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Lu Y, Chen J, Wang F, Zhou Q, Zhang X. A novel multi-channel applicator with a U-shaped channel for vaginal intracavity brachytherapy. J Appl Clin Med Phys 2024:e14521. [PMID: 39259886 DOI: 10.1002/acm2.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Endometrial cancer is one of the most common gynecological malignancies in the world. Vaginal brachytherapy is an important postoperative adjuvant treatment for endometrial cancer. However, a common problem with existing applicators is insufficient dose at the vaginal apex. PURPOSE This study describes the Hangzhou (HZ) cylinder, a novel 3D printed vaginal intracavity brachytherapy applicator, detailing its characteristics, dose distribution, and clinical applications. METHODS AND MATERIALS The HZ cylinder is distinguished by its unique structure: a U-shaped channel with a 2 mm diameter, a straight central axis channel of the same diameter, and 10 parallel straight channels. For comparison, standard plans were employed, designed to ensure that a minimum of 95% of the prescribed dose reached 5 mm beneath the mucosal surface. We conducted comparative analyses of mucosal surface doses and doses at a 5 mm depth below the mucosa between the HZ cylinder and a conventional single-channel cylinder across various treatment schemes. Additionally, the study examined dose differences in target volume and organs at risk (OARs) between actual HZ cylinder plans and hypothetical single-channel plans. RESULTS In the standard plans, mucosal surface doses at the apex of the vagina were 209.32% and 200.61% of the prescribed dose with the HZ and single-channel cylinders, respectively. The doses on the left and right wall mucosal surfaces varied from 149.26% to 178.13% and 142.98% to 180.75% of the prescribed dose, and on the anterior and posterior wall mucosal surfaces varied from 128.87% to 138.50% and 142.98% to 180.75% of the prescribed dose. Analysis of 24 actual treatment plans revealed that when the vaginal tissue volume dose covering 98% (vaginal D98%) was comparable between the HZ cylinder and virtual single-channel plans (6.74 ± 0.07 Gy vs. 6.69 ± 0.10 Gy, p = 0.24), rectum doses of HZ cylinder plans were significantly lower than those of single-channel plans (D1cc, 5.96 ± 0.56 Gy vs. 6.26 ± 0.71 Gy, p = 0.02 and D2cc, 5.26 ± 0.52 Gy vs. 5.56 ± 0.62 Gy, p = 0.02). CONCLUSIONS The HZ cylinder demonstrates a reduction in dose to the rectum and bladder while maintaining adequate target volume coverage. Its mucosal surface dose is comparable to that of the traditional single-channel cylinder. These findings suggest that the HZ cylinder is a viable and potentially safer alternative for vaginal brachytherapy, warranting further investigation with larger sample sizes.
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Affiliation(s)
- Yanfei Lu
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jianhong Chen
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Fangfang Wang
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Qiong Zhou
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xiang Zhang
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Yashaswini BR, Pasha T, Reddy BR, Naveen T, Palled SR, Krishna U, Lokesh V, Sridhar P, Nikhila R, Thejaswini B, Swaroopa C. Comparison of dosimetric analysis of organs at risk and target volumes for ovoids and cylinders in endometrial carcinoma. J Contemp Brachytherapy 2023; 15:414-421. [PMID: 38230405 PMCID: PMC10789155 DOI: 10.5114/jcb.2023.134171] [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: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose To compare dose volume parameters of target and organs at risk in vaginal vault brachytherapy using ovoids or cylinder in post-operative endometrial carcinoma. Material and methods The study was done among 25 histologically proven post-operative endometrial carcinoma patients requiring vaginal brachytherapy. All patients underwent both cylinder and ovoids application alternatively on weekly basis. Ovoids size ranged from 2 to 3 cm diameter. Diameters of cylinder ranged between 2.5 and 3.5 cm. Bladder, rectum, urethra, and clinical target volume (CTV) were contoured on CT simulation images. Prescribed dose was 6-7 Gy in 2-3 fractions at 0.5 cm from the surface of applicator. Results The mean values of D90, D50, V150, V100, V90, and V50 of CTV were comparable between cylinder and ovoids plans. The mean dose of CTV was significantly higher with cylinder than with ovoids, and D100 was significantly higher with ovoids (mean = 15.63 Gy vs. 14.64 Gy, p = 0.016, and D100 = 37.82% vs. 42.86%, p = 0.042, for cylinder vs. ovoids). In the dosimetry of the vault, D90, D50, V100, V90, V50, and mean of the vault did not show any significant difference between cylinder and ovoids. The V150 was significantly higher with cylinder plans than ovoids, and D100 of the vault was significantly higher with ovoids plans (V150 = 14.81% vs. 6.86%, p = 0.02, and D100 = 37.77% vs. 44.80%, p = 0.029, for cylinder vs. ovoids). D0.1cc, D1cc, D2cc, and mean for the bladder, rectum, and urethra were comparable between the cylinder and ovoid plans. Conclusions The present study showed that the dose to organs at risk, most of the dosimetric parameters of CTV, and vault were comparable between the cylinder and ovoid plans. Both applicators provide good reproducibility. The choice of applicator will ultimately depend on the institutional policies and oncologist decision. However, in patients with dog-ear configuration of the vagina, ovoids may be preferred as per ABS guidelines.
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Affiliation(s)
- BR Yashaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Tanvir Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - B Rekha Reddy
- Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - T Naveen
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Siddanna R Palled
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Uday Krishna
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - V Lokesh
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - P Sridhar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - R Nikhila
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Rios-Doria E, Cun HT, Filippova OT, Mueller JJ, Alektiar KM, Ellenson LH, Makker V, Lakhman Y, Leitao MM, Jhingran A, Soliman PT, Abu-Rustum NR. Isolated vaginal recurrence in women with stage I endometrial cancer. Gynecol Oncol 2023; 179:9-15. [PMID: 37864854 PMCID: PMC11215939 DOI: 10.1016/j.ygyno.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To compare clinical and pathologic characteristics of women with surgical stage I endometrial carcinoma by location of first recurrence and describe characteristics of isolated vaginal recurrence. METHODS Patients with 2009 International Federation of Obstetrics and Gynecology (FIGO) stage I endometrial carcinoma treated at two large cancer centers from 1/1/2009-12/31/2017 were identified. Sarcoma histology was excluded. Recurrences were grouped into isolated vaginal or extravaginal. Isolated vaginal recurrences were localized by anatomic location within the vaginal vault. Clinical and pathologic variables were compared with chi-square analysis, and Kaplan-Meier curves with log-rank tests. RESULTS Of 2815 women identified, 278 (10%) experienced a recurrence. Sixty-one patients (2%) had an isolated vaginal recurrence, including 42 (69%) at the vaginal apex; 217 (8%) had an extravaginal recurrence, including 18 with a vaginal component. Median time to recurrence was 11 months (range, 1-68) for isolated vaginal recurrence and 20 months (range, 1-98) for extravaginal recurrence (P < .004). Of 960 patients (34%) treated with adjuvant vaginal brachytherapy (VBT), 156 (16%) recurred; 19 (2%) had an isolated vaginal recurrence, including 16 (84%) at the vaginal apex. Three-year PFS rates for isolated vaginal recurrence were 97.6% (SE ± 0.4%) with minimally invasive surgery (MIS) versus 96.9% (SE ± 1.1%) with open (P = .8), and for extravaginal recurrence were 91.8% (SE ± 0.7%) with MIS versus 90.8% (SE ± 1.8%) with open (P = .8). CONCLUSIONS Isolated vaginal recurrences in stage I endometrial cancer are detected earlier than non-vaginal recurrences. Surgical approach does not appear to impact recurrence. Adjuvant VBT after primary surgery carries a 1%-2% risk of isolated vaginal apex recurrence.
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Affiliation(s)
- Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Han T Cun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora H Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Noorian F, Abellana R, Zhang Y, Herreros A, Baltrons C, Lancellota V, Tagliaferri L, Sabater S, Torne A, Rovirosa A. Are 7.5 Gy×2 fractions more efficient than 6 Gy×3 in exclusive postoperative endometrial cancer brachytherapy? A clinical and dosimetrical analysis. Radiother Oncol 2023; 189:109909. [PMID: 37699447 DOI: 10.1016/j.radonc.2023.109909] [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: 05/20/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To compare two vaginal brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) patients considering vaginal-cuff relapses (VCR), late toxicities, dosimetry analysis and vaginal dilator use. MATERIAL AND METHODS 110 PEC patients were treated with exclusive high-dose-rate VBT using two schedules. Group-1:44-patients received 6 Gy×3fractions (September-2011-April-2014); Group-2:66-patients were treated with 7.5 Gy×2fractions with a dose limit of equivalent total doses in 2-Gy fr (EQD2(α/β=3)) of 68 Gy in the most exposed 2 cm3 of clinical target volume (CTV) (July-2015-November-2021). The dose was prescribed at 5 mm from the applicator surface. Were evaluated the overall radiation dose delivered to 90% of the CTV (D90), the CTV receiving 100% of the prescription dose (V100) and the EQD2(α/β=3) received in the most exposed 2 cm3 to dose in CTV. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum and objective LENT-SOMA criteria for late vaginal toxicity (LVT). STATISTICS Descriptive analysis, Chi-square, Student's t-tests and Kaplan and Meier method. RESULTS The median follow-up was 60 months (15.9-60). There were no VCR or late toxicities in bladder or rectum. LVT ≥ G1 appeared in 26/44 (59.1%) in Group-1 and 25/66 (37.9%) in Group-2. The mean EQD2(α/β=3) received by the most exposed 2 cm3 of CTV was 63.7 Gy ± 10.0 in Group-1 and 60.5 Gy ± 3.8 in Group-2 (p = 0.063). There were no differences in adherence to vaginal dilator use ≥9 months, overall D90 and V100. CONCLUSION Considering the lack of vaginal relapses and similar LVT over time, 7.5 Gy×2fractions seem more efficient in terms of patient comfort, workload, and cost. This is the first study using dosimetry parameters to compare effectivity of schedules. Larger series are needed to confirm the present results.
