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Dankulchai P, Prasartseree T, Sittiwong W, Chansilpa Y, Apiwarodom N, Petsuksiri J, Thephamongkhol K, Treechairusame T, Jitwatcharakomol T, Setakornnukul J, Teyateeti A, Rongthong W, Thaweerat W, Suntornpong N, Veerasarn V, Tuntapakul P, Chareonsiriwat N, Manopetchkasem S. Clinical Outcome Comparison between CT-Guided Versus all MRI-Guided Scenarios in Brachytherapy for Cervical Cancer: A Single-Institute Experience. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00322-4. [PMID: 39218741 DOI: 10.1016/j.clon.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Image-guided adaptive brachytherapy (IGABT) is the standard of care for patients with cervical cancer. The objective of this study was to compare the treatment outcomes and adverse effects of computed tomography (CT)-guided and magnetic resonance imaging (MRI)-guided scenarios. MATERIALS AND METHODS Data of patients with cervical cancer treated using external beam radiotherapy followed by IGABT from 2012 to 2016 were retrospectively reviewed. CT-guided IGABT was compared with the three modes of MRI-guided IGABT: pre-brachytherapy (MRI Pre-BT) without applicator insertion for fusion, planning MRI with applicator in-place in at least 1 fraction (MRI ≥1Fx), and MRI in every fraction (MRI EveryFx). Patient characteristics, oncologic outcomes, and late radiation toxicity were analyzed using descriptive, survival, and correlation statistics. RESULTS Overall, 354 patients were evaluated with a median follow-up of 60 months. The 5-year overall survival (OS) rates were 61.5%, 65.2%, 54.4%, and 63.7% with CT-guided, MRI PreBT, MRI ≥1Fx, and MRI EveryFx IGABT, respectively with no significant differences (p = 0.522). The 5-year local control (LC) rates were 92.1%, 87.8%, 80.7%, and 76.5% (p = 0.133), respectively, with a significant difference observed between the CT-guided and MRI ≥1Fx (p = 0.018). The grade 3-4 late gastrointestinal toxicity rates were 6% in the CT-guided, MRI ≥1Fx, and MRI EveryFx, and 8% in MRI PreBT. The grade 3-4 late genitourinary toxicity rates were 4% in the CT-guided, 2% in MRI PreBT, 1% in MRI ≥1Fx, and none in MRI EveryFx. No significant differences were observed in the oncologic and toxicity outcomes among MRI PreBT, MRI ≥1Fx, and MRI EveryFx. CONCLUSIONS CT-guided IGABT yielded an acceptable 5-year OS, LC, and toxicity profile compared with all MRI scenarios and is a potentially feasible option in resource-limited settings.
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Affiliation(s)
- P Dankulchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Prasartseree
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - W Sittiwong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Y Chansilpa
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Apiwarodom
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - J Petsuksiri
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - K Thephamongkhol
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Treechairusame
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T Jitwatcharakomol
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - J Setakornnukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - A Teyateeti
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Rongthong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Thaweerat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Suntornpong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - V Veerasarn
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Tuntapakul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Chareonsiriwat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Manopetchkasem
