-volume brachytherapy center. Brachytherapy 2018; 17:753-760. [PMID: 29844009 DOI: 10.1016/j.brachy.2018.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE We report the clinical workflow and time required for MRI-based image-guided brachytherapy (MR-IGBT) of cervical cancer patients in a high-volume brachytherapy center with 10 years of experiences to provide a practical guideline for implementing MR-IGBT into clinical use. METHODS AND MATERIALS We recorded the time and workflow of each procedure step within the 40 consecutive ring and tandem applicator fractions of MR-IGBT by our multidisciplinary team. We divided the entire procedure into four sections based on where the procedure was performed: (1) applicator insertion under sedation, (2) MR imaging, (3) planning, and (4) treatment delivery. In addition, we compared the current procedure time to the initial procedure time when first implementing MR-IGBT in 2007-2008 via a retrospective review. RESULTS Mean total procedure time was 149.3 min (SD 17.9, ranges 112-178). The multidisciplinary team included an anesthesia team, radiologist, radiation oncologist, nurses, radiation therapists, MRI technicians, dosimetrists, and physicists. The mean procedure time and ranges for each section (min) were as follows: (1) 56.2 (28.0-103.0), (2) 31.0 (19.0-70.0), (3) 44.3 (21.0-104.0), and (4) 17.8 (9.0-34.0). Under current setting, the combined mean procedure time for MR imaging and planning was 63.2 min. In comparison, the same procedure took 137.7 min in 2007-2008 period, which was significantly longer than the current workflow (p < 0.001). CONCLUSIONS A skilled and dedicated multidisciplinary team is required for an efficient clinical workflow and delivery of MR-IGBT. Over the years, we have improved efficiency with clinical experience and continuous efforts in staff education.
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Mayadev J, Klapheke A, Yashar C, Hsu IC, Kamrava M, Mundt AJ, Mell LK, Einck J, Benedict S, Valicenti R, Cress R. Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. Gynecol Oncol 2018; 150:73-78. [PMID: 29709291 DOI: 10.1016/j.ygyno.2018.04.563] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. METHODS Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). RESULTS We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). CONCLUSIONS The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.
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Affiliation(s)
| | - Amy Klapheke
- California Cancer Registry, Sacramento, CA, United States
| | | | - I-Chow Hsu
- UCSF Medical Center, San Francisco, CA, United States
| | | | | | | | - John Einck
- UC San Diego, San Diego, CA, United States
| | | | | | - Rosemary Cress
- California Cancer Registry, Sacramento, CA, United States
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Tanderup K, Kirisits C, Damato AL. Treatment delivery verification in brachytherapy: Prospects of technology innovation. Brachytherapy 2018; 17:1-6. [PMID: 29406123 DOI: 10.1016/j.brachy.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - Christian Kirisits
- Department of Radiotherapy, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Antonio L Damato
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
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