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Affiliation(s)
- Faegheh Noorian
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Rosa Abellana
- Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Yaowen Zhang
- Cancer Center, Henan Provincial People's Hospital, No.7 Weiwu Road, Zhengzhou 450003, China.
| | - Antonio Herreros
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Clara Baltrons
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
| | - Vallentina Lancellota
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
| | | | - Aureli Torne
- Gynecological Cancer Unit, Hospital Clinic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
| | - Angeles Rovirosa
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
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Kunz JN, Huang YJ, Casper AC, Suneja G, Burt LM, Jhingran A, Joyner MM, Harkenrider MM, Small W, Grant JD, Kidd EA, Boucher K, Gaffney DK. Dosimetric Evaluation of Organs at Risk From SAVE Protocol. Int J Radiat Oncol Biol Phys 2023; 117:274-280. [PMID: 37023988 DOI: 10.1016/j.ijrobp.2023.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The objective of this work was to evaluate dosimetric characteristics to organs at risk (OARs) from short-course adjuvant vaginal cuff brachytherapy (VCB) in early endometrial cancer compared with standard of care (SOC) in a multi-institutional prospective randomized trial. METHODS AND MATERIALS SAVE (Short Course Adjuvant Vaginal Brachytherapy in Early Endometrial Cancer Compared to Standard of Care) is a prospective, phase 3, multisite randomized trial in which 108 patients requiring VCB were randomized to an experimental short-course arm (11 Gy × 2 fractions [fx] to surface) and SOC arm. Those randomized to the SOC arm were subdivided into treatment groups based on treating physician discretion as follows: 7 Gy × 3 fx to 5 mm, 5 to 5.5 Gy × 4 fx to 5 mm, and 6 Gy × 5 fx to surface. To evaluate doses to OARs of each SAVE cohort, the rectum, bladder, sigmoid, small bowel, and urethra were contoured on planning computed tomography, and doses to OARs were compared by treatment arm. Absolute doses for each OAR and from each fractionation scheme were converted to 2 Gy equivalent dose (EQD23). Each SOC arm was compared with the experimental arm separately using 1-way analysis of variance, followed by pairwise comparisons using Tukey's honestly significant difference test. RESULTS The experimental arm had significantly lower doses for rectum, bladder, sigmoid, and urethra compared with the 7 Gy × 3 and 5 to 5.5 Gy × 4 fractionation schemes; however, the experimental arm did not differ from the 6 Gy × 5 fractionation scheme. For small bowel doses, none of the SOC fractionation schemes were statistically different than the experimental. The highest EQD23 doses to the examined OARs were observed to come from the most common dose fractionation scheme of 7 Gy × 3 fx. With a short median follow-up of 1 year, there have been no isolated vaginal recurrences. CONCLUSIONS Experimental short-course VCB of 11 Gy × 2 fx to the surface provides a comparable biologically effective dose to SOC courses. Experimental short-course VCB was found to reduce or be comparable to D2cc and D0.1cc EQD23 doses to rectum, bladder, sigmoid, small bowel, and urethra critical structures. This may translate into a comparable or lower rate of acute and late adverse effects.
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Affiliation(s)
- Jeremy N Kunz
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
| | - Y Jessica Huang
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anthony C Casper
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lindsay M Burt
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anuja Jhingran
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Melissa M Joyner
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Jonathan D Grant
- Department of Radiation Oncology, Intermountain Medical Center, Intermountain Health Care, Murray, Utah
| | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Ken Boucher
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Wang W, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Hu K, Zhang F, Hou X, Wei L, Zou L. Practice patterns of adjuvant radiotherapy in women with stage I to II endometrial carcinoma: a real-world multi-institutional analysis in China. BMC Womens Health 2023; 23:417. [PMID: 37553639 PMCID: PMC10410771 DOI: 10.1186/s12905-023-02548-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/14/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND This study aimed to report clinical practice patterns of postoperative radiotherapy for stage I to II endometrial carcinoma (EC) patients treated in 13 Chinese medical centers. METHODS We included early stage EC patients treated by hysterectomy and adjuvant RT between 2003 and 2017 from 13 institutions. Patients were classified into 4 risk groups based on ESMO-ESGO-ESTRO recommendations (2014). RESULTS A total of 1,227 cases were analyzed. Along the 15 years of the study, an increasing tendency was found towards administration for vaginal brachytherapy (VBT) alone, while the proportion of external beam pelvic radiotherapy (EBRT) alone remained stable in the corresponding period. When radiation modalities were stratified by risk groups, proportion of VBT alone significantly increased in all risk groups. The higher the risk, the later VBT became the main adjuvant treatment modality. However, EBRT alone or with VBT remained the main adjuvant method for high-risk patients. There were 13 dose-fractionation schemes for VBT alone with the scheme of 30 Gy in 6 fractions prescribed at 0.5cm under the vaginal mucosa accounting for most. There were 17 schemes for VBT boost and the most common schedule was 10 Gy in 2 fractions. The upper 3-5cm part of vagina was the most frequent target. 89.6% of the practitioners performed two-dimensional VBT technique. The median dose for EBRT was 50 Gy. From 2003 to 2017, conventional radiotherapy was gradually replaced by three-dimensional conformal radiotherapy modality and intensity modulated radiotherapy. CONCLUSION We report a significant shift from EBRT to VBT alone for high-intermediate-risk, intermediate-risk and low-risk EC patients from 2003 to 2017 while EBRT remained the main radiation modality for high-risk early stage patients. There has been remarkable heterogeneity among VBT dose fractionation schedules across China. TRIAL REGISTRATION The clinical trial ID was ChiCTR-PRC-17010712. It was authorized by the Institutional Review Board of Peking Union Medical College Hospital (N0. S-K139).
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Affiliation(s)
- Wenhui Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tiejun Wang
- Department of Radiation Oncology, The Second Hospital Affiliated By Jilin University, Changchun, People's Republic of China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianli He
- Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Xiaoge Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Wei Zhong
- Gynaecological Oncology Radiotherapy, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Fengjv Zhao
- Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, People's Republic of China
| | - Sha Li
- Department of Radiation Oncology, The 940Th Hospital of Joint Logistics Support Force of Chinesc People's Liberation Army, Lanzhou, Gansu, People's Republic of China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital Central South University, Changsha, Hunan, People's Republic of China
| | - Zhanshu Ma
- Department of Radiation Oncology, Affiliated Hospital of Chi Feng University, Chifeng, Inner Mongolia, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (the Fourth Military Medical University), Xi'an, People's Republic of China.
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China.
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Wallner K, Sherertz T, Anderson A, Blau M, Panjwani N. (Potential) mishaps of high dose rate vaginal cuff brachytherapy. Pract Radiat Oncol 2023:S1879-8500(23)00050-4. [PMID: 36889643 DOI: 10.1016/j.prro.2023.02.005] [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: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Considering how commonly vaginal cuff brachytherapy is used, there is relatively little literature regarding the potential, albeit low, risk for complications. We present here three potentially serious mishaps, involving cylinder misplacement, dehiscence, and excessive normal tissue irradiation due to unique anatomy. METHODS Three patients with potentially serious treatment errors were encountered in the authors' usual clinical practice. Each patient's records were reviewed for this report. RESULTS For patient #1, CT simulation revealed grossly inadequate cylinder insertion, most obvious on the sagittal view. For patient #2, CT simulation revealed that the cylinder extended beyond the perforated vaginal cuff and was surrounded by bowel. For patient #3, CT images were used only to verify cylinder depth. A standard library plan, based on cylinder diameter and active length was used. In retrospect, the images revealed an unusually thin rectovaginal septum, with the lateral and posterior vaginal wall thickness estimated to be less than 2 mm. Her fractional normal tissue doses were calculated for this report, revealing a rectal Dmax (per fraction) of 10.8 Gy, D2.0 of 7.4 Gy, and a V100 of 2.8 cc. All doses were far in excess of those anticipated for a minimal 0.5 cm vaginal wall depth. CONCLUSION Vaginal cuff HDR brachytherapy is a high volume, routine procedure. Even in experienced hands, however, it carries a risk of improper cylinder placement, cuff dehiscence, and excessive normal tissue dose, all of which could seriously impact outcomes. These potential mishaps would be better appreciated and avoided with more extensive use of CT-based quality assurance measures.
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Affiliation(s)
- Kent Wallner
- Department of Radiation Oncology, University of Washington, Seattle, WA.
| | - Tracy Sherertz
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - August Anderson
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Molly Blau
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Neil Panjwani
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Harkenrider MM, Kamrava M. Embracing a future of progress in gynecologic brachytherapy. Brachytherapy 2023; 22:6-8. [PMID: 36725200 DOI: 10.1016/j.brachy.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/31/2023]
Abstract
In the last 20 years, gynecologic brachytherapy has made tremendous advancements, most prominently evidenced by the evolution of cervical cancer brachytherapy. In its 20 year history, Brachytherapy has become known as a journal of science, education, and advocacy for our specialty and for our patients. In this review, we celebrate the 25 most impactful manuscripts in gynecologic brachytherapy in the journal's history.
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Affiliation(s)
- Matthew M Harkenrider
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL.
| | - Mitchell Kamrava
- Cedars Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA
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Harkenrider MM, Abu-Rustum N, Albuquerque K, Bradfield L, Bradley K, Dolinar E, Doll CM, Elshaikh M, Frick MA, Gehrig PA, Han K, Hathout L, Jones E, Klopp A, Mourtada F, Suneja G, Wright AA, Yashar C, Erickson BA. Radiation Therapy for Endometrial Cancer: An American Society for Radiation Oncology Clinical Practice Guideline. Pract Radiat Oncol 2023; 13:41-65. [PMID: 36280107 DOI: 10.1016/j.prro.2022.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE With the results of several recently published clinical trials, this guideline informs on the use of adjuvant radiation therapy (RT) and systemic therapy in the treatment of endometrial cancer. Updated evidence-based recommendations provide indications for adjuvant RT and the associated techniques, the utilization and sequencing of adjuvant systemic therapies, and the effect of surgical staging techniques and molecular tumor profiling. METHODS The American Society for Radiation Oncology convened a multidisciplinary task force to address 6 key questions that focused on the adjuvant management of patients with endometrial cancer. The key questions emphasized the (1) indications for adjuvant RT, (2) RT techniques, target volumes, dose fractionation, and treatment planning aims, (3) indications for systemic therapy, (4) sequencing of systemic therapy with RT, (5) effect of lymph node assessment on utilization of adjuvant therapy, and (6) effect of molecular tumor profiling on utilization of adjuvant therapy. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation. RESULTS The task force recommends RT (either vaginal brachytherapy or external beam RT) be given based on the patient's clinical-pathologic risk factors to reduce risk of vaginal and/or pelvic recurrence. When external beam RT is delivered, intensity modulated RT with daily image guided RT is recommended to reduce acute and late toxicity. Chemotherapy is recommended for patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II with high-risk histologies and those with FIGO stage III to IVA with any histology. When sequencing chemotherapy and RT, there is no prospective data to support an optimal sequence. Sentinel lymph node mapping is recommended over pelvic lymphadenectomy for surgical nodal staging. Data on sentinel lymph node pathologic ultrastaging status supports that patients with isolated tumor cells be treated as node negative and adjuvant therapy based on uterine risk factors and patients with micrometastases be treated as node positive. The available data on molecular characterization of endometrial cancer are compelling and should be increasingly considered when making recommendations for adjuvant therapy. CONCLUSIONS These recommendations guide evidence-based best clinical practices on the use of adjuvant therapy for endometrial cancer.
