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Camprodon G, Gabro A, El Ayachi Z, Chopra S, Nout R, Maingon P, Chargari C. Personalized strategies for brachytherapy of cervix cancer. Cancer Radiother 2024:S1278-3218(24)00153-7. [PMID: 39395842 DOI: 10.1016/j.canrad.2024.09.006] [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: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 10/14/2024]
Abstract
Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects.
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Affiliation(s)
- Guillaume Camprodon
- Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France
| | - Alexandra Gabro
- Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France
| | - Zineb El Ayachi
- Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France
| | - Supriya Chopra
- Department of Radiation Oncology and Medical Physics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Remi Nout
- Department of Radiation Oncology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Philippe Maingon
- Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France
| | - Cyrus Chargari
- Department of Radiation Oncology, hôpital Pitié Salpêtrière, Assistance publique-hôpitaux de Paris, Sorbonne université, Paris, France.
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Ross DH, Gomez K, Harmon G, Mysz ML, Shea SM, Goldberg A, Liotta M, Potkul R, Winder A, Lee B, Jackson J, Roeske JC, Small W, Harkenrider MM. Evaluating outcomes and toxicities for a newly implemented MRI-based brachytherapy program for cervical cancer. Gynecol Oncol 2024; 183:33-38. [PMID: 38492475 DOI: 10.1016/j.ygyno.2024.03.003] [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: 12/19/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE We report an updated analysis of the outcomes and toxicities of MRI-based brachytherapy for locally advanced cervical cancer from a U.S. academic center. METHODS A retrospective review was performed on patients treated with MRI-based brachytherapy for cervical cancer. EBRT was standardly 45 Gy in 25 fractions with weekly cisplatin. MRI was performed with the brachytherapy applicator in situ. Dose specification was most commonly 7 Gy for 4 fractions with optimization aim of D90 HR-CTV EQD2 of 85-95 Gyα/β=10 Gy in 2 implants each delivering 2 fractions. RESULTS Ninety-eight patients were included with median follow up of 24.5 months (IQR 11.9-39.8). Stage IIIA-IVB accounted for 31.6% of cases. Dosimetry results include median GTV D98 of 101.0 Gy (IQR 93.3-118.8) and HR-CTV D90 of 89 Gy (IQR 86.1-90.6). Median D2cc bladder, rectum, sigmoid, and bowel doses were 82.1 Gy (IQR 75.9-88.0), 65.9 Gy (IQR 59.6-71.2), 65.1 Gy (IQR 57.7-69.6), and 55 Gy (IQR 48.9-60.9). Chronic grade 3+ toxicities were seen in the bladder (8.2%), rectosigmoid (4.1%), and vagina (1.0%). Three-year LC, PFS, and OS were estimated to be 84%, 61.7%, and 76.1%, respectively. CONCLUSION MRI-based brachytherapy demonstrates excellent local control and acceptable rates of high-grade morbidity. These results are possible in our population with relatively large volume primary tumors and extensive local disease.
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Affiliation(s)
- Dylan H Ross
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA
| | - Kayeromi Gomez
- Loyola University Medical Center, Maywood, IL 60153, USA; Biostatistics Collaborative Core, Clinical Research Office, Health Sciences Campus. Loyola University Chicago, Maywood, IL 60153, USA
| | - Grant Harmon
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA
| | - Michael L Mysz
- Loyola University Medical Center, Maywood, IL 60153, USA
| | - Steven M Shea
- Loyola University Medical Center, Maywood, IL 60153, USA; Department of Radiology and Medical Imaging, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Ari Goldberg
- Loyola University Medical Center, Maywood, IL 60153, USA; Department of Radiology and Medical Imaging, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Margaret Liotta
- Loyola University Medical Center, Maywood, IL 60153, USA; Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Ronald Potkul
- Loyola University Medical Center, Maywood, IL 60153, USA; Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Abigail Winder
- Loyola University Medical Center, Maywood, IL 60153, USA; Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Brian Lee
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jacob Jackson
- Loyola University Medical Center, Maywood, IL 60153, USA
| | - John C Roeske
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA; Loyola University Medical Center, Maywood, IL 60153, USA.
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Tharavichitkul E, M. Galalae R. Ultrasound-Guided Brachytherapy for Cervical Cancer - A Tool for Quality Improvement in Brachytherapy? Radiat Oncol 2022. [DOI: 10.5772/intechopen.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Nowadays, brachytherapy is one of the major components to treat inoperable cervical cancer. Brachytherapy yields a higher dose to the target (cervix) while sparing normal tissues. Developments of brachytherapy stepped forward in the previous decade by image-guided brachytherapy (IGBT) turning brachytherapy from point-based planning to volume-based planning and IGBT improves the treatment quality for cervical cancer. Magnetic resonance imaging (MRI) or computed tomography (CT) is utilized in brachytherapy and showed promising results internationally. However, in a limited-resource area, the implementation of IGABT is difficult due to many causes (manpower, equipment, or budgets). To improve the quality in limited resources, ultrasound is introduced. The utilization of ultrasound in brachytherapy practice is to prevent uterine perforation during application. With present data, measurement by ultrasound showed the correlation to MRI measurement in uterine dimensions. With these aspects, there are many researches using ultrasound to improve the quality of treatment in brachytherapy, for example, to guide contouring on CT or to support brachytherapy planning. The use of ultrasound improves the quality of brachytherapy in comparison to conventional planning and supports the improvement in brachytherapy for cervical cancer.
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Li H, Wang S, Liu Y, Wang T, Jin S, Liu Z. Prophylactic extended-field irradiation for locally advanced cervical cancer. Gynecol Oncol 2022; 166:606-613. [PMID: 35868881 DOI: 10.1016/j.ygyno.2022.07.009] [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: 04/04/2022] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Concomitant chemoradiotherapy is the standard treatment for locally advanced cervical cancer. Pelvic irradiation is commonly recommended for patients with negative para-aortic lymph nodes(PALNs). However, owing to the development of imaging-guided brachytherapy, distant failure has become the main failure pattern. The PALNs are a vital site of distant metastasis, and the para-aortic region may contain occult microscopic metastases that are barely detected owing to imaging technology restriction. The prognostic of patients who experienced PALN failure is dismal. Typically, there are four ways to decrease PALN failure. First, surgical staging can be performed to assess the occurrence of metastasis in the para-aortic region; however, the application of surgical staging is decreasing owing to controversial survival benefits and accompanying complications of surgery. Second, regular imaging surveillance and timely salvage of early recurrences could reduce PALN failure. Third, better systemic adjuvant therapy could be recommended since it has enormous potential to reduce distant metastases and improve overall survival. Fourth, performing prophylactic extended-field irradiation (EFI), including pelvic and para-aortic region irradiation, can sterilize occult microscopic metastases in the para-aortic region and improve survival. Prior investigations have revealed that prophylactic EFI could reduce PALN failure as well as distant metastasis and present the benefit of survival. Yet, owing to the serious morbidity induced by enlarged irradiation field in the era of conventional irradiation techniques, further research on EFI is stagnated. Nowadays, with the development of new technologies, intensity modulated radiation therapy can deliver a higher dose to tumors with acceptable toxicity. Prophylactic EFI regained attention. However, the inclusion criteria of prophylactic EFI in existing studies reveal great discrepancies. Thus, it is urgent to precisely identify indications for better survival and lower complications in patients with cervical cancer. In this review, we identify indications and summary guidelines for prophylactic EFI, which may provide a foundation for further trials and clinical applications.