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yang C, Qin LH, Xie YE, Liao JY. Deep learning in CT image segmentation of cervical cancer: a systematic review and meta-analysis. Radiat Oncol 2022; 17:175. [PMID: 36344989 PMCID: PMC9641941 DOI: 10.1186/s13014-022-02148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background This paper attempts to conduct a systematic review and meta-analysis of deep learning (DLs) models for cervical cancer CT image segmentation. Methods Relevant studies were systematically searched in PubMed, Embase, The Cochrane Library, and Web of science. The literature on DLs for cervical cancer CT image segmentation were included, a meta-analysis was performed on the dice similarity coefficient (DSC) of the segmentation results of the included DLs models. We also did subgroup analyses according to the size of the sample, type of segmentation (i.e., two dimensions and three dimensions), and three organs at risk (i.e., bladder, rectum, and femur). This study was registered in PROSPERO prior to initiation (CRD42022307071). Results A total of 1893 articles were retrieved and 14 articles were included in the meta-analysis. The pooled effect of DSC score of clinical target volume (CTV), bladder, rectum, femoral head were 0.86(95%CI 0.84 to 0.87), 0.91(95%CI 0.89 to 0.93), 0.83(95%CI 0.79 to 0.88), and 0.92(95%CI 0.91to 0.94), respectively. For the performance of segmented CTV by two dimensions (2D) and three dimensions (3D) model, the DSC score value for 2D model was 0.87 (95%CI 0.85 to 0.90), while the DSC score for 3D model was 0.85 (95%CI 0.82 to 0.87). As for the effect of the capacity of sample on segmentation performance, no matter whether the sample size is divided into two groups: greater than 100 and less than 100, or greater than 150 and less than 150, the results show no difference (P > 0.05). Four papers reported the time for segmentation from 15 s to 2 min. Conclusion DLs have good accuracy in automatic segmentation of CT images of cervical cancer with a less time consuming and have good prospects for future radiotherapy applications, but still need public high-quality databases and large-scale research verification. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02148-6.
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Uezono H, Tsujino K, Inoue Y, Kajihara A, Marudai M, Bessho R, Sekii S, Kubota H, Yamaguchi S, Ota Y. CT-based image-guided brachytherapy in uterine cervical cancer: Effect of tumor dose and volume on local control. Brachytherapy 2022; 21:814-822. [PMID: 36155168 DOI: 10.1016/j.brachy.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To determine the optimal primary tumor dose for cervical cancer treatment using computed tomography (CT)-based image-guided brachytherapy (IGBT). MATERIALS AND METHODS We retrospectively reviewed 171 patients with cervical cancer who underwent both external beam radiation therapy (EBRT) and IGBT between May 2015 and December 2019. Majority of EBRT plan included central shielding technique. CT-based IGBT was performed weekly a median of three times. Magnetic resonance imaging preceded the first and third session of IGBT for target delineation. RESULTS The median age of the patients was 64 years (range: 30-91 years). The median follow-up time for living patients was 43 months (range: 6-76 months). The 3-year local control rates according to the International Federation of Gynecology and Obstetrics (FIGO, 2008) stages were 89%, 100%, 92%, 89%, 78%, and 100% for stages IB, IIA, IIB, IIIA, IIIB, and IVA, respectively. The median EBRT dose to the central pelvis and parametrium/pelvic wall was 41.4 Gy and 50.4 Gy, respectively. Patients who received a cumulative 2 Gy equivalent dose (EQD2) (α/β = 10 Gy) of high-risk clinical target volume (HR CTV) D90% ≥ 75 Gy achieved a long-term local control rate of 93%, compared with 80% in those who received <75 Gy (p = 0.02). CONCLUSION This is one of the largest CT-based IGBT series examining the treatment of cervical cancer based on the tumor dose-volume relationship. An HR CTV D90% ≥75 Gy was significantly associated with favorable local control in this study.