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Affiliation(s)
- Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
| | - Nadeem Abu-Rustum
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Kristin Bradley
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin
| | | | - Corinne M Doll
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Mohamed Elshaikh
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Melissa A Frick
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Paola A Gehrig
- Division of Gynecologic Oncology, University of Virginia, Charlottesville, Virginia
| | - Kathy Han
- Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas Mourtada
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California, San Diego, California
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Wang W, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Hu K, Zhang F, Hou X, Wei L, Zou L. Overview of adjuvant radiotherapy on survival, failure pattern and toxicity in stage I to II endometrial carcinoma: a long-term multi-institutional analysis in China. BMC Cancer 2022; 22:266. [PMID: 35287626 PMCID: PMC8919553 DOI: 10.1186/s12885-022-09343-4] [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: 10/09/2021] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background This research aimed to provide an overview of the impact of adjuvant vaginal brachytherapy (VBT) and external beam pelvic radiotherapy (EBRT) with or without VBT on survival in stage I to II EC patients in China from a long-term multi-institutional analysis. Methods We retrospectively analyzed stage I to II EC patients from 13 institutions treated between 2003 and 2015. All patients underwent surgical staging and received adjuvant RT. Patients were divided into groups of low-risk (LR), intermediate-risk (IR), high-intermediate-risk (HIR) and high-risk (HR). Survival statistics, failure pattern, and toxicity of different radiation modalities in different risk groups were analyzed. Results A total of 1048 patients were included. HR disease represented 27.6%, HIR 17.7%, IR 27.7% and LR 27.1%, respectively. Endometrioid adenocarcinoma (EAC) and non-endometrioid carcinoma (NEC) accounted for 92.8 and 7.2%. A total of 474 patients received VBT alone and 574 patients received EBRT with or without VBT. As for EAC patients, the 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rate was: 94.6, 90.4, 93.0 and 91.6%, respectively. For LR patients, EBRT (with or without VBT) seemed to be a risk factor. With the higher risk category, the survival benefit of EBRT gradually became remarkable. EBRT (with or without VBT) significantly increased DFS, LRFS and DMFS compared to VBT alone in the HR group (p < 0.05). Distant metastasis was the main failure pattern for all risk groups. As for NEC patients, the 5-year OS, DFS, LRFS and DMFS rate was: 93.4, 87.2, 91.7 and 89.3%, respectively. As for toxicity, EBRT (with or without VBT) significantly increased the incidence of grade 1–2 gastrointestinal, urinary, and hematological toxicity. Conclusions For stage I to II EC patients, EAC accounted for the majority and had better prognosis than NEC. For EAC patients, VBT alone resulted in comparable survival to EBRT in the LR, IR and HIR groups, while EBRT significantly increased survival in the HR group. EBRT had higher rate of toxicity than VBT.
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Affiliation(s)
- Wenhui Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Tiejun Wang
- Department of Radiation Oncology, The second hospital Affiliated by Jilin University, Changchun, People's Republic of China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianli He
- Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Xiaoge Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Wei Zhong
- Gynaecological Oncology Radiotherapy, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Fengjv Zhao
- Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, People's Republic of China
| | - Sha Li
- Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support force of Chinesc People's Liberation Army, Lanzhou, Gansu, People's Republic of China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital Central South University, Changsha, Hunan, People's Republic of China
| | - Zhanshu Ma
- Department of Radiation Oncology, Affiliated Hospital of Chi feng University, Chifeng, Inner Mongolia, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China.
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (the Fourth Military Medical University), Xi'an, People's Republic of China.
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China.
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Parsons MW, Huang YJ, Burt L, Suneja G, Gaffney D. Vaginal cuff brachytherapy for endometrial cancer: a review of major clinical trials with a focus on fractionation. Int J Gynecol Cancer 2022; 32:311-315. [DOI: 10.1136/ijgc-2021-002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
The use of vaginal cuff brachytherapy in the adjuvant management of endometrial cancer has increased over time. Recommendations from the American Brachytherapy Society, American Society of Radiation Oncology, and European Society for Medical Oncology help to guide the application of vaginal cuff brachytherapy. However, wide variation in practice remains regarding treatment techniques. This article reviews the use of vaginal cuff brachytherapy in the post-operative management of endometrial cancer. It covers risk stratification, treatment rationale, outcomes, and treatment planning recommendations with a specific focus on dose-fractionation regimens. The authors performed a thorough literature review of articles pertinent to the goals of this review. Also presented are early results of the Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared with Standard of Care (SAVE) trial of a two-fraction vaginal cuff brachytherapy regimen.Adjuvant vaginal cuff brachytherapy for early-stage endometrial cancer results in excellent disease control with minimal toxicity. The PORTEC-2 trial showed that vaginal cuff brachytherapy is non-inferior to external beam radiation for vaginal recurrence in patients at high-intermediate risk. Vaginal cuff brachytherapy may also be used as a boost following external beam radiation in combination with chemotherapy for high-risk histologies. Numerous techniques can be used for vaginal cuff brachytherapy, including various medical devices, dose-fractionation schedules, and treatment planning approaches. The early control results of the SAVE trial are promising and we are hopeful that this trial establishes two fraction regimens as a viable option for vaginal cuff brachytherapy.
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Lancellotta V, Macchia G, Dinapoli N, Autorino R, Campitelli M, Nardangeli A, Salvati A, Fionda B, Casà C, Cornacchione P, Rovirosa A, Kovács G, Morganti AG, Ferrandina MG, Gambacorta MA, Tagliaferri L. EROS 2.0 study: evaluation of two interventional radiotherapy (brachytherapy) schedules for endometrial cancer: a comparison of late vaginal toxicity rates. LA RADIOLOGIA MEDICA 2022; 127:341-348. [PMID: 35092552 PMCID: PMC8960610 DOI: 10.1007/s11547-022-01455-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the late toxicity rates after two different high dose rate (HDR) adjuvant intravaginal interventional radiotherapy (IRT-brachytherapy) dose schedules in stage I-II endometrial cancer. METHODS Stage I-II patients with endometrial cancer treated with surgery (with or without lymphadenectomy) and adjuvant HDR-IRT between 2014 and 2020 were included in this analysis. Patients were treated with two schedules. In the first cohort (C1), 21 Gy were delivered in three weekly fractions (7 Gy) prescribed 0.5 cm from the applicator surface. In the second cohort (C2), 24 Gy were delivered in four weekly fractions (6 Gy). The clinical target volume was the upper third of the vagina for C1 and the upper 3 cm for C2. HDR-IRT technique and point prescription (5 mm depth from the applicator surface) were the same for all patients. Vaginal toxicity was scored according to the CTCAE 5.0 scale in terms of the presence versus absence of any toxicity grade. The correlation among toxicity and clinical covariates (age, lymphadenectomy, fractionation, stage) was tested by Pearson correlation test (univariate) and by logistic regression (multivariable). RESULTS 114 stage I and three stage II patients, median age 62 (range: 32-85) years, were included in this analysis. The mean follow-up was 56.3 months in C1 (40-76) and 20 months in C2 (8-42). Vaginal late toxicity was recorded in 40 and 15 patients in C1 and 2, respectively. Age, lymphadenectomy, and fractionation were significantly correlated with toxicity at univariate analysis (p value = 0.029, 0.006, and 0.002, respectively), while stepwise logistic regression confirmed only age and fractionation as significantly correlated parameters (p value = 0.02 and 0.001, respectively). Three-year local relapse-free, distant metastasis-free and cause-specific survival rates were 96.6%, 94.8%, and 99.1%, respectively. CONCLUSIONS This analysis showed lower vaginal late toxicity rate in C2 compared to C1.
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Affiliation(s)
- Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Gabriella Macchia
- Gemelli Molise Hospital, Radiation Oncology Unit, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy.
| | - Nicola Dinapoli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Rosa Autorino
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Maura Campitelli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Alessia Nardangeli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Alessandra Salvati
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
| | - Angeles Rovirosa
- Department of Radiation Oncology, Hospital Clinic i Universitari, Fonaments Clinics Department, University of Barcelona, 08036, Barcelona, Spain
| | - György Kovács
- Università Cattolica del Sacro Cuore, 00128, Roma, Italy
| | - Alessio Giuseppe Morganti
- Radiotherapy Center, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138, Bologna, Italy
- DIMES, Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Maria Gabriella Ferrandina
- Woman, Child and Public Health Department, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Roma, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00128, Rome, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00128, Rome, Italy
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The role for vaginal cuff brachytherapy boost after external beam radiation therapy in endometrial cancer. Brachytherapy 2022; 21:177-185. [PMID: 35210017 DOI: 10.1016/j.brachy.2021.10.006] [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: 06/17/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the role and technique of a vaginal cuff brachytherapy (VB) boost to adjuvant external beam (EB) radiation for endometrial cancer through a systematic review. METHODS AND MATERIALS Relevant trials were identified through a systematic search of the literature. RESULTS A total of 21 prospective and retrospective studies which had a patient cohort undergoing EB + VB was identified to evaluate for rates of vaginal and pelvic recurrences, overall survival, and toxicity. Additional database studies were utilized to demonstrate differences in local control and overall survival between EB and EB + VB. CONCLUSIONS While there is limited prospective evidence to guide the use of a VB boost after EB, the evidence suggests that patients with a higher risk of a vaginal recurrence such as those with cervical stromal involvement in select Stage III patients may derive local control and survival benefits from a VB boost. Additional individual risk factors such as grade, histology, extent of invasion, margin status, age, and the use of lower doses of EB should be considered when deciding when to add a VB boost.
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Nieto K, Levine B, Brown D, Lanier C, Carriere P, McGinnis H, Hines K, Greven K. Pilot study to assess sexual function, quality of life (QOL) and change in vaginal dimensions following vaginal brachytherapy (VBT). Brachytherapy 2022; 21:283-290. [DOI: 10.1016/j.brachy.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
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Abstract
Although endometrial cancer management remains challenging, a deeper understanding of the genetic diversity as well as the drivers of the various pathogenic states of this disease has led to development of divergent management approaches in an effort to improve therapeutic precision in this complex malignancy. This comprehensive review provides an update on the epidemiology, pathophysiology, diagnosis and molecular classification, recent advancements in disease management, as well as important patient quality-of-life considerations and emerging developments in the rapidly evolving therapeutic landscape of endometrial cancers.
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Affiliation(s)
- Vicky Makker
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Helen MacKay
- University of Toronto, Division of Medical Oncology & Hematology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Leon Berard, Laboratoire Reshape University Claude Bernard Lyon, Lyon, France
| | - Douglas A Levine
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Merck Research Labs, Rahway, NJ, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Jiang P, Zou L, Wei L, Cheng G, Sun B, Zhang F, Wang R, Wang T, Qu A, Yuan X, Qiu B, Wei S, Liu Z, Zhang Y, Wang J. Chinese Expert Consensus on Iodine 125 Seed Implantation for Recurrent Cervical Cancer in 2021. Front Oncol 2021; 11:700710. [PMID: 34858802 PMCID: PMC8630633 DOI: 10.3389/fonc.2021.700710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/14/2021] [Indexed: 01/07/2023] Open
Abstract
The treatment modality for recurrent cervical cancer (rCC) is limited, and the prognosis of these patients is poor. Seed implantation could be an important component of rCC management in the context of dose boost or salvage therapy after surgery or radiotherapy, which is characterized by a minimally invasive, high local dose, and rapidly does fall, sparing normal tissue. For patients with good performance status and lateral pelvic wall recurrence with an available puncture path, seed implantation was recommended, as well as for selected central pelvic recurrence and extra-pelvic recurrence. The combination of brachytherapy treatment planning system and CT guidance was needed, and three-dimensional printing templates could greatly improve the accuracy, efficiency, and quality of seed implantation to achieve a potential ablative effect and provide an efficient treatment for rCC. However, the recommendations of seed implantation were mainly based on retrospective articles and lack high-quality evidence, and multicenter prospective randomized studies are needed. In this consensus on iodine125 seed implantation for rCC, indication selection, technical process and requirements, dosimetry criteria, radiation protection, combined systemic therapy, and outcomes of seed implantation for rCC are discussed.