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Affiliation(s)
- Huanhuan Li
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shu Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Yingying Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Tiejun Wang
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China
| | - Shunzi Jin
- NHC Key Laboratory of Radiobiology,Jilin University, Changchun 130021, China
| | - Zhongshan Liu
- Department of radiation oncology, The Second affiliated Hospital of Jilin University, Changchun 130041, China.
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Cheung CK, Chew J, Wai K, Calkins SM, Ha PK, Ryan WR, Cunha A, Yom SS, Hsu IC, Chan JW. Feasibility of accelerated image-guided high-dose-rate interstitial brachytherapy with inverse planning simulated annealing (IPSA-HDRBT) for post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue. Brachytherapy 2022; 21:686-691. [PMID: 35715306 DOI: 10.1016/j.brachy.2022.05.005] [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: 02/15/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Inverse planning simulated annealing (IPSA) produces highly conformal dose distributions and quick optimizations for high-dose-rate interstitial brachytherapy (HDRBT). We report our dosimetry and overall outcomes using this approach for the accelerated post-operative treatment of pathologically node-negative squamous cell carcinomas of the oral tongue (OTSCC) with high risk of local recurrence. METHODS Patients with newly diagnosed pN0 OTSCC treated with partial glossectomy, neck dissection, and post-operative HDRBT alone from 2007 to 2021 were retrospectively reviewed. Patients received 30 Gy in 5 fractions over 2.5 days. Target volume and mandible dosimetry are reported. Actuarial rates of local control, regional control, disease-specific survival, and overall survival were estimated using the Kaplan-Meier method. Toxicity was categorized using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. RESULTS 19 consecutive patients were reviewed. Median follow-up was 3.2 years (IQR 1.4-8.2 years) with a 3-year estimated local control rate of 81%. Target volumes were generally small, as the median volume was 12.66 cc. Median V150% and V200% were 52% and 24%, respectively. D1cc and D2cc to the mandible were 17.31 Gy and 14.42 Gy, respectively. CONCLUSIONS IPSA-HDRBT is feasible and highly efficient for post-operative treatment of the primary tumor bed in patients with pathologically node-negative squamous cell carcinomas of the oral tongue. Further technical optimization and prospective clinical evaluation in a larger patient cohort are planned.
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Affiliation(s)
- Christopher K Cheung
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Jessica Chew
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Katherine Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - Sarah M Calkins
- Department of Pathology, University of California, San Francisco, CA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA
| | - Adam Cunha
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Sue S Yom
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - I-Chow Hsu
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA
| | - Jason W Chan
- Department of Radiation Oncology, Helen Diller Comprehensive Cancer Care Center, University of California, San Francisco, CA.
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Hsu IC, Yoshida E. Ultrasound guidance for cervical implantation. Int J Gynecol Cancer 2022; 32:266-272. [DOI: 10.1136/ijgc-2021-002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 11/03/2022] Open
Abstract
Ultrasound can provide real-time imagery without the risk of radiation exposure, and it is widely available at a relatively low cost. It can provide updated three-dimensional information that can improve the physician’s spatial awareness during a brachytherapy procedure for cervical cancer. There is mounting evidence demonstrating the numerous benefits of ultrasound-guided brachytherapy in the published literature. This evidence supports its routine use to improve the safety and the effectiveness of cervical brachytherapy. In this report we will review various methods in which ultrasound imaging has been used during cervical brachytherapy. We also include a description of our own institutional approach to ultrasound-guided cervical implementation that has been in use for all cervical brachytherapy procedures over the past two decades.
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le Guyader M, Lam Cham Kee D, Thamphya B, Schiappa R, Gautier M, Chand-Fouche ME, Hannoun-Levi JM. High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes. Clin Transl Radiat Oncol 2022; 32:15-23. [PMID: 34816022 PMCID: PMC8592834 DOI: 10.1016/j.ctro.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Brachytherapy (BT) boost after radio-chemotherapy (RCT) is a standard of care in the management of locally advanced cervical cancer (LACC). As there is no consensus on high-dose-rate (HDR) BT fractionation schemes, our aim was to report the oncological outcome and toxicity profile of four different schemes using twice-a-day (BID) HDR-BT. PATIENTS AND METHODS This was an observational, retrospective, single institution study for patients with LACC receiving a HDR-BT boost. The latter was performed with a single implant and single imaging done on day 1. The different fractionation schemes were: 7 Gy + 4x3.5 Gy (group 1); 7 Gy + 4x4.5 Gy (group 2); 3x7Gy (group 3) and 3x8Gy (group 4). Local (LFS), nodal (NFS) and metastatic (MFS) recurrence-free survival as well as progression-free survival (PFS) and overall survival (OS) were analyzed. Acute (≤6 months) and late toxicities (>6 months) were reported. RESULTS From 2007 to 2018, 191 patients were included. Median follow-up was 57 months [45-132] and median EQD210D90CTVHR was 84, 82 and 90 Gy for groups 2, 3 and 4 respectively (dosimetric data missing for group 1). The 5-year LFS, NFS, MFS, PFS and OS were 85% [81-90], 83% [79-86], 70% [67-73], 61% [57-64] and 75% [69-78] respectively, with no significant difference between the groups. EQD210D90CTVHR < 85 Gy was a prognostic factor for local recurrence in univariate analysis (p = 0.045). The rates of acute/late grade ≥ 2 urinary, digestive and gynecological toxicities were 9%/15%, 3%/15% and 9%/25% respectively. CONCLUSION Bi-fractionated HDR-BT boost seems feasible with good oncological outcome and slightly more toxicity after dose escalation.