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Affiliation(s)
- Haruka Uezono
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Yuko Inoue
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Akifumi Kajihara
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Mitsuru Marudai
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Ryosuke Bessho
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan; Department of Radiation Oncology, Kitaharima Medical Center, Ono, Hyogo, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan; Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo, Japan
| | | | - Yosuke Ota
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
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Hayashi H, Kimoto N, Maeda T, Tomita E, Asahara T, Goto S, Kanazawa Y, Shitakubo Y, Sakuragawa K, Ikushima H, Okazaki T, Hashizume T. A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy. Med Phys 2021; 48:4621-4635. [PMID: 33760234 DOI: 10.1002/mp.14857] [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: 10/07/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We aimed to develop a disposable rectum dosimeter and to demonstrate its ability to measure exposure dose to the rectum during brachytherapy for cervical cancer treatment using high-dose rate 192 Ir. Our rectum dosimeter measures the dose with an optically stimulated luminescence (OSL) sheet which was furled to a catheter. The catheter we used is 6 mm in diameter; therefore, it is much less invasive than other rectum dosimeters. The rectum dosimeter developed in this study has the characteristics of being inexpensive and disposable. It is also an easy-to-use detector that can be individually sterilized, making it suitable for clinical use. METHODS To obtain a dose calibration curve, phantom experiments were performed. Irradiation was performed using a cubical acrylic phantom, and the response of the OSL dosimeter was calibrated with the calculation value predicted by the treatment planning system (TPS). Additionally, the dependence of catheter angle on the dosimeter position and repeatability were evaluated. We also measured the absorbed dose to the rectum of patients who were undergoing brachytherapy for cervical cancer (n = 64). The doses measured with our dosimeters were compared with the doses calculated by the TPS. In order to examine the causes of large differences between measured and planned doses, we classified the data into common and specific cases when performing this clinical study. For specific cases, the following three categories were considered: (a) patient movement, (b) gas in the vagina and/or rectum, and (c) artifacts in the X-ray image caused by applicators. RESULTS A dose calibration curve was obtained in the range of 0.1 Gy-10.0 Gy. From the evaluation of the dependence of catheter angle on the dosimeter position and repeatability, we determined that our dosimeter can measure rectum dose with an accuracy of 3.1% (k = 1). In this clinical study, we succeeded in measuring actual doses using our rectum dosimeter. We found that the deviation of the measured dose from the planned dose was derived to be 12.7% (k = 1); this result shows that the clinical study included large elements of uncertainty. The discrepancies were found to be due to patient motion during treatment, applicator movement after planning images were taken, and artifacts in the planning images. CONCLUSIONS We present the idea that a minimally invasive rectum dosimeter can be fabricated using an OSL sheet. Our clinical study demonstrates that a rectum dosimeter made from an OSL sheet has sufficient ability to evaluate rectum dose. Using this dosimeter, valuable information concerning organs at risk can be obtained during brachytherapy.
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Affiliation(s)
- Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Natsumi Kimoto
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tatsuya Maeda
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Emi Tomita
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Asahara
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.,Okayama University Hospital, Kitaku, Okayama, Japan
| | - Sota Goto
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yuki Kanazawa
- Graduate School of Health Sciences, Tokushima University, Tokushima, Japan
| | | | | | - Hitoshi Ikushima
- Graduate School of Health Sciences, Tokushima University, Tokushima, Japan.,Tokushima University Hospital, Tokushima, Japan
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Zeng J, Liu Z, Jiang S, Pang Q, Wang P. Verification of Guiding Needle Placement by Registered Ultrasound Image During Combined Intracavitary/Interstitial Gynecologic Brachytherapy. Cancer Manag Res 2021; 13:1917-1928. [PMID: 33658854 PMCID: PMC7917343 DOI: 10.2147/cmar.s294498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Our previous research demonstrated that under ideal conditions, rigid registration between MRI images and US images had high accuracy for real-time image guidance. The work presented in this paper focused on the application of the previously established procedures to a new context, including preoperative CT images. Materials and Methods We used a template to calibrate the US probe and completed the registration between preoperative CT images and US images. Marker experiments on the accuracy of real-time needle trajectories in CT images were performed using micro electromagnetic sensors. Pelvic phantom experiments were carried out to test the registration accuracy between CT and US images, in addition to registration accuracy between US images and real-time needle trajectories (real-time space model). Results The US probe calibration error in CT images was 0.879 ± 0.149 mm. The difference of registration between US images and CT images was 0.935 ± 0.166 mm in the axial plane (n = 30) and 0.916 ± 0.143 mm in the sagittal plane (n =12). The difference of registration between US images and the needle’s real-time trajectories was 0.951 ± 0.202 mm. Conclusion Under ideal conditions, rigid registration between CT images and US images had high accuracy for real-time image guidance.