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Affiliation(s)
- Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Lijuan Zou
- Department Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baosheng Sun
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Beijing, China
| | - Ruoyu Wang
- Department of Radiation Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Tiejun Wang
- Department of Radiation Oncology, The Second Hospital of Jilin University, Changchun, China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xiangkun Yuan
- Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Shuhua Wei
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zi Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xian, China
| | - Yunyan Zhang
- Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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17
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Nichols MR, Gaskins JT, Metzinger DS, Todd SL, Eldredge-Hindy HB, Silva SR. Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky. South Med J 2021; 114:630-635. [PMID: 34599340 DOI: 10.14423/smj.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed. METHODS Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women. RESULTS The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined. CONCLUSIONS The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.
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Affiliation(s)
- Matthew R Nichols
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Jeremy T Gaskins
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Daniel S Metzinger
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sarah L Todd
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Harriet B Eldredge-Hindy
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Scott R Silva
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
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Harkenrider MM, Albuquerque K, Brown D, Kamrava M, King M, Mourtada F, Orio P, Patel R, Price M, Rassiah P, Solanki AA, Small W, Schechter NR. ACR-ABS-ASTRO practice parameter for the performance of radionuclide-based high-dose-rate brachytherapy. Brachytherapy 2021; 20:1071-1082. [PMID: 34588143 DOI: 10.1016/j.brachy.2021.08.009] [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: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This practice parameter aims to detail the processes, qualifications of personnel, patient selection, equipment, patient and personnel safety, documentation, and quality control and improvement necessary for an HDR brachytherapy program. METHODS AND MATERIALS This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO). RESULTS Brachytherapy is a radiotherapeutic modality in which radionuclide or electronic sources are used to deliver a radiation dose at a distance of up to a few centimeters by surface, intracavitary, intraluminal, or interstitial application. Brachytherapy alone or combined with external beam radiotherapy plays an important role in the management and treatment of patients with cancer. High-dose-rate (HDR) brachytherapy uses radionuclides, such as iridium-192, at dose rates of ≥12 Gy/hr to a designated target point or volume, and it is an important treatment for a variety of malignant and benign conditions. Its use allows for application of high doses of radiation to defined target volumes with relative sparing of adjacent critical structures. CONCLUSIONS HDR brachytherapy requires detailed attention to personnel, equipment, patient and personnel safety, and continuing staff education. Coordination between the radiation oncologist and treatment planning staff and effective quality assurance procedures are important components of successful HDR brachytherapy programs.
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Affiliation(s)
| | - Kevin Albuquerque
- UT Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX
| | | | | | - Martin King
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - Peter Orio
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - Michael Price
- Columbia University Irving Medical Center, New York, NY
| | - Prema Rassiah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - William Small
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Naomi R Schechter
- Keck Medical Center of USC, Norris Comprehensive Cancer, Center, University of Southern California, Los Angeles, CA
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19
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Rovirosa A, Zhang Y, Chargari C, Cooper R, Bownes P, Wojcieszek P, Stankiewicz M, Hoskin P, Van der Steen-Banasik E, Segedin B, Najjari D, Pötter R, Tanderup K, Van Limbergen E. Exclusive 3D-brachytherapy as a good option for stage-I inoperable endometrial cancer: a retrospective analysis in the gynaecological cancer GEC-ESTRO Working Group. Clin Transl Oncol 2021; 24:254-265. [PMID: 34272660 DOI: 10.1007/s12094-021-02680-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Analyse outcomes of stage-I inoperable endometrial cancer (EC) patients from seven European centres treated with 3D-image-guided brachytherapy (IGBT) alone. MATERIALS AND METHODS From 2004 to 2018, 62 patients (41 stage-IA and 21 IB) were retrospectively studied, analysing anaesthetic procedure, applicator type, BT-planning imaging, clinical target volume (CTV), BT schedule, overall daily-dose equivalent to 2 Gy (EQD2(α/β=4.5 or 3)) to the CTV(α/β=4.5) and D2 cm3(α/β=3) for organs at risk. Complications were evaluated using CTCAEv4 scores. The 2 and 5 year survival was calculated [cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS)]. Descriptive analysis and the Kaplan-Meier method were used for survival analysis. RESULTS Mean follow-up: 32.8 months (SD 33.7). Spinal anaesthesia (38/62) followed by none (16/62) were the most common. Y-shaped Rotte applicators were used in 74% of patients. High-dose rate brachytherapy was administered in 89%. Median D90 to the CTV was 58.9 Gy (8.66-144 Gy). Eight patients presented relapse: four uterine, four nodal and four distant. The 2 and 5 year CSS was 93.3 and 80.5%, DFS 84.8 and 80.5%, LRFS was 93.1 and 88.7%, LRRFS was 91 and 91% and DMFS was 90.2 and 90.2%, respectively, CSS was better in stage-IA vs. IB (p = 0.043). Late vaginal and bladder G3-complication rates were 2.1%, respectively. CONCLUSION Inoperable EC patients can be safely treated by BT with 2 and 5 year CSS of 93 and 80.5%, respectively, with even better results for IA cases. Prospective studies on 3D-IGBT are necessary to better analyse EC patient outcomes based on dose and treated volumes.
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Affiliation(s)
- Angeles Rovirosa
- Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, C/Casanovas 153, 08036, Barcelona, Spain.
| | - Yaowen Zhang
- Cancer Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Cyrus Chargari
- Radiation Oncology Department, Institute Gustave Roussy, 114, rue Édouard-Vaillant, 94805, Villejuif Cedex, France
| | - Rachel Cooper
- Leeds Cancer Centre, Beckett Street, Leeds, LS9 7TF, UK
| | - Peter Bownes
- Leeds Cancer Centre, Beckett Street, Leeds, LS9 7TF, UK
| | - Piotr Wojcieszek
- Maria Sklodowska-Curie National Research Institute of Oncology, Oddział w Gliwicach Ul Wybrzeże Armii Krajowej, 15 44-102, Gliwice, Poland
| | - Magdalena Stankiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Oddział w Gliwicach Ul Wybrzeże Armii Krajowej, 15 44-102, Gliwice, Poland
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | | | - Barbara Segedin
- Institute of Oncology of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Dina Najjari
- Institut Català D'Oncologia, Avinguda Granvia de l'Hospitalet 199-203, 08908, l', Hospitalet de Llobregat, Barcelona, Spain
| | - Richard Pötter
- Department of Radiation Oncology, Medical University of Vienna, Spitalgasse, 23 1090, Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Erik Van Limbergen
- Radiation Oncology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
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20
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Jensen GL, Barry PN, Eldredge-Hindy H, Silva SR, Todd SL, Hammonds KP, Zimmerman WR, Metzinger DS, El-Ghamry MN. Vaginal cuff brachytherapy: do we need to treat to more than a two-centimeter active length? J Contemp Brachytherapy 2021; 13:294-301. [PMID: 34122569 PMCID: PMC8170526 DOI: 10.5114/jcb.2021.105971] [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: 11/21/2020] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE American Brachytherapy Society (ABS) guidelines recommend using a 3-5 cm active length (AL) when treating vaginal cuff (VC) in adjuvant setting of endometrial cancer (EC). The purpose of this study was to evaluate local control and toxicity, using an AL of 1 or 2 cm and immobilization with a traditional table-mounted (stand) or patient-mounted (suspenders) device. MATERIAL AND METHODS Between 2005 and 2019, 247 patients with EC were treated with adjuvant high-dose-rate vaginal cuff (HDR-VC) brachytherapy with or without external beam radiation (EBRT). Treatment was prescribed to a 0.5 cm depth, with an AL of 1 or 2 cm, using stand or suspenders. VC boost after EBRT was typically administered with 2 fractions of 5.5 Gy, while VC brachytherapy alone was typically applied with 3 fractions of 7 Gy or 5 fractions of 5.5 Gy. RESULTS The combination of suspender immobilization and an AL of 2 cm (n = 126, 51%) resulted in 5-year local control of 100%. An AL of 2 cm compared to 1 cm correlated with better local control (99.1% vs. 88.5%, p = 0.0479). Regarding immobilization, suspenders correlated with improved local control compared to stand (100% vs. 86.7%, p = 0.0038). Immobilization technique was significantly correlated with AL (p < 0.0001). Only 5 (2.0%) patients experienced grade ≥ 3 toxicity, all of whom received EBRT. CONCLUSIONS In the present series, an AL of 2 cm provided excellent local control, while 1 cm was inadequate. Suspender immobilization was a practical alternative to stand immobilization in HDR brachytherapy of the vaginal cuff.
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Affiliation(s)
- Garrett L. Jensen
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, USA
| | - Parul N. Barry
- Department of Radiation Oncology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Magee Women’s Hospital, Pittsburgh, USA
| | - Harriet Eldredge-Hindy
- Department of Radiation Oncology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
| | - Scott R. Silva
- Department of Radiation Oncology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
| | - Sarah L. Todd
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
| | | | - Walker R. Zimmerman
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, USA
| | - Daniel S. Metzinger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
| | - Moataz N. El-Ghamry
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, USA
- Department of Radiation Oncology, Division of Gynecologic Oncology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, USA
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21
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Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Martin AG, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol 2021; 154:327-353. [PMID: 33712263 DOI: 10.1016/j.radonc.2020.11.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Austria; Evangelische Kliniken Essen-Mitte, Germany.
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain; Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Austria; School of Medicine, Johannes Kepler University Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden Netherlands
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22
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Adjuvant vaginal cuff brachytherapy in surgically treated endometrial carcinoma patients - in view of the recent evidence. J Contemp Brachytherapy 2021; 13:221-230. [PMID: 33897797 PMCID: PMC8060967 DOI: 10.5114/jcb.2021.105291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/01/2021] [Indexed: 12/24/2022] Open
Abstract
Vaginal cuff brachytherapy is an essential component of adjuvant post-operative therapy in endometrial carcinoma. Brachytherapy boost, as a part of adjuvant pelvic radiotherapy, including concomitant chemoradiotherapy combined with four cycles carboplatin/paclitaxel chemotherapy, is used in early-stage high-risk and advanced stage disease. This strategy is widely accepted and recommended by international guidelines, despite the fact that combined therapy has never been verified in randomized trials. Brachytherapy alone is the adjuvant treatment of choice for many patients with early-stage endometrial cancer, with high-intermediate features, replacing external beam pelvic radiotherapy. It provides equivalent vaginal control with a lower risk of toxicity, and minimal impact on health-related quality of life. Available evidence did not demonstrate the superiority of sole vaginal brachytherapy combined with three cycles of carboplatin/paclitaxel chemotherapy, over the standard pelvic irradiation for patients with early-stage, high-intermediate-, and high-risk endometrial cancer. This article summarized the available evidence on the role of post-operative vaginal cuff brachytherapy in endometrial cancer patients. Additionally, the risk groups definition, some aspects of brachytherapy technique, and the importance of pathological and molecular risk factors for endometrial cancer risk stratification were presented. Furthermore, the role of brachytherapy according to the European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology 2021 guidelines for the management of patients with endometrial carcinoma was presented.