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Key Words
- BED, biologically effective dose
- BID, twice-a-day
- BMI, body-mass index
- BT, brachytherapy
- Brachytherapy
- CT, computerized tomography
- CTCAE, common terminology criteria for adverse events
- CTV, clinical target volume
- Cervical cancer
- EBRT, external beam radiotherapy
- EMBRACE, image guided intensity modulated External beam radiochemotherapy and MRI based Adaptative BRAchytherapy in locally advanced CErvical cancer
- EQD2Gy, equivalent dose at 2 Gy
- ESTRO, European Society for Radiotherapy and Oncology
- FIGO, International Federation of Gynecology and Obstetrics
- Fractionation scheme
- GEC, groupe européen de curiethérapie
- GTV, gross tumor volume
- HDR, high-dose-rate
- HIV, human immunodeficiency virus
- HR, high-risk
- High-dose-rate
- ICRU, International Commission on Radiation Units and measurements
- IGABT, image-guided adaptative brachytherapy
- IMRT, intensity modulated radiotherapy
- IR, intermediate-risk
- LACC, locally advanced cervical cancer
- LDR, low-dose-rate
- LFS, local recurrence-free survival
- LQ, linear quadratic
- MFS, metastatic recurrence-free survival
- MFU, median follow up
- MRI, magnetic resonance imaging
- NA, not available
- NCI, national cancer institute
- NFS, nodal recurrence-free survival
- OAR, organs at risk
- OS, overall survival
- OTT, overall treatment time
- PDR, pulsed-dose-rate
- PET, positron emission tomography
- PFS, progression-free survival
- PTV, planning target volume
- RCT, radio-chemotherapy
- SCC, squamous cell cancer
- SEER, surveillance, epidemiology and end results
- pt, patient
- pts, patients
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Affiliation(s)
- Maud le Guyader
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Pôle Santé République, Clermont-Ferrand, France
| | - Brice Thamphya
- Department of Statistics, Antoine Lacassagne Cancer Center, University of Côte d’Azur, Nice, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center, University of Côte d’Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
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Comparative dosimetry of brachytherapy treatment planning between a volume-based plan by CT and a point-based plan by TAUS in CT datasets for brachytherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
To evaluate comparative dosimetry of brachytherapy treatment planning between a volume-based plan by computed tomography (CT) and a point-based plan by transabdominal ultrasound (TAUS) in CT datasets for brachytherapy.
Materials and methods:
From 2019 to 2021, 59 different datasets of CT images were collected from 38 patients treated by intracavitary brachytherapy with tandem ovoid or tandem ring applicators. At that time, TAUS was performed to prevent uterine perforation and to evaluate topography of the cervix during application. In volume-based planning by CT, the target dose was used to keep the dose at 90% of high-risk clinical target volume (HR-CTV), to give a dose of at least 7Gy, while in the point-based plan by TAUS, the target dose was used to keep the minimum dose to eight cervix reference points (measured by TAUS), to give a dose of at least 7Gy. The doses to targets and organs at risk were evaluated and compared between volume-based planning by CT and the point-based plan by TAUS.
Results:
Of 59 fractions, a tandem ovoid applicator was used in 48 fractions (81·3%). In the volume-based plan by CT, the mean doses to HR-CTV(D90), intermediate-risk clinical target volume (IR-CTV)(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 7·0, 3·9, 4·9, 2·9 and 3·3 Gy, respectively, while in the point-based plan by TAUS, the mean doses to HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 8·2, 4·6, 5·9, 3·4 and 3·9 Gy, respectively. The percentages of mean dose differences between TAUS and CT of HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 17·7, 19·5, 20·5, 19·5, 21·3 and 19·8%, respectively. With the target dose to the point-based plan by TAUS (7 Gy to the cervix reference points), this was close to D98 of HR-CTV with a mean percentage of difference of 0·6%.
Findings:
The point-based plan by TAUS showed higher values to targets and organs at risk than the volume-based plan by CT. With the point-based plan by TAUS, it was close to D98 of HR-CTV.
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Williamson CW, Liu HC, Mayadev J, Mell LK. Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer. Clin Oncol (R Coll Radiol) 2021; 33:567-578. [PMID: 34266728 DOI: 10.1016/j.clon.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
The standard of care for the definitive treatment of locoregionally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost. Historically, EBRT was delivered via a two-dimensional technique based primarily on bony landmarks. This gave way to three-dimensional conformal radiation therapy, which allows for dose calculation and adjustment based on individual tumour and patient anatomy. Further technological advances have established intensity-modulated radiation therapy (IMRT) as a standard treatment modality, given the ability to maintain tumoricidal doses to target volumes while reducing unwanted radiation dose to nearby critical structures, thereby reducing toxicity. Routine image guidance allows for increased confidence in patient alignment prior to treatment, and the ability to visualise the daily position of the targets and organs at risk has been instrumental in allowing safe reductions in treated volumes. Additional EBRT technologies, including proton therapy and stereotactic body radiation therapy, may further improve the therapeutic index. In the realm of brachytherapy, a shift from point-based dose planning to image-guided brachytherapy has been associated with improved local control and reduced toxicity, with additional refinement ongoing. Here we will discuss these advances, the supporting data and future directions.
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Affiliation(s)
- C W Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - H C Liu
- La Jolla Center for Precision Radiation Medicine, La Jolla, California, USA
| | - J Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - L K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA; La Jolla Center for Precision Radiation Medicine, La Jolla, California, USA.
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Tan LT, Tanderup K, Nappa A, Petric P, Jürgenliemk-Schulz IM, Serban M, Swamidas JV, Palmu M, Duke SL, Mahantshetty U, Nesvacil N, Pötter RC, Nout RA. Impact of transitioning to an online course - A report from the ESTRO gyn teaching course. Clin Transl Radiat Oncol 2021; 29:85-92. [PMID: 34189283 PMCID: PMC8220299 DOI: 10.1016/j.ctro.2021.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction In 2020, the ESTRO course on image-guided radiotherapy and chemotherapy in gynaecological cancer was converted into an online version due to the COVID-19 pandemic. This paper describes the change process and evaluates the impact on participants compared with previous live courses. Methods and materials The 2019 live course contained 41 h of educational content, comprising 33 h of synchronous activities (lectures, interactive activities, videos) and 8 h of homework (contouring, dose planning). For the online course, the lectures were provided as pre-course material (11 mandatory, 22 optional). Contouring/dose planning homework was unchanged. The synchronous sessions were reconfigured as six 2-hour webinars (total educational content ~38 h).Participant numbers/characteristics, engagement and satisfaction for six live courses and the online course were compared. Results Participant numbers for the online and live courses were similar (90 vs. mean 96). There were more participants from outside Europe (28% vs. mean 18%) and more non-doctors (47% vs. mean 33%). Proportion of participants responding to the pre-course questionnaire was similar (77% vs. mean 78%) but post-course questionnaire response was lower (62% vs. mean 92%).43% participants viewed ≥75% of mandatory lectures before the webinars. 86% viewed the optional lectures. Submissions of contouring and dose planning homework was higher (contouring 77%-90% vs. 56%-69%, dose planning 74%-89% vs. 29%-57%).96% (47/49) participants rated the online course as Excellent (43%) or Good (53%). Overall satisfaction was similar (4.4 vs. mean 4.6). Conclusion Participant satisfaction and engagement with the online course remained high despite less contact time with faculty.
