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Dahbi Z, Fadila K, Vinh-Hung V. Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison. Cureus 2023; 15:e37235. [PMID: 37038382 PMCID: PMC10082648 DOI: 10.7759/cureus.37235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The standard treatment for locally advanced cervical cancer involves chemo-radiation followed by brachytherapy. However, some patients are unable to undergo brachytherapy intensification. Recent advancements in radiation technology have provided several techniques, with stereotactic body radiation therapy (SBRT) theoretically able to mimic the dose distribution of brachytherapy with a high dose gradient. METHODS We analyzed 20 high-dose-rate intra-cavity brachytherapy plans for women with cervical cancer and simulated an adjunctive stereotactic radiotherapy plan at the same doses used for brachytherapy (21 Gray [Gy] in three fractions). No planning tumoral volume (PTV) margin was added for SBRT dosimetry. We used the dose constraints for brachytherapy from the EMBRACE trial and the dose constraints for SBRT in three fractions. Dose distribution, maximum dose points on target volumes, bladder, rectum, and dose-volume histograms were compared between the two techniques. RESULTS The mean volume of the high-risk clinical tumoral volume (CTV) was 64 cm3, and the mean volume of the intermediate-risk CTV was 93 cm3. The mean minimum dose received by 90% of the high-risk CTV (D90 CTV HR) was 17 Gy for brachytherapy versus 8.3 Gy for SBRT. The average minimum dose received by 90% of the intermediate-risk CTV (D90 CTV IR) was 7.5 Gy for brachytherapy versus 8.9 Gy for SBRT. The mean minimum dose delivered to 2cc of the bladder was 74.6 Gy for brachytherapy versus 84.7 Gy for SBRT. The mean minimum dose delivered to 2cc of the rectum was 71.8 Gy for brachytherapy versus 74.7 Gy for SBRT. CONCLUSION We confirmed the dosimetric superiority of brachytherapy over SBRT in terms of target volume coverage and organ-at-risk sparing. Therefore, pending the results of further clinical studies, no current radiotherapy technique can replace brachytherapy for cervical cancer boost after external radiotherapy.
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Affiliation(s)
- Zineb Dahbi
- Radiotherapy, International University Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
- Medicine, Mohammed VI Polytechnic University, Benguerir, MAR
| | - Kouhen Fadila
- Radiation Oncology, International University Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Vincent Vinh-Hung
- Radiation Oncology, University Hospital of Martinique, Fort-de-France, MTQ
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Sturdza AE, Stephanides M, Jurgenliemk-Schulz I, Eriksen JG, Benstead K, Hoskin P, Vlad S, Escande A, Corradini S, Knoth J, Westerveld H, Tagliaferri L, Najari-Jamali D, Konat-Baska K, Plesinac V, Tan LT, Nout R, Strnad V, Niehoff P, Pieters BR, Tanderup K, Kamrava M. Brachytherapy training survey among radiation oncology residents in Europe. Radiother Oncol 2022; 177:172-178. [PMID: 36328092 DOI: 10.1016/j.radonc.2022.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/03/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022]
Abstract
We aim to investigate the current state of brachytherapy (BT) training among the radiation oncology trainees in Europe. MATERIAL AND METHODS A 22-question online survey based on the one by the American Association of Radiation Oncology Residents (2017) with added queries pertinent to training in Europe was sent to 1450 residents in two iterations. These included site-specific training, volume of experience, barriers to training, institutional support, and preferences for further education. Responses to individual statements were given on a 1 to 5 Likert-type scale. The answers were reported by junior (≤3 years of training) and senior years of training (year of training 4/5/6 and junior staff). Descriptive statistics were used to describe frequencies. RESULTS Residents from 21 European countries participated, 445 (31%) responded. 205 (47%) were senior residents. 60% residents consider that performing BT independently at the end of residency is very or somewhat important. Confidence in joining a brachytherapy practice at the end of residency was high or somewhat high in 34% of senior residents. They reported as barriers to achieving independence in BT to be lack of appropriate didactic/procedural training from supervisors (47%) and decreased case load (31%). 68% reported their program lacks a formal BT curriculum and standardized training assessment. CONCLUSIONS Residents in Europe, feel independent BT practice is very or somewhat important, but do not feel confident they will achieve this goal. To address this gap, efforts are needed to develop and implement a formal and comprehensive BT curriculum with easy access to trained instructors.