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23
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Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review. J Contemp Brachytherapy 2021; 13:231-243. [PMID: 33897798 PMCID: PMC8060961 DOI: 10.5114/jcb.2021.105292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose This systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements. Material and methods A systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained. Results All studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC – 124, mixed – 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC – 866, mixed – 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%. Conclusions These data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.
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24
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Vaginal cuff brachytherapy practice in endometrial cancer patients: a report from the Turkish Oncology Group. J Contemp Brachytherapy 2021; 13:152-157. [PMID: 33897788 PMCID: PMC8060958 DOI: 10.5114/jcb.2021.105282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The American Brachytherapy Association is attempting to develop standards for delivering brachytherapy, although differences in practice have been reported in the literature. This study evaluated vaginal cuff brachytherapy (VBT) practice and quality of life-related recommendations among Turkish radiation oncologists. Material and methods A nationwide web-based 17-item survey was distributed to the members of the Turkish Society for Radiation Oncology. These members received e-mail notifications, and a link was posted on the Turkish Society for Radiation Oncology internet site to solicit voluntary responses The survey addressed the simulation processes, target volume, prescribed dose, delivery schedules, and recommendations related to vaginal side effects. Results Fifty-seven radiation oncologists responded to the survey. The most used dose fraction schemes for adjuvant VBT were 7 Gy × 3 fractions (30%), 5.5 Gy × 5 fractions (26%), and 6 Gy × 5 fractions (28%). The preferred VBT scheme was 5 Gy × 3 fractions (50%) when the external beam radiotherapy (EBRT) dose was 45 Gy external radiotherapy, while the preferred schemes were 6 Gy × 3 fractions (30%) or 5 Gy × 3 fractions (32%) when the external radiotherapy dose was increased to 50.4 Gy. One-half of the respondents delivered VBT twice a week, and the dose was prescribed to 0.5 cm from vaginal mucosa by 86% of the respondents. There was no common definition for the dose prescription length, which was defined as 3 cm from the vaginal cuff in 33% of responses and as 4 cm in 35% of responses. For serous and clear cell histological types, 38% of the respondents targeted "full cylinder length". To prevent vaginal side effects, 78% of the respondents recommended using a vaginal dilator and/or sexual intercourse after VBT. Conclusions This survey revealed variations in the clinical practice of VBT among Turkish radiation oncologists, which suggests that standardization is necessary.
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25
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Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann JA, Bosse T, Chargari C, Fagotti A, Fotopoulou C, González-Martín A, Lax SF, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell DE, Querleu D, Raspollini MR, Sehouli J, Sturdza AE, Taylor A, Westermann AM, Wimberger P, Colombo N, Planchamp F, Matias-Guiu X. ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma. Virchows Arch 2021; 478:153-190. [PMID: 33604759 DOI: 10.1007/s00428-020-03007-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria. .,Evangelische Kliniken Essen-Mitte, Essen, Germany.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke M Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
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26
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Glaser SM, Mohindra P, Mahantshetty U, Beriwal S. Complications of intracavitary brachytherapy for gynecologic cancers and their management: A comprehensive review. Brachytherapy 2021; 20:984-994. [PMID: 33478905 DOI: 10.1016/j.brachy.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Intracavitary gynecologic brachytherapy in the form of tandem-based brachytherapy and vaginal cylinder-based brachytherapy represents a fundamental component of the treatment of women with cervical or uterine cancer due to the ability to deliver a therapeutic dose of radiation with sharp dose falloff. This results in highly effective treatment in terms of oncologic outcomes with an overall favorable toxicity profile. Still, complications and side effects of brachytherapy do exist. While advances in brachytherapy techniques have led to a significant decrease in the rates of toxicity, a thorough understanding of the potential complications is crucial to ensuring optimal outcomes for women with gynecologic cancer undergoing brachytherapy. Use of equivalent dose at 2 Gy per fraction (EQD2) models has allowed incorporation of external beam radiotherapy dose to the brachytherapy dose leading to development of consolidated dose constraints for organs-at-risk in the modern era. This manuscript offers a comprehensive review of potential complications associated with intracavitary brachytherapy for gynecologic cancer including predictive factors, mitigation tactics, and management strategies.
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Affiliation(s)
- Scott M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
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Preliminary results of modified interstitial MIAMI brachytherapy applicator for treatment of upper and apical vaginal tumors. J Contemp Brachytherapy 2021; 12:562-571. [PMID: 33437304 PMCID: PMC7787207 DOI: 10.5114/jcb.2020.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Intracavitary vaginal brachytherapy (VBT) cylinders are limited in treating upper/apical vaginal disease due to the distance between the target and radiation source positions. Interstitial brachytherapy devices directly expose the vaginal mucosa to radiation sources, increasing morbidity. To target apical disease while limiting excessive treatment to the vaginal mucosa and organs at risk, we modified the commercially available multichannel MIAMI applicator, allowing the direct extension of needles into the apex with the protection of cylinder. Material and methods The device has one central plastic core with six peripheral channels. The modified device permits titanium needles to surpass the apical surface into vaginal tissue. A retrospective analysis on thirteen patients treated with this device was conducted. Patient demographics, gross tumor volume (GTV)/clinical target volume (CTV), initial diagnosis and management, toxicity data, and EQD2 data for the bladder and rectum were obtained. Results There were ten patients with vaginal recurrences and three with primary vaginal/cervical cancers. Mean dosage of VBT treatment was 25.5 Gy in 3-5 fractions. Mean dosage of external beam radiation therapy (EBRT) treatment was 44 Gy. Common acute toxicities included diarrhea, fatigue, cystitis, and nausea. Common chronic toxicities were pelvic pain, vaginal stenosis, and skin telangiectasia. Mean EQD2 dose for bladder and rectum were 72.3 Gy and 62.3 Gy, respectively. Ten patients had no evidence of relapse, two suffered from distant metastases, and one patient with stage IIIA cervical adenocarcinoma had loco-regional recurrence seventeen months after radiation treatment. Conclusions Our data suggests that the custom applicator is associated with robust dosimetric coverage, good loco-regional control, acceptable toxicity, and reduced tissue trauma. This device allows treatment of apically located vaginal tumors without significant damage to the vaginal vault and organs at risk. Additionally, it provides the flexibility to treat multiple patients with variable vaginal diameters and sizes/depths of apical tumors using a single device.
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Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Gonzalez Martin A, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2020; 31:12-39. [PMID: 33397713 DOI: 10.1136/ijgc-2020-002230] [Citation(s) in RCA: 878] [Impact Index Per Article: 219.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multi-disciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria .,Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
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Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer. Cancers (Basel) 2020; 12:cancers12123613. [PMID: 33287244 PMCID: PMC7761733 DOI: 10.3390/cancers12123613] [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: 11/01/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Several trials sought to improve outcomes in endometrial cancer patients with multimodal strategies. Histopathological, clinical, and molecular tumor characteristics were demonstrated to correlate with outcomes. We tested the hypothesis that specific histopathological and clinical parameters are prognosticators for outcomes in patients irradiated postoperatively at our Gynecological Cancer Center. First, we found a significant influence of grading and nodal stage on outcomes. These findings underline the recommendations of more intense treatment in these patient groups, as reflected in current guidelines. Secondly, age had a significant influence on survival be it due to comorbidities and/or due to too hesitant treatment regimen in elderly. Thus, here, it should be aimed at particular treatment strategies. Lastly, we found low rates of side effects associated with brachytherapy and moderate rates of side effects associated with teletherapy. Overall, our study serves as basis for further improvement of treatment strategies and for conceptualization of clinical trials. Abstract Numerous clinical trials sought to improve outcomes in endometrial cancer patients with multimodal treatment strategies. We tested the hypothesis that specific histopathological and clinical parameters are prognosticators for outcomes at our Gynecological Cancer Center. A total of 203 patients (median age, 69.5 years) was included. They were irradiated postoperatively (n = 184: Brachytherapy, n = 19: Teletherapy) between 05/2007 and 03/2020. The median follow-up was 37.2 months. As statistical methods, we used the univariable Cox proportional hazards regression, and log-rank statistics. First, we found a significant influence of grading and nodal stage on outcomes. These findings underline the recommendations of more intense treatment in these patient groups, as already reflected in current guidelines. Secondly, we found that patient age had a significant influence on survival be it due to comorbidities and/or due to too hesitant treatment regimen in the elderly. Thus, it should be aimed at particular strategies in treatment of these patients. Lastly, we found very low rates of treatment-related side effects in patients treated with brachytherapy and moderate rates of side effects in patients treated with teletherapy. Overall, our study serves as basis for further improvement of treatment strategies and for conceptualization of clinical trials.
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Gultekin M, Yilmaz MT, Biltekin F, Yuce D, Sari SY, Akyol F, Yildiz F. Adjuvant vaginal cuff brachytherapy: dosimetric comparison of conventional versus 3-dimensional planning in endometrial cancer. J Contemp Brachytherapy 2020; 12:601-605. [PMID: 33437309 PMCID: PMC7787204 DOI: 10.5114/jcb.2020.101694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/01/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate dosimetric differences between point-based 2-dimensional (2D) vaginal brachytherapy (VBT) treatment planning technique and volume-based 3-dimensional (3D) VBT method for endometrial cancer (EC). MATERIAL AND METHODS Ten patients with uterine-confined EC treated with VBT were included in this study. All patients received 27.5 Gy in 5 fractions. Three different treatment plans were performed for each patient: plan A for dose prescribed to the entire vaginal wall thickness delineated via computed tomography guidance, plan B for dose prescribed to the vaginal mucosa/cylinder surface, and plan C for dose prescribed to 5 mm beyond the vaginal mucosa/cylinder surface. Dose-volume histograms (DVH) of treatment volumes and organs at risk (OARs) were evaluated and compared. RESULTS DVH analysis of target volume doses (D100, D95, and D90) showed a significant difference between plan A and plan B (p = 0.005), and plan B was found lower. D100 for plan C was significantly higher than plan A (p = 0.009), but for D95 and D90, no statistically significant difference was found (p = 0.028 and p = 0.028, respectively). In terms of OARs doses, including vagina, rectum, bladder, and sigmoid, D2cm3 doses were significantly higher in plan A than plan B (p = 0.009, p = 0.009, p = 0.005, and p = 0.005, respectively). All these doses were also significantly lower than in plan C (p = 0.005, p = 0.012, and p = 0.013, respectively), except for sigmoid (p = 0.155). CONCLUSIONS In this dosimetric analysis, we have shown that the volume-based 3D VBT technique provides the ability to balance the target dose against the sparing of OARs. Therefore, in the new modern 3D treatment era, instead of normalization of the dose to standard reference points, customized 3D volume-based VBT planning should be recommended.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatih Biltekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Yuce
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Samper Ots PM, Rovirosa Casino A, Herreros Martínez A, Rodriguez Villalba S, Pérez Calatayud J, Polo Cezón R, Gutiérrez Miguélez C, Anchuelo Latorre J, Rodríguez Rodríguez I, Córdoba Largo S, Pérez Echagüen S, Sanz Freire CJ, Clemente Gutiérrez F, De Las Peñas Cabrera D, Villafranca Iturre E. Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM. Clin Transl Oncol 2020; 23:1193-1200. [PMID: 33237447 DOI: 10.1007/s12094-020-02510-8] [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: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVE(S) On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). MATERIALS/METHODS A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. RESULTS The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7-175), and the mean number of procedures per centre was 175 ± 150 (range 24-701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR. After presenting the results of the survey, the consensus meeting discussion focused on the issues for which there was no consensus. CONCLUSION A consensus document on postoperative VCBT of the Spanish Brachytherapy Groups of SEOR-SEFM was elaborated.