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Affiliation(s)
- L T Tan
- Cambridge University Hospitals NHS Trust, United Kingdom
| | | | - A Nappa
- European Society of Radiotherapy and Oncology (ESTRO), Brussels, Belgium
| | - P Petric
- Institute of Oncology, Ljubljana, Slovenia
| | | | - M Serban
- McGill University Health Center, Montreal, Canada
| | | | - M Palmu
- European Society of Radiotherapy and Oncology (ESTRO), Brussels, Belgium
| | - S L Duke
- Cambridge University Hospitals NHS Trust, United Kingdom
| | | | | | | | - R A Nout
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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11
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Fu Q, Xu Y, Zuo J, An J, Huang M, Yang X, Chen J, Yan H, Dai J. Comparison of two inverse planning algorithms for cervical cancer brachytherapy. J Appl Clin Med Phys 2021; 22:157-165. [PMID: 33626225 PMCID: PMC7984476 DOI: 10.1002/acm2.13195] [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: 09/11/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare two inverse planning algorithms, the hybrid inverse planning optimization (HIPO) algorithm and the inverse planning simulated annealing (IPSA) algorithm, for cervical cancer brachytherapy and provide suggestions for their usage. MATERIAL AND METHODS This study consisted of 24 cervical cancer patients treated with CT image-based high-dose-rate brachytherapy using various combinations of tandem/ovoid applicator and interstitial needles. For fixed catheter configurations, plans were retrospectively optimized with two methods: IPSA and HIPO. The dosimetric parameters with respect to target coverage, localization of high dose volume (LHDV), conformal index (COIN), and sparing of organs at risk (OARs) were evaluated. A plan assessment method which combines a graphical analysis and a scoring index was used to compare the quality of two plans for each case. The characteristics of dwell time distributions of the two plans were also analyzed in detail. RESULTS Both IPSA and HIPO can produce clinically acceptable treatment plans. The rectum D2cc was slightly lower for HIPO as compared to IPSA (P = 0.002). All other dosimetric parameters for targets and OARs were not significantly different between the two algorithms. The generated radar plots and scores intuitively presented the plan properties and enabled to reflect the clinical priorities for the treatment plans. Significant different characteristics were observed between the dwell time distributions generated by IPSA and HIPO. CONCLUSIONS Both algorithms could generate high-quality treatment plans, but their performances were slightly different in terms of each specific patient. The clinical decision on the optimal plan for each patient can be made quickly and consistently with the help of the plan assessment method. Besides, the characteristics of dwell time distribution were suggested to be taken into account during plan selection. Compared to IPSA, the dwell time distributions generated by HIPO may be closer to clinical preference.
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Affiliation(s)
- Qi Fu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Yingjie Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zuo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Jusheng An
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Manni Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Xi Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Jiayun Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Hui Yan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medial Sciences and Peking Union Medical College, Beijing, China
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12
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Tharavichitkul E, Muangwong P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Nobnop W, Tippanya D, Galalae RM, Chitapanarux I. Comparison of clinical outcomes achieved with image-guided adaptive brachytherapy for cervix cancer using CT or transabdominal ultrasound. Brachytherapy 2021; 20:543-549. [PMID: 33551272 DOI: 10.1016/j.brachy.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/20/2020] [Accepted: 12/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate retrospectively the treatment results when using various image-guided adaptive brachytherapy treatments for cervical cancer treated by radical radiotherapy. METHODS AND MATERIALS From 2014 to 2017, 188 patients with cervical carcinoma were treated by whole pelvic radiotherapy plus four fractions of image-guided brachytherapy. Eight patients were excluded because of missing data. Consequently, 180 patients were analyzed. Of 180 patients, 92 were treated by CT-based brachytherapy (CT-BT), and transabdominal ultrasound-based brachytherapy (TAUS-BT) was used to treat another group. The treatment results and toxicity outcomes were evaluated by comparing the image-guidance techniques. RESULTS The mean follow-up time was 32 months (interquartile range 29.5-42 months). The mean age was 57 years (interquartile range from 50 to 65 years). In the CT-BT group, the mean cumulative doses to high-risk clinical target volume, bladder, rectum, and sigmoid were 87.2 Gy, 84.0 Gy, 68.8 Gy, and 69.8 Gy, respectively. In the TAUS-BT group, the mean cumulative doses to the cervix reference, bladder, and rectum points were 84.0 Gy, 65.5 Gy, and 74.0 Gy, respectively. There were no differences in the 2-year local control rate (p = 0.88) and disease-free survival rate (p = 0.34) in both groups. No difference in gastrointestinal and genitourinary toxicity was observed in both groups, but there was higher vaginal toxicity in the TAUS-BT group compared with the CT-BT group (p = 0.03). CONCLUSIONS No difference in treatment results was observed between CT-based and TAUS-based approaches. However, TAUS-BT had higher vaginal toxicity in our retrospective analysis.