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Affiliation(s)
- Jing Zeng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.,Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, People's Republic of China
| | - Ziqi Liu
- School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
| | - Qingsong Pang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ping Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
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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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Zhang D, Yang Z, Jiang S, Zhou Z, Meng M, Wang W. Automatic segmentation and applicator reconstruction for CT-based brachytherapy of cervical cancer using 3D convolutional neural networks. J Appl Clin Med Phys 2020; 21:158-169. [PMID: 32991783 PMCID: PMC7592978 DOI: 10.1002/acm2.13024] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
In this study, we present deep learning-based approaches to automatic segmentation and applicator reconstruction with high accuracy and efficiency in the planning computed tomography (CT) for cervical cancer brachytherapy (BT). A novel three-dimensional (3D) convolutional neural network (CNN) architecture was proposed and referred to as DSD-UNET. The dataset of 91 patients received CT-based BT of cervical cancer was used to train and test DSD-UNET model for auto-segmentation of high-risk clinical target volume (HR-CTV) and organs at risk (OARs). Automatic applicator reconstruction was achieved with DSD-UNET-based segmentation of applicator components followed by 3D skeletonization and polynomial curve fitting. Digitization of the channel paths for tandem and ovoid applicator in the planning CT was evaluated utilizing the data from 32 patients. Dice similarity coefficient (DSC), Jaccard Index (JI), and Hausdorff distance (HD) were used to quantitatively evaluate the accuracy. The segmentation performance of DSD-UNET was compared with that of 3D U-Net. Results showed that DSD-UNET method outperformed 3D U-Net on segmentations of all the structures. The mean DSC values of DSD-UNET method were 86.9%, 82.9%, and 82.1% for bladder, HR-CTV, and rectum, respectively. For the performance of automatic applicator reconstruction, outstanding segmentation accuracy was first achieved for the intrauterine and ovoid tubes (average DSC value of 92.1%, average HD value of 2.3 mm). Finally, HDs between the channel paths determined automatically and manually were 0.88 ± 0.12 mm, 0.95 ± 0.16 mm, and 0.96 ± 0.15 mm for the intrauterine, left ovoid, and right ovoid tubes, respectively. The proposed DSD-UNET method outperformed the 3D U-Net and could segment HR-CTV, bladder, and rectum with relatively good accuracy. Accurate digitization of the channel paths could be achieved with the DSD-UNET-based method. The proposed approaches could be useful to improve the efficiency and consistency of treatment planning for cervical cancer BT.
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Affiliation(s)
- Daguang Zhang
- School of Mechanical EngineeringTianjin UniversityTianjinChina
| | - Zhiyong Yang
- School of Mechanical EngineeringTianjin UniversityTianjinChina
| | - Shan Jiang
- School of Mechanical EngineeringTianjin UniversityTianjinChina
| | - Zeyang Zhou
- School of Mechanical EngineeringTianjin UniversityTianjinChina
| | - Maobin Meng
- Department of Radiation OncologyTianjin Medical University Cancer Institute and HospitalTianjinChina
| | - Wei Wang
- Department of Radiation OncologyTianjin Medical University Cancer Institute and HospitalTianjinChina