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Affiliation(s)
- P M Samper Ots
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - A Rovirosa Casino
- Departament de Fonaments Clínics, Universitat de Barcelona, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | - A Herreros Martínez
- Departament de Fonaments Clínics, Universitat de Barcelona, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | | | | | - R Polo Cezón
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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Zhang Y, Fornes B, Gómez G, Bentoldrà I, Carmona C, Herreros A, Sabater S, Nicolás I, Li Y, Sánchez J, Biete A, Torné A, Ascaso C, Rovirosa Á. EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma. Cancers (Basel) 2020; 12:E3059. [PMID: 33092163 PMCID: PMC7589275 DOI: 10.3390/cancers12103059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background: To evaluate whether EQD2(α/β = 3Gy) at 2 cm3 of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, 43p were included in this study. BT was administered: 3-fractions of 6Gy in 37p and 2-fractions of 7.5Gy in 6p. The dose was prescribed at a depth of 5 mm from the applicator surface with dose-point optimization based on distance. The active treatment length was 2.5 cm. CTV-D90 and the dose to the most exposed 2 cm3 of the vagina was calculated for each patient. Late toxicity of the bladder and rectum was assessed using Radiation Therapy Oncology Group (RTOG) criteria, and vaginal toxicity by objective Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) (LENT-SOMA) criteria. Statistics: frequency tables, mean, median, range, standard deviation, and box plot. Results: The median follow-up was 51 months (12-68). 20 p (46.5%) and 2 p (4.7%) developed G1 and G2 vaginal complications, respectively. Only 1/2 p-G2 receiving EQD2(α/β = 3Gy) at 2 cm3 >68Gy presented vaginal shortening and 18/20 p-G1 received doses < 68Gy. Conclusions: PECp receiving exclusive brachytherapy with doses < 68Gy EQD2(α/β = 3Gy) at 2 cm2 of the vagina presented only G0-G1 vaginal toxicity, except for one with bleeding telangiectasias. Larger prospective studies are necessary to confirm the present results.
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Affiliation(s)
- Yaowen Zhang
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
| | - Balbino Fornes
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Gabriela Gómez
- Radiation Oncology Department, Hospital Ángeles Chihuahua, 31217 Chihuahua, Mexico;
| | - Irene Bentoldrà
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Clara Carmona
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Antonio Herreros
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
| | - Sebastià Sabater
- Radiation Oncology Department, Hospital General Universitario de Albacete, 02006 Albacete, Spain;
| | - Inmaculada Nicolás
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Yan Li
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Joan Sánchez
- Economics Department, Hospital Clínic Universitari, 08036 Barcelona, Spain;
| | - Albert Biete
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Aureli Torné
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
| | - Carlos Ascaso
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
| | - Ángeles Rovirosa
- Fonaments Clinics Department, University of Barcelona, 08036 Barcelona, Spain; (Y.Z.); (B.F.); (I.B.); (C.C.); (A.H.); (Y.L.); (A.B.); (C.A.)
- Radiation Oncology Department, Hospital Clínic Universitari, 08036 Barcelona, Spain
- Gynecologic Cancer Unit, Hospital Clínic Unversitari, 08036 Barcelona, Spain; (I.N.); (A.T.)
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Lapuz C, Govindjmirojulu G, Tacey M, Lim A, Johnson C. Adjuvant radiotherapy for endometrial cancer with cervical stromal involvement: A patterns of practice survey in Australia and New Zealand. J Med Imaging Radiat Oncol 2020; 65:95-101. [PMID: 33043615 DOI: 10.1111/1754-9485.13107] [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: 06/23/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study is to describe the patterns of practice in Australia and New Zealand for post-operative radiotherapy in endometrial cancer with cervical stromal involvement. METHODS A ten-item survey including five clinical case scenarios in endometrial cancer with cervical stromal invasion was emailed to Royal Australian and New Zealand College of Radiologists (RANZCR) radiation oncologists in 2018. Responses were analysed to determine relative frequency distributions and preferred adjuvant treatment modalities for the clinical case scenarios. RESULTS A total of 65 respondents initiated the survey with 27 respondents treating more than 11 endometrial cancer cases annually. Only 31 respondents answered all five clinical case scenarios. Preferred adjuvant radiotherapy modalities varied for the Stage II cases between vault brachytherapy (VB), pelvic external beam radiotherapy (EBRT) or a combination. For the stage IIIA and IIIC1 cases, the majority recommended pelvic EBRT with or without VB boost (79% and 77%), and of these, most combined with chemotherapy (61% and 88%). For 4 of the 5 case scenarios, when pelvic EBRT was offered, most recommended a VB boost. CONCLUSION This patterns of practice survey suggests variability in adjuvant radiotherapy recommendations in endometrial cancer with cervical involvement, particularly in cases where there is lack of randomised data and discrepancies in consensus guidelines.
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Affiliation(s)
- Carminia Lapuz
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia.,GenesisCare Victoria, Melbourne, Victoria, Australia
| | - Geetha Govindjmirojulu
- Department of Radiation Oncology, Calvary Mater Newcastle, Wjmirotah, New South Wales, Australia
| | - Mark Tacey
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Adeline Lim
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Carol Johnson
- Wellington Blood and Cancer Centre, Wellington Regional Hospital, Wellington, New Zealand
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Itami J. Modern development of high-dose-rate brachytherapy. Jpn J Clin Oncol 2020; 50:490-501. [PMID: 32134450 DOI: 10.1093/jjco/hyaa029] [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: 12/16/2019] [Revised: 01/09/2020] [Accepted: 02/04/2000] [Indexed: 01/02/2023] Open
Abstract
Brachytherapy is an invasive therapy with placement of radiation source into or near the tumor. The difference between planning target volume and clinical target volume is minimal, and the dose out of the tumor reduces rapidly due to the inverse-square law. High-dose-rate brachytherapy enables three-dimensional image guidance, and currently, tumor dose as well as doses of the surrounding normal structures can be evaluated accurately. High-dose-rate brachytherapy is the utmost precision radiation therapy even surpassing carbon ion therapy. Biological disadvantages of high-dose rate have been overcome by the fractional irradiation. High-dose-rate brachytherapy is indispensable in the definitive radiation therapy of cervical cancer. Also in prostate cancer and breast cancer, high-dose-rate brachytherapy plays a significant role. Brachytherapy requires techniques and skills of radiation oncologists at the time of invasive placement of the radiation source into the tumor area. Education of young radiation oncologists is most urgent and important.
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Affiliation(s)
- Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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35
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Williams VM, Kahn JM, Harkenrider MM, Chino J, Chen J, Fang LC, Dunn EF, Fields E, Mayadev JS, Rengan R, Petereit D, Dyer BA. COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation. Brachytherapy 2020; 19:401-411. [PMID: 32359937 PMCID: PMC7172676 DOI: 10.1016/j.brachy.2020.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.
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Affiliation(s)
| | - Jenna M Kahn
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR
| | | | - Junzo Chino
- Department of Radiation Oncology, Duke University, Durham, VA
| | - Jonathan Chen
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Emily F Dunn
- Department of Radiation Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, OR
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Daniel Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, SD
| | - Brandon A Dyer
- Department of Radiation Oncology, University of Washington, Seattle, WA.
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One-week vaginal brachytherapy schedule as exclusive adjuvant post-operative treatment in intermediate- and high-intermediate-risk endometrial cancer patients. J Contemp Brachytherapy 2020; 12:124-130. [PMID: 32395136 PMCID: PMC7207237 DOI: 10.5114/jcb.2020.94581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/14/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose The aim of the study was to report survival outcomes and toxicities incidence by using one-week vaginal brachytherapy (VBT) schedule in intermediate- and high-intermediate-risk endometrial cancer patients. Material and methods One hundred and eight patients were treated with exclusive high-dose-rate (HDR) brachytherapy short schedule (7 Gy/fraction/every other day/1 week). Acute and late rectal, urinary, and vaginal toxicities were recorded according to radiation therapy oncology group (RTOG) scores and late effects normal tissue task force – subjective, objective, management, analytic (LENT-SOMA) scores, respectively. Overall survival (OS), cause specific survival (CSS), and disease-free survival (DFS) were evaluated. Results Median follow-up was 44 months (range, 6-117 months). The 5-year OS, CSS, and DFS rates were 92.7%, 96.4%, and 89.5%, respectively. Seven of 108 (6.5%) patients relapsed after a median time of 31 months (range, 5-56 months). Death occurred in 6 patients. Four patients died for intercurrent causes without an evidence of disease. Acute bladder toxicity G1-G2 was reported in 11 of 108 (10%) patients, vaginal toxicity G1-G2 in 6 of 108 (5.5%), and gastrointestinal toxicity was observed in 3 of 108 (3%) patients. Late bladder and gastrointestinal G1 toxicities were reported in 4 of 108 (4%) and 1 of 108 (1%) patients, respectively. Late vaginal toxicity (G1-G2) was recorded in 3 of 108 (3%) cases. No grade 3-4 bladder, vaginal, and gastrointestinal toxicities were noted. Conclusions Exclusive short course adjuvant VBT is an effective treatment in patients with early-stage endometrial cancer and provides good outcomes in terms of disease local control and DFS, with low rates of toxicity profile.