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Affiliation(s)
- Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Pooriwat Muangwong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pitchayaponne Klunklin
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannapha Nobnop
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Damrongsak Tippanya
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Razvan M Galalae
- MedAustron, Center for Carbon Ion Therapy and Research, Wiener Neustadt, Vienna Austria; Department of Radiotherapy, Faculty of Medicine, Christian-Albrechts University, Kiel, Germany
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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13
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Education and training for image-guided adaptive brachytherapy for cervix cancer—The (GEC)-ESTRO/EMBRACE perspective. Brachytherapy 2020; 19:827-836. [DOI: 10.1016/j.brachy.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
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14
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Elledge CR, LaVigne AW, Bhatia RK, Viswanathan AN. Aiming for 100% Local Control in Locally Advanced Cervical Cancer: The Role of Complex Brachytherapy Applicators and Intraprocedural Imaging. Semin Radiat Oncol 2020; 30:300-310. [PMID: 32828386 PMCID: PMC7875154 DOI: 10.1016/j.semradonc.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The use of brachytherapy for the treatment of gynecologic malignancies, particularly cervical cancer, has a long and rich history that is nearly as long as the history of radiation oncology itself. From the first gynecologic brachytherapy treatments in the early 20th century to the modern era, significant transformation has occurred driven largely by advancements in technology. The development of high-dose rate sources, remote afterloaders, novel applicators, and 3-dimensional image guidance has led to improved local control, and thus improved survival, solidifying the role of brachytherapy as an integral component in the treatment of locally advanced cervical cancer. Current research efforts examining novel magnetic resonance imaging sequences, active magnetic resonance tracking, and the application of hydrogel aim to further improve local control and reduce treatment toxicity.
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Affiliation(s)
- Christen R Elledge
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna W LaVigne
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rohini K Bhatia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
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15
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Li C, Li X, You J, Liang B, Su X, Huang Y, Chen Y, Hu Q, Deng J, Wang H, Pu Y, Liu H, Ma Y, Wang W, Wu H, Zhang Y. Impact of radiation source activity on short- and long-term outcomes of cervical carcinoma patients treated with high-dose-rate brachytherapy: A retrospective cohort study. Gynecol Oncol 2020; 159:365-372. [PMID: 32933759 DOI: 10.1016/j.ygyno.2020.08.037] [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: 06/26/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE High-dose-rate (HDR) afterloading brachytherapy using Iridium-192 source involves large radiation activity varieties due to fast decay. It was unknown but clinically desirable to evaluate its impacts on patient outcomes to support more informed decisions. METHODS Data of 510 cervical carcinoma (CC) patients were retrospectively included. High-radioactive (HR) and low-radioactive (LR) groups were statistically defined per patient-specific average mean-dose-rate (MDR) of all fractions. The cutoffs were calculated using R-3.6.1 packages based on significance of correlation with binary outcome or survival time. Categorized 1-month and 3-month follow-up results were analyzed as short-term outcomes. Long-term outcomes were evaluated using local recurrence-free survival (LRFS) and metastatic recurrence-free survival (MRFS). Propensity-score-matched (PSM) pairs were generated to reduce bias. RESULTS The median follow-up time was 47.1 months (interquartile range: 33.9 months-66.4 months), involving MDR varieties of up to 9 folds ranging from 6059.99 cGy/h to 54013.66 cGy/h due to 17 source replacements at intervals ranging from 93 days-199 days. Both short-term (1-month: p = 0.22; 3-month: p = 0.79) and long-term (LRFS: p = 0.10; MRFS: p = 0.46) outcomes showed no significant difference between HR and LR. Subgroup analysis displayed significantly better results in LR for stage I-II (3-month, p = 0.02) and stage II (LRFS, p = 0.04) patients. Both LRFS and MRFS of LR were significantly non-inferior to HR (p ≤ 0.02). CONCLUSIONS LR is clinically non-inferior or partially superior to HR for CC treatment using HDR, which dispels concerns of potentially undermined patient outcomes when source replacement is delayed.
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Affiliation(s)
- Chenguang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Xiaofan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Jing You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Baosheng Liang
- Department of Biostatistics, Health Science Center, Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China.
| | - Xing Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yuliang Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
| | - Qiaoqiao Hu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, CT 06511, United States.
| | - Haiyang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yichen Pu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Hongjia Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yanan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China.
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China.
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16
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Mignot F, Gouy S, Schernberg A, Bockel S, Espenel S, Maulard A, Leary A, Genestie C, Annede P, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C. Comprehensive analysis of patient outcome after local recurrence of locally advanced cervical cancer treated with concomitant chemoradiation and image-guided adaptive brachytherapy. Gynecol Oncol 2020; 157:644-648. [PMID: 32173045 DOI: 10.1016/j.ygyno.2020.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Since dose escalation allowed by image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), local relapses have become a rare event. Only scarce data are available on the outcome of patients experiencing a local relapse after IGABT. METHODS Between 2004 and 2016, all consecutive patients treated at Gustave Roussy Institute for LACC and receiving concomitant chemoradiation and IGABT were analysed. Clinical and treatment-related prognostic factors for survival after local relapse were searched, in order to potentially identify patients requiring salvage treatment. RESULTS Two hundred and fifty-nine patients were treated during this period. With a median follow-up of 4.1 years, 10.8% (n = 28) had a local relapse. Among these patients, 53.6% had synchronous lymph nodes or distant metastatic relapse and only 13 patients (5% of all patients) had isolated local relapse. After local relapse, median survival was 47 months and three patients were alive at last follow-up. Only three patients with local relapse could receive salvage surgery (10.7%). Metastases occurrence and pelvic wall involvement were the main contraindications (67.9%) for salvage surgery. Among the three patients treated with surgery, two are still alive at last follow-up without significant complication. Improved survival was observed among the two patients who could have surgery (p = .02). Local progression led to serious symptoms in 75% of patients. Only the time interval between brachytherapy and relapse (<1 year) was prognostic for 2-year overall survival (p = .005). CONCLUSION Salvage surgery is feasible in a very low number of highly selected patients with local relapse following IGABT. Local failure is a major cause of severe local symptoms, confirming that every effort should be done to achieve long-term local control through dose escalation.
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Affiliation(s)
- F Mignot
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France.