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Tang X, Mu X, Zhao Z, Zhao H, Mao Z. Dose-effect response in image-guided adaptive brachytherapy for cervical cancer: A systematic review and meta-regression analysis. Brachytherapy 2020; 19:438-446. [PMID: 32265118 DOI: 10.1016/j.brachy.2020.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/27/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to integrate and update the dose-effect relationship between volumetric dose and local control for cervical cancer brachytherapy. METHODS AND MATERIALS We identified studies that reported high-risk clinical target volume (HR-CTV) D90 and local control probability by searching PubMed, Web of Science, and the Cochrane Library databases through Oct 27, 2019. The regression analyses were performed using a probit model between HR-CTV D90, D100, intermediate-risk clinical target volume (IR-CTV) D90, and dose to Point A vs. local control probability. Subgroup analyses were performed according to stratification: time of local control, income level of the country or region, stage of cancer, pathology, mean volume of HR-CTV, dose rate, image modality, concurrent chemoradiotherapy proportion, interstitial proportion, and mean overall treatment time. RESULTS Thirty-three studies encompassing 2893 patients were included. The probit model showed a significant relationship between the HR-CTV D90 value and the local control probability, p < 0.0001. The D90 corresponding to a probability of 90% local control was 83.7 GyEQD2,10 (80.6-87.8 GyEQD2,10). Of the 33 studies included in our analysis, eight studies, including 1172 patients, reported the IR-CTV D90 value, ranging from 59.1 GyEQD2,10 to 72.3 GyEQD2,10. The probit model also showed a significant relationship between the IR-CTV D90 value and the local control probability, p = 0.0464. The 60 GyEQD2,10 for IR-CTV D90 corresponded to an 86.1% local control probability (82.0%-89.8%). CONCLUSIONS A significant dependence of local control on HR-CTV D90 and IR-CTV D90 was found. A tumor control probability of >90% can be expected at doses >84 GyEQD2,10 and 69 GyEQD2,10, respectively, based on an updated meta-regression analysis.
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Affiliation(s)
- Xiaodi Tang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun City, PR China
| | - Xin Mu
- Department of Radiation Oncology, Jilin City Hospital of Chemical Industry, Jilin City, PR China
| | - Zhipeng Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun City, PR China
| | - Hongfu Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun City, PR China.
| | - Zhuang Mao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun City, PR China
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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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Mittal P, Chopra S, Pant S, Mahantshetty U, Engineer R, Ghosh J, Gupta S, Ghadi Y, Menachery S, Swamidas J, Gurram L, Shrivastava SK. Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance-Based Brachytherapy? J Glob Oncol 2019; 4:1-9. [PMID: 30085892 PMCID: PMC6223510 DOI: 10.1200/jgo.18.00028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Recent guidelines recommend magnetic resonance imaging-based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with chemoradiation and point A-based brachytherapy (BT) using x-ray- or computed tomography-based planning. Methods Patients treated between January 2014 and December 2015 were included. Patients underwent x-ray- or computed tomography-based BT planning with an aim to deliver equivalent doses in 2 Gy (EQD2) > 84 Gy10 to point A while minimizing maximum dose received by rectum or bladder to a point or 2 cc volume to < 75 Gy EQD2 and < 90 Gy EQD2, respectively. The impact of known prognostic factors was evaluated. Results A total of 339 patients were evaluated. Median age was 52 (32 to 81) years; 52% of patients had stage IB2 to IIB and 48% had stage III to IVA disease. There was 85% compliance with chemoradiation, and 87% of patients received four or more cycles. Median point A dose was 84 (64.8 to 89.7) Gy. The median rectal and bladder doses were 73.5 (69.6 to 78.4) Gy3 and 83 (73.2 to 90.0) Gy3, respectively. At a median follow-up of 28 (4 to 45) months, the 3-year local, disease-free, and overall survival for stage IB to IIB disease was 94.1%, 83.3%, and 82.7%, respectively. The corresponding rates for stage III to IVA were 85.1%, 60.7%, and 69.6%. Grade III to IV proctitis and cystitis were observed in 4.7% and 0% of patients, respectively. Conclusion This audit demonstrates good 3-year outcomes that are comparable to published MRBT series. Conventional BT with selective use of interstitial needles and MRBT should continue as standard procedures until level-I evidence for MRBT becomes available.