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Affiliation(s)
- Alina Emiliana Sturdza
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria
| | | | - Ina Jurgenliemk-Schulz
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, Netherlands
| | - Jesper Grau Eriksen
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Kim Benstead
- Gloucestershire NHS Foundation Trust, Gloucester, United Kingdom
| | - Peter Hoskin
- Mount Vernon Cancer Centre, London, and Division of Cancer Sciences, University of Manchester, United Kingdom
| | - Stefanel Vlad
- Neolife Bucuresti - Enayati Medical City, Bucharest, Romania
| | - Alexandre Escande
- University of Lille, Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Knoth
- Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, Vienna, Austria
| | | | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Katarzyna Konat-Baska
- Wroclaw Comprehensive Cancer Center, Department of Oncology, Wroclaw Medical University, Poland
| | | | - Li Tee Tan
- Cambridge University Addenbrooke's Hospital, Department of Clinical Oncology, Cambridge, United Kingdom
| | - Remi Nout
- Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Peter Niehoff
- Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069 Offenbach am Main, University Witten - Herdecke, Germany
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers/University of Amsterdam, Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Netherlands
| | - Kari Tanderup
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, United States
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Chargari C, Peignaux K, Escande A, Renard S, Lafond C, Petit A, Lam Cham Kee D, Durdux C, Haie-Méder C. Radiotherapy of cervical cancer. Cancer Radiother 2021; 26:298-308. [PMID: 34955418 DOI: 10.1016/j.canrad.2021.11.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
External beam radiotherapy and brachytherapy are major treatments in the management of cervical cancer. For early-stage tumours with local risk factors, brachytherapy is a preoperative option. Postoperative radiotherapy is indicated according to histopathological criteria. For advanced local tumours, chemoradiation is the standard treatment, followed by brachytherapy boost, which is not optional. We present the update of the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for cervical cancer.
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Affiliation(s)
- C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - K Peignaux
- Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, avenue Professeur-Marion, 21000 Dijon, France
| | - A Escande
- Département de radiothérapie, centre Oscar-Lambret, avenue Frédéric-Combemale, 59000 Lille, France
| | - S Renard
- Département de radiothérapie, centre Alexis Vautrin, Vandœuvre-lès-Nancy, France
| | - C Lafond
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Petit
- Département de radiothérapie, centre régional de lutte contre le cancer institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - D Lam Cham Kee
- Département de radiothérapie, centre Alexandre-Lacassagne, avenue de Valombrose, 06000 Nice, France
| | - C Durdux
- Département d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Haie-Méder
- Département d'oncologie radiothérapie, centre de cancérologie, Charlebourg la Défense, 65, avenue Foch, 92250 La Garenne-Colombes, France
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Charra-Brunaud C, Salleron J, Menoux I, Peignaux K, Ducassou A, Petit A, Pommier P, Barillot I, Serre AA, Thomas L, Delannes M, Thibouw D, Antoni D, Renard S, Peiffert D. [Dose optimization in 3D pulsed dose rate brachytherapy for patients with locally advanced cervical cancer: A French multicenter phase II trial]. Cancer Radiother 2021; 26:474-480. [PMID: 34301498 DOI: 10.1016/j.canrad.2021.06.030] [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: 01/16/2021] [Revised: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We present the results of the PHRC Tridicol, a prospective French phase II study whose objective was to increase the dose delivered to the target volume during brachytherapy for locally advanced cervical cancers. MATERIAL AND METHODS Eight centers included 48 patients, treated with concomitant radiochemotherapy, then uterovaginal brachytherapy. RESULTS The median follow-up was 63 months. The dose of brachytherapy delivered in biological equivalent dose (EQD2) to 90% of the High Risk CTV (D90 CTV HR) was 80Gy in median dose. The 5-year local control rate (LC) was 84%, close to the hypothesis of 86.7%. The rate of severe complications (grade 3-4) was 23% at 5 years. The rectal dose was correlated with the risk of severe complications. CONCLUSION HR CTV dose was below the target (85Gy) due to low use of parametrial interstitial needles, as the centers did not always have an adequate applicator, or were at the time at the beginning of their learning curve. The 5-year LC rate was improved compared to that of the comparable STIC PDR group (78%) but lower than the retroEMBRACE cohort of GEC ESTRO (89%). The complication rate was higher than in the comparable group of STIC PDR but close to that of retroEMBRACE. Training brachytherapy teams in interstitial implantation or referring patients to referral centers should help improve the therapeutic index of cervical cancer.