| | - S Gouy
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Schernberg
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Bockel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Espenel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Maulard
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Annede
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - M Kissel
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - I Fumagalli
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - E Deutsch
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Morice
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; French Military Health Services Academy, Paris, France; Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France
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17
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Bajwa HK, Singareddy R, Krishnam Raju A. Outcomes of freehand interstitial brachytherapy in advanced gynecologic malignancies. Brachytherapy 2020; 19:669-673. [PMID: 32466952 DOI: 10.1016/j.brachy.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of the study is to present the first results of freehand interstitial brachytherapy (ISBT) used to treat patients with carcinoma of the cervix and the vagina. METHODS AND MATERIALS Patients diagnosed with carcinoma of the cervix or carcinoma of the vagina who were not suitable for intracavitary brachytherapy were treated with freehand ISBT. The implant was performed transperineally using C arm or transrectal ultrasound guidance. Patients received an external beam radiotherapy dose of 50 Gy in 25 fractions. The dose delivered by high-dose-rate ISBT was 18 Gy in three fractions, 6 Gy per fraction, 6 h apart. The brachytherapy dose volume parameters were analyzed after CT-based planning using GEC ESTRO image-guided brachytherapy-based guidelines. RESULTS From June 2018 till November 2018, 14 patients were treated with freehand ISBT. The mean dose received by 90% of the high-risk clinical target volume (D90) was 82 Gy EQD210 for patients with carcinoma of the cervix and 80 Gy EQD210 for patients with carcinoma of the vagina. The mean dose received by 2 cc volume of the bladder and rectum was 80 Gy EQD23 and 70 Gy EQD23 for patients with carcinoma of the cervix and 75 Gy EQD23 and 72 Gy EQD23 for patients with carcinoma of the vagina, respectively. The mean dose received by 2 cc of the sigmoid was 65 Gy EQD23 for cervical carcinoma and 58 Gy EQD23 for vaginal carcinoma, respectively. At a median followup of 14 months, 2 patients developed local recurrence. Two patients developed Grade 2 gastro intestinal toxicity, and 1 patient developed Grade 2 genitourinary toxicity. None of the patients developed Grade 3 or 4 toxicities. CONCLUSION A freehand interstitial implant is feasible in resource limited settings and provides acceptable local control with minimal acute toxicity.
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Affiliation(s)
- Harjot Kaur Bajwa
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rohith Singareddy
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
| | - Alluri Krishnam Raju
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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18
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Perdrizet J, D'Souza D, Skliarenko J, Ang M, Barbera L, Gutierrez E, Ravi A, Tanderup K, Warde P, Chan K, Isaranuwatchai W, Milosevic M. A Cost-Utility Analysis of Magnetic Resonance (MR) Guided Brachytherapy Versus Two-Dimensional and Computed Tomography (CT) Guided Brachytherapy for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2020; 107:512-521. [PMID: 32169410 DOI: 10.1016/j.ijrobp.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent cisplatin followed by brachytherapy. Traditionally, 2-dimensional brachytherapy (2DBT) or computed tomography guided brachytherapy (CTgBT) has been used, but magnetic resonance guided brachytherapy (MRgBT) improves clinical outcomes and has become the new standard of care. This cost-utility analysis was undertaken to compare MRgBT to CTgBT and 2DBT. METHODS AND MATERIALS A Markov model was constructed to evaluate the cost-utility from the perspective of the public health care payer in Ontario. Treatment effectiveness, expressed as quality-adjusted life years, and costs, expressed in 2016 Canadian dollars, were evaluated for MRgBT, CTgBT, and 2DBT. Results were reported as incremental cost-effectiveness ratios for all patients and separately for low and high-risk subgroups. Sensitivity analyses were performed to assess the impact of uncertainty in model parameters. RESULTS MRgBT improved tumor control, reduced side effects, and was less costly compared with either CTgBT or 2DBT for all patients and in low- and high-risk prognostic subgroups separately. Sensitivity analysis supported the robustness of the findings and identified the cost of treating cancer recurrence to be the single most influential model parameter. CONCLUSIONS MRgBT is more effective and less costly than CTgBT or 2DBT by avoiding downstream costs of treating cancer recurrence and managing side effects. These findings will assist health care providers and policymakers with future infrastructure and human resource planning to ensure optimal care of women with this disease.
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Affiliation(s)
- Johnna Perdrizet
- St. Michael's Hospital, Centre for Excellence in Economic Analysis Research, Toronto, Ontario, Canada
| | - David D'Souza
- London Health Sciences Centre, London, Ontario, Canada
| | - Julia Skliarenko
- South Muskoka Regional Cancer Program, Barrie, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Ang
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Eric Gutierrez
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre and Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Padraig Warde
- Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Kelvin Chan
- Odette Cancer Centre and Sunnybrook Hospital, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- St. Michael's Hospital, Centre for Excellence in Economic Analysis Research, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Milosevic
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.
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19
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Nomden CN, Pötter R, de Leeuw AA, Tanderup K, Lindegaard JC, Schmid MP, Fortin I, Haie-Meder C, Mahantshetty U, Hoskin P, Segedin B, Bruheim K, Rai B, Huang F, Cooper R, Van Der Steen Banasik E, Van Limbergen E, Jürgenliemk-Schulz IM. Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort. Radiother Oncol 2019; 134:185-190. [DOI: 10.1016/j.radonc.2019.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/14/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
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20
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Development and assessment of 3D-printed individual applicators in gynecological MRI-guided brachytherapy. J Contemp Brachytherapy 2019; 11:128-136. [PMID: 31139221 PMCID: PMC6536148 DOI: 10.5114/jcb.2019.84741] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/29/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate the clinical use of 3D printing technology for the modelling of individual applicators for advanced gynecological tumors in magnetic resonance imaging (MRI)-based brachytherapy (BT). Material and methods We tested individually designed 3D-printed applicators in nine patients with advanced gynecological cancer. Before BT was performed, all patients were treated with external beam radiotherapy (EBRT). The most common indication for individualized BT was advanced gynecological tumors where the use of standard BT applicators was not feasible. Other indications were suboptimal dose-volume histogram (DVH) parameters for high-risk clinical target volume (CTV-THR) at the first BT (V100 ≤ 90% of CTV-THR volume and D98 ≤ 80%, D90 ≤ 100%, and D100 ≤ 60% of dose aim). The EQD2 dose aim to the target volume D90 CTV-THR per one BT fraction was 20 Gy for cervical or recurrent endometrial cancer and 16 Gy for vaginal cancer patient. The first BT with the standard applicator in situ was used as the virtual plan for designing a 3D-printed applicator. The next BT was performed with a 3D-printed applicator in situ. The primary endpoint was to improve CTV-THR DVH parameters without exceeding the dose to the organs at risk (OARs). Results All DVH parameters for CTV-THR were significantly higher with the use of an individually designed applicator. Mean D90 CTV-THR improved from 14.1 ±5.4 Gy to 22.0 ±2.5 Gy and from 7.1 Gy to 16.2 Gy for cervical/recurrent endometrial and vaginal cancer, respectively (p < 0.001). The mean D2cm3 bladder, rectum, sigmoid, and bowel dose was within institutional dose constraints, and increased from 13.0 ±1.5 Gy to 13.6 ±1.5 Gy (p = 0.045), 10.8 ±1.2 Gy to 11.7 ±1.3 Gy (p = 0.004), 8.9 ±3.2 Gy to 10.3 ±3.3 Gy (p = 0.008), and 8.7 ±3.8 Gy to 9.2 ±3.1 Gy (p = 0.2). Conclusions With the use of individual 3D-printed applicators, all DVH parameters for CTV-THR significantly improved without compromising the dose constraints for the OARs.