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3D printer-based novel intensity-modulated vaginal brachytherapy applicator: feasibility study. J Contemp Brachytherapy 2020; 12:17-26. [PMID: 32190066 PMCID: PMC7073342 DOI: 10.5114/jcb.2020.92407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To design a novel high-dose-rate intracavitary applicator which may lead to enhanced dose modulation in the brachytherapy of gynecological cancers. Material and methods A novel brachytherapy applicator, auxiliary equipment and quality control phantom were modeled in SketchUp Pro 2017 modeling software and printed out from a MakerBot Replicator Z18 three-dimensional printer. As a printing material polylactic acid (PLA) filament was used and compensator materials including aluminum, stainless-steel and Cerrobend alloy were selected according to their radiation attenuation properties. To evaluate the feasibility of the novel applicator, two sets of measurements were performed in a Varian GammaMed iX Plus high-dose rate iridium-192 (192Ir) brachytherapy unit and all of the treatment plans were calculated in Varian BrachyVision treatment planning system v.8.9 with TG43-based formalism. In the first step, catheter and source-dwell positioning accuracy, reproducibility of catheter and source positions, linearity of relative dose with changing dwell times and compensator materials were tested to evaluate the mechanical stability of the designed applicator. In the second step, to validate the dosimetric accuracy of the novel applicator measured point dose and two-dimensional dose distributions in homogeneous medium were compared with calculated data in the treatment planning system using PTW VeriSoft v.5.1 software. Results In mechanical quality control tests source-dwell positioning accuracy and linearity of the designed applicator were measured as ≤ 0.5 mm and ≤ 1.5%, respectively. Reproducibility of the treatment planning was ≥ 97.7% for gamma evaluation criteria of 1 mm distance to agreement and 1% dose difference of local dose. In dosimetric quality control tests, maximum difference between measured and calculated point dose was found as 3.8% in homogeneous medium. In two-dimensional analysis, the number of passing points was greater than 90% for all measurements using gamma evaluation criteria of 3 mm distance to agreement and 3% dose difference of local dose. Conclusions The novel brachytherapy applicator met the necessary requirements in quality control tests.
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Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group. J Contemp Brachytherapy 2020; 12:84-89. [PMID: 32190074 PMCID: PMC7073336 DOI: 10.5114/jcb.2020.92765] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Brachytherapy (BT, interventional radiotherapy - IRT) is a kind of radiation therapy, in which the radioactive source is placed nearby or even inside the cancer itself. Even though this kind of radiation therapy appears effective and valuable, BT has been facing a slow but progressive decline over the past decades in Europe, particularly in Italy. Aims of this study were to identify the practical and theoretical reasons why BT is facing a slow decline in Italy, and to define a vision of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and a strategy about this emerged issues. Material and methods A programmatic path divided into three steps like a trilogy was launched by AIRO Interventional Radiotherapy study group. The study group performed an initial data collection to highlight both the clinical and the educational topics and problems through specific surveys. After having analyzed the results of the surveys and shared a vision about the emerged issues, a specific strategy was adopted. Results Four relevant domains were identified and for each ones, a strategy has been discussed and defined. This manuscript shows in detail the individual actions defined (accomplished or in progress). Conclusions The AIRO vision implies that specific strategic interventions must be carried out in the field of national guidelines, education, research, and communication with patients and colleagues of other specialties in an interdisciplinary setting.
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The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review. J Contemp Brachytherapy 2020; 12:61-66. [PMID: 32190072 PMCID: PMC7073340 DOI: 10.5114/jcb.2020.92698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Serous adenocarcinoma (uterine serous carcinoma – USC) is a rare and aggressive histologic subtype of endometrial cancer, with a high-rate of recurrence and poor prognosis. The adjuvant treatment for stage I patients is unclear. The purpose of this study was to evaluate the outcomes of stage I USC treated exclusively with chemotherapy plus vaginal brachytherapy (VBT). Material and methods A systematic research using PubMed, Scopus, and Cochrane library was conducted to identify full articles evaluating the efficacy of VBT in patients with stage I USC. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials, and in PROSPERO for searching ongoing or recently completed systematic reviews. Results All studies were retrospective and 364 of evaluated patients were found. The average local control was 97.5% (range, 91-100%), the disease free-survival was 88% (range, 82-94%), the overall survival was 93% (range, 72-100%), the specific cancer survival was 89.4% (range, 84.8-94%), and the G3-G4 toxicity was 0-8%. Conclusions These data support the concept that in adequately selected patients, VBT alone may be a suitable radiotherapy technique in women with stage I USC who underwent surgical staging and received adjuvant chemotherapy.
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Outcomes of intermediate-risk to high-risk stage I endometrial cancer: 10-year clinical experiences of using in-house multi-channel applicators in a single center. Chin Med J (Engl) 2020; 132:1935-1941. [PMID: 31365429 PMCID: PMC6708688 DOI: 10.1097/cm9.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are only very few reports on clinical outcomes using multi-channel applicators (MCA) for patients with endometrial cancer (EC) in China. We aimed to evaluate the clinical experience of treating intermediate-risk (IR) to high-risk (HR) stage I EC using in-house made multi-channel applicators (IH-MCA) in a single institution. METHODS Three hundred and ninety patients with stage I IR to HR EC were treated with hysterectomy and adjuvant radiotherapy from 2003 to 2015. All patients received post-operative vaginal cuff brachytherapy (VBT) alone or as a boost after external beam radiotherapy (EBRT). The prescriptions were 500 cGy per fraction for a total of 5 to 6 fractions with brachytherapy alone or 400 to 600 cGy per fraction for 2 to 3 fractions if it was combined with EBRT. Two types of applicators including a traditional rigid IH-MCA and a recent model custom-made with 3 dimension printing technology were used for treatment. The Kaplan-Meier method was used to calculate survival rate. RESULTS Follow-up rate was 92.8% and the median follow-up time was 48 months (range 4-172 months). The 5-year overall survival (OS), progression-free survival, local recurrence, and distant metastasis rates for all patients were 96.3%, 92.1%, 2.9%, and 4.8% respectively. Two patients had isolated relapse in vagina outside the irradiated volume. The univariate and multivariate analysis showed that age and grade were the prognostic factors correlated with OS (hazard ratio: 0.368, 95% confidence interval [CI]: 0.131-1.035, P = 0.048; hazard ratio: 0.576, 95% CI: 0.347-0.958, P = 0.026,). CONCLUSIONS For patients with IR to HR stage I EC, adjuvant VBT alone or in combination with EBRT using IH-MCA led to excellent survival and recurrence rates. Age and grade were the prognostic factors correlated with OS.
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Zhang Y, Ascaso C, Herreros A, Sánchez J, Del Pino M, Torné A, Li Y, Sabater S, Arenas M, Biete A, Rovirosa Á. Is one brachytherapy fraction of 7 Gy similar to more fractions after external beam irradiation in postoperative endometrial carcinoma? Clin Transl Oncol 2019; 22:1295-1302. [PMID: 31865604 DOI: 10.1007/s12094-019-02255-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine whether brachytherapy with a single hypofractionated dose of 7 Gy provides the similar vaginal-cuff relapses and safety profile in terms of complications compared to schedules of 2 or 3 fractions of lower doses in patients treated previously with external beam irradiation in postoperative endometrial carcinoma. METHODS/MATERIAL From June 2003 to December 2016, 325 patients were treated with 3 different schedules of high-dose-rate brachytherapy after external beam irradiation for postoperative endometrial carcinoma. The patients were divided into 3 groups: Group-1: 125 patients were treated with 3 fractions of 4-6 Gy per fraction (3 fractions/week) between 2003 and 2008; Group-2: 93 patients were treated with 2 consecutive daily fractions of 5-6 Gy between 2008 and 2011; Group-3: 107 patients received a single fraction of 7 Gy between 2011 and 2016. Bladder and rectum complications were assessed using RTOG scores and with the objective scores of LENT-SOMA for the vagina. STATISTICS the chi-square test. RESULTS The mean follow-up of Groups 1, 2 and 3 was 95, 67 and 51 months, respectively. Three patients in Group-1, 2 in Group-2, 1 in Group-3 developed vaginal-cuff relapse (p = 0.68). No differences were found in late toxicity among the three groups. CONCLUSIONS One single dose of 7 Gy is safe and effective and may be the best treatment schedule with a similar incidence of vaginal-cuff relapses, complications and patient comfort with less hospital attendance.
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Affiliation(s)
- Y Zhang
- Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - C Ascaso
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - A Herreros
- Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - J Sánchez
- Economics Department, Hospital Clinic I Universitari, Barcelona, Spain
| | - M Del Pino
- Gynecological Cancer Unit, Gynecological and Obstetrics Department, Hospital Clinic I Universitari, Barcelona, Spain
| | - A Torné
- Gynecological Cancer Unit, Gynecological and Obstetrics Department, Hospital Clinic I Universitari, Barcelona, Spain
| | - Y Li
- Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - S Sabater
- Radiation Oncology Department, Hospital General Universitario de Albacete, Albacete, Spain
| | - M Arenas
- Radiation Oncology Department, Hospital San Joan de Reus, Reus, Spain
| | - A Biete
- Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Á Rovirosa
- Radiation Oncology Department, Hospital Clinic I Universitari, C/ Villarroel 170, 08036, Barcelona, Spain.
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
- Gynecological Cancer Unit, Gynecological and Obstetrics Department, Hospital Clinic I Universitari, Barcelona, Spain.
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Clinical Outcome of Exclusively Radiographer-led Delivery of Postoperative Vaginal Vault Brachytherapy for Endometrial Cancer – The Addenbrooke's Experience. Clin Oncol (R Coll Radiol) 2019; 31:844-849. [DOI: 10.1016/j.clon.2019.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
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Alban GM, Buscariollo DL, Cheng T, Pretz J, Krechmer B, Buzurovic I, Singer L, King M, Lee L. Low-Dose Adjuvant Cylinder Brachytherapy for Endometrioid Endometrial Cancer. Pract Radiat Oncol 2019; 10:95-103. [PMID: 31783169 DOI: 10.1016/j.prro.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Our purpose was to evaluate outcomes and sites of failure for women with early stage endometrial adenocarcinoma treated with adjuvant high-dose-rate (HDR) vaginal brachytherapy (VB) with a low dose scheme. METHODS AND MATERIALS Retrospective review identified 318 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-II endometrioid endometrial cancer who received adjuvant HDR VB to a dose of 24 Gray (Gy) in 6 fractions from 2005 to 2017. Patients with <6 months follow-up were excluded. Dose was prescribed to cylinder surface and computerized tomography (CT) imaging was performed before each fraction to assess cylinder placement. Rates of vaginal relapse (VR), pelvic nodal relapse, distant metastasis, recurrence-free survival, and overall survival were calculated by Kaplan-Meier method. Univariate analysis was performed by log rank test or Cox proportional hazards. Pretreatment CT images were analyzed for patients with VR. RESULTS Median follow-up was 42 months for 243 patients. The 3-year rates of VR, pelvic nodal relapse, distant metastasis, recurrence-free survival, and overall survival were 1.9%, 1.5%, 4.3%, 94.1%, and 98.9%, respectively. The 3-year VR rates by Gynecologic Oncology (GOG)-99 risk groups were 0%, 1.4%, and 3.2% for low risk, low-intermediate risk, and high-intermediate risk (HIR) disease (P = .5). By Post-operative Radiation Therapy in Endometrial Carcinoma (PORTEC) risk stratification, 3-year VR rate was 1.3% for HIR disease. On review of pretreatment CT images of the 6 patients with VR, 3 patients had relapse at the introitus outside of the treated vaginal length, and 3 had in-field recurrence at the vaginal apex. Higher body mass index (BMI) was associated with VR, with a 14% increase in risk per BMI unit (kg/m2, P = .02). There were no reported grade 2 GI or any grade 3 toxicities. CONCLUSIONS Adjuvant HDR VB with a low-dose regimen results in excellent clinical outcomes for patients with early stage endometrioid endometrial cancer. Patients with higher BMI may be at increased risk of VR, and additional study is needed to optimize brachytherapy treatment parameters.