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Affiliation(s)
- C Charra-Brunaud
- Service de radiothérapie, Institut de cancérologie de Lorraine, route de Bourgogne, 54519 Vandœuvre-les-Nancy, France.
| | - J Salleron
- Service de biostatistique, Institut de cancérologie de Lorraine, route de Bourgogne, 54519 Vandœuvre-les-Nancy, France
| | - I Menoux
- Service de radiothérapie, Centre Paul-Strauss, 3, rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - K Peignaux
- Service de radiothérapie, Centre GF-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - A Ducassou
- Service de radiothérapie, Institut Claudius-Regaud, IUCT-Oncopole, 20-24, rue du Pont Saint-Pierre, 31300 Toulouse, France
| | - A Petit
- Service de radiothérapie, Institut Bergonié, 229, Cours de l'Argonne, 33000 Bordeaux, France
| | - P Pommier
- Service de radiothérapie, Centre Léon-Berard, 28, Prom.-Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - I Barillot
- Service de radiothérapie, CHRU de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France
| | - A A Serre
- Service de radiothérapie, Centre Léon-Berard, 28, Prom.-Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - L Thomas
- Service de radiothérapie, Institut Bergonié, 229, Cours de l'Argonne, 33000 Bordeaux, France
| | - M Delannes
- Service de radiothérapie, Institut Claudius-Regaud, IUCT-Oncopole, 20-24, rue du Pont Saint-Pierre, 31300 Toulouse, France
| | - D Thibouw
- Service de radiothérapie, Centre GF-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - D Antoni
- Service de radiothérapie, Centre Paul-Strauss, 3, rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - S Renard
- Service de radiothérapie, Institut de cancérologie de Lorraine, route de Bourgogne, 54519 Vandœuvre-les-Nancy, France
| | - D Peiffert
- Service de radiothérapie, Institut de cancérologie de Lorraine, route de Bourgogne, 54519 Vandœuvre-les-Nancy, France
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Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review. Cancers (Basel) 2021; 13:cancers13061226. [PMID: 33799617 PMCID: PMC7999189 DOI: 10.3390/cancers13061226] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Local recurrence in gynecological malignancies occurring in a previously irradiated field is a difficult clinical issue. Curative-intent treatment is salvage surgery and is associated with non-negligible peri-operative morbidity and has a substantial impact on long-term quality of life. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative, especially in non-operable patients. The aim of this review is to report outcomes and toxicities of reirradiation 3D-IGBT in this context. 3D-IGBT appears to be a feasible alternative to salvage surgery in inoperable patients, with an acceptable outcome for patients who have no other curative therapeutic options, however long-term toxicities were high in some studies. Each case should be referred to highly experienced expert centers. Abstract Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for reirradiation in the context of local recurrences from gynecological malignancies. Methods: We conducted a large-scale literature research, and 15 original studies, responding to our research criteria, were finally selected. Results: Local control rates ranged from 44% to 71.4% at 2–5 years, and overall survival rates ranged from 39.5% to 78% at 2–5 years. Grade ≥3 toxicities ranged from 1.7% to 50%, with only one study reporting a grade 5 event. Results in terms of outcome and toxicities were highly variable depending on studies. Several studies suggested that local control could be improved with 2 Gy equivalent doses >40 Gy. Conclusion: IGBT appears to be a feasible alternative to salvage surgery in inoperable patients or patients refusing surgery, with an acceptable outcome for patients who have no other curative therapeutic options, however at a high cost of long-term grade ≥3 toxicities in some studies. We recommend that patients with local recurrence from gynecologic neoplasm occurring in previously irradiated fields should be referred to highly experienced expert centers. Centralization of data and large-scale multicentric international prospective trials are warranted. Efforts should be made to improve local control while limiting the risk of toxicities.
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[Seeking colleagues' advice when facing complex clinical situations]. Cancer Radiother 2020; 24:623-627. [PMID: 32828668 DOI: 10.1016/j.canrad.2020.06.015] [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: 06/21/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/23/2022]
Abstract
Seeking a second medical advice as a medical practitioner is a frequent situation that should be facilitated to best suit patients' expectations, while maintaining medical confidentiality. The patient and his relatives need to be involved with diagnostic and therapeutic procedures. The radiation oncologist should accept and help a patient who seeks a second advice, and patients will always appreciate when the physician helps them to seek such an advice. Examples that each practitioner should know include tertiary centers tumor boards, centers with access to innovation or clinical research, or with special teams to take care of specific populations such as adolescents and young adults. In some situations, no treatment can also be the best treatment, and it takes time to explain and discuss such watchful waiting strategies to patients. In case of recurrent disease after radiotherapy, salvage reirradiation must be discussed at a tertiary tumor board and weighed against other options, especially for rare and complex cases. Radiation oncology has gained multiple options with technological advances, such as proton therapy, brachytherapy, stereotactic body radiotherapy with respiratory tracking or contact therapy. Radiation oncologists must know the benefits associated with each option in terms of survival, local control or organ preservation in order to address patients to the best practitioner.
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