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Lin AJ, Samson P, Zoberi J, Garcia-Ramirez J, Williamson JF, Markovina S, Schwarz J, Grigsby PW. Concurrent chemoradiation for cervical cancer: Comparison of LDR and HDR brachytherapy. Brachytherapy 2019; 18:353-360. [PMID: 30971370 DOI: 10.1016/j.brachy.2018.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare clinical outcomes between low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy for cervical cancer patients. METHODS AND MATERIALS All consecutive newly diagnosed cervical cancer patients undergoing pretreatment 18-fluorodeoxyglucose positron emission tomography imaging and treated with curative-intent definitive chemoradiation from 1997 to 2016 at a U.S. academic center were included. Brachytherapy boost was LDR or HDR 2D treatment planning from 1997 to 2005 and HDR with MR-based 3D planning from 2005 to 2016. Local control (LC), cancer-specific survival (CSS), and late bowel/bladder complications were evaluated. RESULTS Tumor stages were International Federation of Gynecology and Obstetrics IB1-IIB (n = 457; 75%) and III-IVA (n = 152; 25%). Brachytherapy was LDR for 104 patients and HDR for 505 patients. Concurrent weekly cisplatin was administered to 536 patients (88%). With median followup of 9.4 years, there was no difference in LC (p = 0.24) or CSS (p = 0.50) between LDR and HDR brachytherapy. Cox multivariable regression showed that only International Federation of Gynecology and Obstetrics stage III-IVA (HR=2.4, p = 0.004) was associated with worse LC. A propensity-matched cohort (90 LDR vs. 90 HDR) was created, and the 5-year LC rates were 88% LDR and 82% HDR, p = 0.26; 5-year CSS rates were 66% LDR and 58% HDR, p = 0.19; 5-year grade ≥3 bowel/bladder toxicities were 23% LDR and 16% HDR, p = 0.44. For all patients, the 5-year late toxicity in stage III-IVA patients was higher with LDR 47% vs. HDR 15%, p = 0.03, with no difference in LC, 86% and 75%, respectively (p = 0.09). CONCLUSIONS There was no difference in LC with either LDR or HDR brachytherapy. The late complication rate was reduced with HDR and 3D-planned brachytherapy compared to LDR and 2D-planned brachytherapy.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pamela Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jacqueline Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey F Williamson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Sethi R, Mayadev J, Sethi S, Rash D, Chen LM, Brooks R, Ueda S, Hsu IC. Patterns of Recurrence in Node-Positive Cervical Cancer Patients Treated With Contemporary Chemoradiation and Dose Escalation: A Multi-Institutional Study. Pract Radiat Oncol 2019; 9:e180-e186. [DOI: 10.1016/j.prro.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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MRI-guided adaptive brachytherapy for locally advanced cervix cancer: Treatment outcomes from a single institution in Hong Kong. Brachytherapy 2019; 18:171-179. [DOI: 10.1016/j.brachy.2018.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/26/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
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Intracavitary Brachytherapy from 2D to 3D. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gebhardt BJ, Vargo JA, Kim H, Houser CJ, Glaser SM, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Courtney-Brooks M, Beriwal S. Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina. Gynecol Oncol 2018; 150:293-299. [PMID: 29929925 DOI: 10.1016/j.ygyno.2018.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Brachytherapy is integral to vaginal cancer treatment and is typically delivered using an intracavitary single-channel vaginal cylinder (SCVC) or an interstitial brachytherapy (ISBT) applicator. Multi-channel vaginal cylinder (MCVC) applicators allow for improved organ-at-risk (OAR) sparing compared to SCVC while maintaining target coverage. We present clinical outcomes of patients treated with image-based high dose-rate (HDR) brachytherapy using a MCVC. METHODS AND MATERIALS Sixty patients with vaginal cancer (27% primary vaginal and 73% recurrence from other primaries) were treated with combination external beam radiotherapy (EBRT) and image-based HDR brachytherapy utilizing a MCVC if residual disease thickness was 7 mm or less after EBRT. All pts received 3D image-based BT to a total equivalent dose of 70-80 Gy. RESULTS The median high-risk clinical target volume was 24.4 cm3 (interquartile range [IQR], 14.1), with a median dose to 90% of 77.2 Gy (IQR, 2.8). After a median follow-up of 45 months (range, 11-78), the 4-year local-regional control, distant control, DFS, and OS rates were 92.6%, 76.1%, 64.0%, and 67.2%, respectively. The 4-year LRC rates were similar between the primary vaginal (92%) and recurrent (93%) groups (p = 0.290). Pts with lymph node positive disease had a lower rate of distant control at 4 years (22.7% vs. 89.0%, p < 0.001). There were no Grade 3 or higher acute complications. The 4-year rate of late Grade 3 or higher toxicity was 2.7%. CONCLUSIONS Clinical outcomes of pts with primary and recurrent vaginal cancer treated definitively in a systematic manner with combination EBRT with image-guided HDR BT utilizing a MCVC applicator demonstrate high rates of local control and low rates of severe morbidity. The MCVC technique allows interstitial implantation to be avoided in select pts with ≤7 mm residual disease thickness following EBRT while maintaining excellent clinical outcomes with extended 4-year follow-up in this rare malignancy.