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Affiliation(s)
- Gabriela M Alban
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Daniela L Buscariollo
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Teresa Cheng
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Pretz
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Betty Krechmer
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ivan Buzurovic
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lisa Singer
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Martin King
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Larissa Lee
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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Onderdonk BE, Wu T, Al-Hallaq H, Son CH, Waller J, Hasan Y. Clinical and Dosimetric Implications of Intrafractional Cylinder Movement During Vaginal Cuff Brachytherapy. Cureus 2019; 11:e6165. [PMID: 31890373 PMCID: PMC6913955 DOI: 10.7759/cureus.6165] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction To quantify the dosimetric and clinical effects of intrafractional cylinder movement in patients receiving high-dose-rate vaginal cuff brachytherapy (VBT) without a formal immobilization device and the implication of motion on institutional clinical outcomes. Methods From 2013-2018, 119 patients were treated with VBT with no formal immobilization device at a single institution. As a quality assessment study, pre-and post-cylinder brachytherapy kilovoltage (kV) images were acquired for 37 fractions in nine consecutive patients who underwent VBT and clinical care representative of institutional practice standards. The D90 and D90 EqD2 were calculated according to each patient's average intrafractional movement throughout the treatment course. The D2cc for organs-at-risk (OARs) were also re-evaluated following the simulated movements. The survival outcomes and toxicity were recorded from the 119 patients. Toxicity was graded as per Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results The measured mean ± standard deviation movement was 5.0 mm ± 3.5, with 62% moving caudad. The D90 from each patient's maximum and average movements were lower than the pre-planned doses: 71%, and 89%, respectively. The doses to the OARs were lower than the pre-planned doses. After a median follow-up of 20 months, there were three local recurrences with a median time of 14.5 months (range: 10-31). There were two acute grade 3+ toxicities and one late grade 3+ toxicity. There was a moderate correlation (r = 0.40) between body mass index (BMI) and intrafraction movement with caudad being more common in smaller BMIs (p = 0.0216). Conclusions Intrafractional vaginal cylinder movement without a table fixation device is about 5.0 mm, with the majority of movements moving caudad. While institutional outcomes suggest that local control may not be compromised, consideration of more formal immobilization devices is warranted, especially for those patients with lower BMIs.
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Affiliation(s)
- Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Tianming Wu
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Hania Al-Hallaq
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Joseph Waller
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
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LVSI positive and NX in early endometrial cancer: Surgical restaging (and no further treatment if N0), or adjuvant ERT? Gynecol Oncol 2019; 156:243-250. [PMID: 31703813 DOI: 10.1016/j.ygyno.2019.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 12/20/2022]
Abstract
Early endometrial cancer has an overall survival of greater than 80% (1). One of the poor prognostic factors that may be associated with the 20% who do not survive 5 years is the presence of lymphovascular space invasion (LVSI). LVSI is associated with increased nodal metastasis and decreased progression free survival (PFS) and overall survival (OS). (2-8). Therefore, unstaged, LVSI positive early endometrial cancer requires additional management with either completion of staging with lymphadenectomy or adjuvant radiation. We focus on reviewing the management of natural history and management of early endometrial cancer followed by the prognostic impact of LVSI, management options and recommendations.
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Zhang Y, Rovirosa A, Ascaso C, Herreros A, Torne A, Li Y, Biete A, Sánchez J. Economic impact of decreasing the fraction number in vaginal cuff brachytherapy: A direct cost analysis. Brachytherapy 2019; 19:60-65. [PMID: 31587986 DOI: 10.1016/j.brachy.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/29/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to analyze the direct economic impact of two vaginal cuff brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) with similar vaginal control and toxicity results. MATERIALS AND METHODS From 2006 to 2015, 397 PEC patients (p) were treated with VBT: mean 40p/year, 67.5% received external beam radiotherapy (EBRT)+VBT and 32.5% exclusive VBT. Schedule 1: 3 fractions (Fr) after EBRT and 6Fr (4-6 Gy/Fr) in exclusive VBT. Schedule 2: 7Gy × 1Fr + EBRT and 6Gy × 3Fr in exclusive VBT. Differential cost analysis of the two schedules was retrospectively performed. The direct costs in each schedule were (1) Personnel: radiotherapy technicians, nurses, radiation oncologists, medical physicists, administrative personnel, orderlies; time dedicated by each professional during CT planning acquisitions and delineation of vagina/organs at risk, dosimetric study and evaluation, autoradiography, procedure reporting time during/after treatment, removal of bladder/rectal tubes and applicators, material cleaning and transportation for sterilization; (2) Health care material (gels, gauzes, gloves, etc); (3) Equipment (time equipment used). The differential between the two schedules was estimated. Indirect costs and evaluation of quality of life-adjusted costs were not considered. RESULTS The overall reduction in the number of Fr per year in Schedule 2 was 93. Cost savings included treatment time per year: 4,185 min (70 h); personnel: 221€ ($246)/p in EBRT + VBT and 331€ ($368)/p in exclusive VBT; and health care material and equipment: 40€ ($44.5)/p in EBRT + VBT and 90€ ($100.2)/p in exclusive VBT. The overall savings per patient was 261€ ($295) in combined treatment and 421€ ($475.7) in exclusive VBT. The total savings per year with Schedule 2 in 40p was 12,503€ ($13,915.8). CONCLUSIONS A 41% reduction in the fractions number in VBT for PEC allowed economic savings of 261€ ($290.5)/p in combined treatment and 421€ ($475.7)/p in exclusive VBT. Other benefits include patient comfort and fewer treatment visits.
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Affiliation(s)
- Yaowen Zhang
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Angeles Rovirosa
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain; Gynaecological Cancer Unit, Gynaecology and Obtetrics Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain.
| | - Carlos Ascaso
- Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Antonio Herreros
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Aureli Torne
- Gynaecological Cancer Unit, Gynaecology and Obtetrics Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Yan Li
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Albert Biete
- Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Joan Sánchez
- Economics Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain
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Guy CL, Fields EC, Quinn BA, Fisher CM, Ladbury CJ, Romano KD, Todor D. The vaginal cylinder: Misunderstood, misused, or trivial? An in-depth dosimetric and multiinstitutional outcome investigation. Brachytherapy 2019; 18:763-770. [PMID: 31558353 DOI: 10.1016/j.brachy.2019.08.007] [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: 03/04/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of the study was to investigate the impact on dose distribution and radiobiological metrics of common high-dose-rate vaginal brachytherapy treatment parameters and to analyze multiinstitutional data for clinically significant impact on outcomes in early-stage endometrial cancer. METHODS AND MATERIALS Treatment plans were created for all combinations of prescription parameters and used to quantify the dosimetric impact of each parameter and to estimate the dose delivered using common voxel-integrated radiobiological metrics. A rating system, based on risk grouping from GOG and PORTEC trials, was used to consolidate staging information into a cancer "aggressiveness" measure. Correlations between the rating, toxicity, disease recurrence, and plan parameters were investigated. RESULTS When prescribing to 5 mm depth, the variation caused by the diameter was very large across all dose metrics, ranging from 51% to 175% increase with the most divergence in BEDmax. For surface prescription, changing the cylinder diameter from 4 cm to 2 cm caused the dose metrics of BEDmin, Dmin, and gBEUD (a = -3) to increase by 117%, 67%, and 52%, respectively. Prescription to 5-mm depth caused changes across all dose metrics of 260% compared with surface prescription for a 2-cm cylinder. Deeper prescription point (p = 0.005) and longer treatment length (p = 0.01) were correlated with increased stenosis rates. No correlation between recurrence and any plan parameter was found. CONCLUSIONS Dramatic differences in dose distributions arise by small variations of plan parameters, with large impact on rates of vaginal stenosis, but no clear relation with local recurrence. To help radiation oncologists interpret the magnitude of these effects for their patients, we created a tool that allows comparison between dose and fractionation parameters.
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Affiliation(s)
- Christopher L Guy
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Emma C Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Bridget A Quinn
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | | | - Colton J Ladbury
- Department of Radiation Oncology, University of Colorado, Aurora, CO
| | - Kara D Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Dorin Todor
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
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Albuquerque K, Hrycushko BA, Harkenrider MM, Mayadev J, Klopp A, Beriwal S, Petereit DG, Scanderbeg DJ, Yashar C. Compendium of fractionation choices for gynecologic HDR brachytherapy—An American Brachytherapy Society Task Group Report. Brachytherapy 2019; 18:429-436. [DOI: 10.1016/j.brachy.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/07/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, Tatebe K, Veneris JL. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019; 69:258-279. [PMID: 31074865 DOI: 10.3322/caac.21561] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Amouzegar Hashemi F, Vesgari Kiasari Z, Kalaghchi B, Aghili M, Gholami S, Mansouri S, Moalej S, Maddah Safaei A. Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer. Asian Pac J Cancer Prev 2019; 20:2039-2043. [PMID: 31350963 PMCID: PMC6745200 DOI: 10.31557/apjcp.2019.20.7.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Brachytherapy in treatment of endometrial cancer patients is growing and therefore, evaluation of more feasible schedule has become of great importance. The purpose of current study was to evaluate the complications of accelerated short course high dose rate intravaginal brachytherapy (HDR IVB), a new brachytherapy approach which is a more feasible treatment option in developing countries. Method: From 2017 to 2018, 54 patients diagnosed with endometrial cancer and FIGO stages IA to IIB who underwent total abdominal hysterectomy with a bilateral salpingo-oophorectomy were enrolled in present study. They were treated with a total dose of 25 Gy in 5 fractions which was prescribed daily. A dose of 5 Gy was prescribed at a depth of 0.5 cm in the upper third and middle third of vagina. Adverse effects related to organs at risk consist of bladder, vagina and rectum were documented based on the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). Results: The accelerated short course HDR IVB was well tolerated and no grade 3 or higher toxicities was reported for patients during the follow up period. There were no chronic rectal toxicities and only one patient showed chronic urinary toxicities. However, the incidence rate of vaginal toxicities at the end of 4-month and 8-month follow up periods was higher than acute toxicities and significantly lower in elderly group compared to younger group. Conclusion: Overall, the accelerated HDR IVB was safe and was well tolerated in endometrial cancer patients and the incidence rate of undue complications were equal, if not less, in elderly patients compared to the younger ones.
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Affiliation(s)
- Farnaz Amouzegar Hashemi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zakieh Vesgari Kiasari
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bita Kalaghchi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahdi Aghili
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soraya Gholami
- Physics Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Mansouri
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. ,Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | | | - Afsaneh Maddah Safaei
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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