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Affiliation(s)
- Brian J Gebhardt
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Hayeon Kim
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher J Houser
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Scott M Glaser
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Paniti Sukumvanich
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Alexander B Olawaiye
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Joseph L Kelley
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Robert P Edwards
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - John T Comerci
- Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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Sethi R, Kuo YC, Edraki B, Lerner D, Paik D, Bice W. Real-time Doppler ultrasound to identify vessels and guide needle placement for gynecologic interstitial brachytherapy. Brachytherapy 2018; 17:742-746. [PMID: 29861268 DOI: 10.1016/j.brachy.2018.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Doppler ultrasound (US) gives real-time information regarding anatomy and blood vessel location to guide needle placement for gynecologic interstitial (IS) brachytherapy (BT). We retrospectively assessed Doppler US images for vessel quantity, size, and distribution in cervical cancer patients undergoing high-dose-rate BT at our institution. METHODS AND MATERIALS Eleven consecutive patients undergoing IS high-dose-rate BT implants for cervical cancer between 2015 and 2017 were included. Transrectal Doppler US was used for real-time image guidance. US images were retrospectively evaluated. Vessel quantity, size, and distribution at superior and inferior levels of the cervix were recorded. Correlation of vessel quantity with tumor size and International Federation of Gynecology and Obstetrics stage was evaluated. RESULTS Average vessel quantity was 4.2 in the inferior cervix and 3.8 in the superior cervix (range 1-11). Median vessel diameter was 2 mm in the inferior cervix and 2 mm in the superior cervix (range 1-6 mm). The most common location was posterolateral (3:00-5:00 and 7:00-9:00), outer third (78% of vessels inferiorly, 64% of vessels superiorly). Vessel quantity was correlated to initial tumor size superiorly (p = 0.04, paired t-test) but not inferiorly (p = 0.31, paired t-test). There was no correlation between vessel quantity and International Federation of Gynecology and Obstetrics stage (p > 0.05, analysis of variance). Doppler US was successfully used to guide needle placement away from visualized blood vessels with no incidents of hemorrhage in these patients. CONCLUSIONS Doppler US is a useful tool to guide needle placement for IS BT for cervical cancer. Vessel quantity varied with increased vessel quantity seen higher in the cervix for larger tumors. Vessels were most commonly distributed in the outer third of the posterolateral cervix.
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Affiliation(s)
- Rajni Sethi
- Department of Radiation, John Muir Health, Walnut Creek, CA.
| | - Yueh Chun Kuo
- Department of Radiation, John Muir Health, Walnut Creek, CA
| | - Babak Edraki
- Department of Gynecologic Oncology, John Muir Health, Walnut Creek, CA
| | - Dimitry Lerner
- Department of Gynecologic Oncology, John Muir Health, Walnut Creek, CA
| | - Daniel Paik
- Department of Gynecologic Oncology, John Muir Health, Walnut Creek, CA
| | - William Bice
- Department of Radiation, John Muir Health, Walnut Creek, CA
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Pötter R, Tanderup K, Kirisits C, de Leeuw A, Kirchheiner K, Nout R, Tan LT, Haie-Meder C, Mahantshetty U, Segedin B, Hoskin P, Bruheim K, Rai B, Huang F, Van Limbergen E, Schmid M, Nesvacil N, Sturdza A, Fokdal L, Jensen NBK, Georg D, Assenholt M, Seppenwoolde Y, Nomden C, Fortin I, Chopra S, van der Heide U, Rumpold T, Lindegaard JC, Jürgenliemk-Schulz I. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9:48-60. [PMID: 29594251 PMCID: PMC5862686 DOI: 10.1016/j.ctro.2018.01.001] [Citation(s) in RCA: 417] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 02/07/2023] Open
Abstract
The publication of the GEC-ESTRO recommendations one decade ago was a significant step forward for reaching international consensus on adaptive target definition and dose reporting in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Since then, IGABT has been spreading, particularly in Europe, North America and Asia, and the guidelines have proved their broad acceptance and applicability in clinical practice. However, a unified approach to volume contouring and reporting does not imply a unified administration of treatment, and currently both external beam radiotherapy (EBRT) and IGABT are delivered using a large variety of techniques and prescription/fractionation schedules. With IGABT, local control is excellent in limited and well-responding tumours. The major challenges are currently loco-regional control in advanced tumours, treatment-related morbidity, and distant metastatic disease. Emerging evidence from the RetroEMBRACE and EMBRACE I studies has demonstrated that clinical outcome is related to dose prescription and technique. The next logical step is to demonstrate excellent clinical outcome with the most advanced EBRT and brachytherapy techniques based on an evidence-based prospective dose and volume prescription protocol. The EMBRACE II study is an interventional and observational multicentre study which aims to benchmark a high level of local, nodal and systemic control while limiting morbidity, using state of the art treatment including an advanced target volume selection and contouring protocol for EBRT and brachytherapy, a multi-parametric brachytherapy dose prescription protocol (clinical validation of dose constraints), and use of advanced EBRT (IMRT and IGRT) and brachytherapy (IC/IS) techniques (clinical validation). The study also incorporates translational research including imaging and tissue biomarkers.
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Affiliation(s)
- Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Astrid de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Center, The Netherlands
| | - Li Tee Tan
- Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke’s Hospital, Cambridge University Hospitals National Health Service Trust, United Kingdom
| | | | | | - Barbara Segedin
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Peter Hoskin
- Cancer Centre, Mount Vernon Cancer Centre, United Kingdom
| | - Kjersti Bruheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fleur Huang
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Max Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Nicole Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Lars Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Dietmar Georg
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | - Yvette Seppenwoolde
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Christel Nomden
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Israel Fortin
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal University, Montreal, Canada
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Uulke van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
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Shaw W, Rae WI, Alber ML. Image-guided adaptive brachytherapy dose escalation for cervix cancer via fractionation compensation. Brachytherapy 2017; 16:534-546. [DOI: 10.1016/j.brachy.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/19/2016] [Accepted: 01/05/2017] [Indexed: 11/16/2022]
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Sturdza A, Pötter R, Fokdal LU, Haie-Meder C, Tan LT, Mazeron R, Petric P, Šegedin B, Jurgenliemk-Schulz IM, Nomden C, Gillham C, McArdle O, Van Limbergen E, Janssen H, Hoskin P, Lowe G, Tharavichitkul E, Villafranca E, Mahantshetty U, Georg P, Kirchheiner K, Kirisits C, Tanderup K, Lindegaard JC. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol 2016; 120:428-433. [DOI: 10.1016/j.radonc.2016.03.011] [Citation(s) in RCA: 371] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 10/21/2022]
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30
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Tanderup K, Lindegaard JC, Kirisits C, Haie-Meder C, Kirchheiner K, de Leeuw A, Jürgenliemk-Schulz I, Van Limbergen E, Pötter R. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome. Radiother Oncol 2016; 120:365-369. [PMID: 27555228 DOI: 10.1016/j.radonc.2016.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Denmark
| | | | - Christian Kirisits
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Christine Haie-Meder
- Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France
| | - Kathrin Kirchheiner
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Astrid de Leeuw
- University Medical Center Utrecht, Department of Radiotherapy, The Netherlands
| | | | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Richard Pötter
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
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A method for restricting intracatheter dwell time variance in high-dose-rate brachytherapy plan optimization. Brachytherapy 2016; 15:246-51. [DOI: 10.1016/j.brachy.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
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Trifiletti DM, Showalter TN. Image-guided brachytherapy in cervical cancer: past, present and future. Future Oncol 2015; 11:2629-2632. [DOI: 10.2217/fon.15.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908, USA
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