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Affiliation(s)
- Prachi Mittal
- All authors: Tata Memorial Centre, Navi Mumbai, India
| | | | - Sidharth Pant
- All authors: Tata Memorial Centre, Navi Mumbai, India
| | | | | | - Jaya Ghosh
- All authors: Tata Memorial Centre, Navi Mumbai, India
| | - Sudeep Gupta
- All authors: Tata Memorial Centre, Navi Mumbai, India
| | - Yogesh Ghadi
- All authors: Tata Memorial Centre, Navi Mumbai, India
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Kawashima A, Isohashi F, Mabuchi S, Sawada K, Ueda Y, Kobayashi E, Matsumoto Y, Otani K, Tamari K, Seo Y, Suzuki O, Sumida I, Tomimatsu T, Kimura T, Ogawa K. A 3-year follow-up study of radiotherapy using computed tomography-based image-guided brachytherapy for cervical cancer. JOURNAL OF RADIATION RESEARCH 2019; 60:264-269. [PMID: 30649485 PMCID: PMC6430254 DOI: 10.1093/jrr/rry104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/28/2018] [Indexed: 05/20/2023]
Abstract
Outcomes for patients with Stage IB1-IVA cervical cancer treated with computed tomography (CT)-based image-guided brachytherapy (IGBT) were examined in this study. A total of 84 patients were analyzed between March 2012 and June 2015. Whole-pelvic radiotherapy with a central shield was performed for each patient, and the total pelvic sidewall dose was 50 Gy. IGBT was delivered in 2-4 fractions. The initial prescription dose (6.8 Gy) was delivered at Point A, and the dose distribution was modified manually by graphical optimization. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions (EQD2). Concurrent chemotherapy was administered to 64 patients (76%). The median follow-up period was 36 months (range 2-62 months). The 3-year overall survival, local control, and progression-free survival rates were 94%, 89% and 81%, respectively. The mean EQD2 for HR-CTV D90 was 73.4 Gy, and the EQD2 for HR-CTV D90 was not significantly associated with the local control rate. In multivariate analysis, adenocarcinoma (P = 0.03) and tumor size ≥45 mm (P = 0.06) were risk factors for local control. The patients were divided into four groups based on histology (squamous cell carcinoma vs adenocarcinoma) and tumor size (<45 vs ≥45 mm). Those with large adenocarcinomas had significantly worse outcomes. In conclusion, CT-based IGBT achieved favorable local control, but different treatment strategies may be necessary for large adenocarcinomas.
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Affiliation(s)
- Atsushi Kawashima
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
- Corresponding author. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, 5650871, Japan. Tel: +81-6-6879-3482; Fax: +81-6-6879-3489;
| | - Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Yuri Matsumoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Keisuke Otani
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Keisuke Tamari
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan
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12
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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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13
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Cordero-Gallardo F, Lee Burnett O, McNamara MM, Weber TM, Zarzour J, Bae S, Jang S, Barrett OC, McDonald A, Kim RY. Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications. Int J Gynecol Cancer 2019; 29:48-52. [PMID: 30640683 DOI: 10.1136/ijgc-2018-000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer. METHODS/MATERIALS We performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated. RESULTS The incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III- IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1-IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013). CONCLUSION This study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.
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Affiliation(s)
| | - O Lee Burnett
- Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, Alberta, USA
| | - Michelle M McNamara
- Department of Diagnostic Radiology, University of Alabama Medical Center, Birmingham, Alabama, USA
| | - Therese M Weber
- Department of Diagnostic Radiology, University of Alabama Medical Center, Birmingham, Alabama, USA
| | - Jessica Zarzour
- Department of Diagnostic Radiology, University of Alabama Medical Center, Birmingham, Alabama, USA
| | - Sejong Bae
- Preventative Medicine, University of Alabama Medical Center, Birmingham, Alabama, USA
| | - Samuel Jang
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Olivia Claire Barrett
- Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, Alberta, USA
| | - Andrew McDonald
- Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, Alberta, USA
| | - Robert Y Kim
- Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, Alberta, USA
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Cho O, Chun M. Management for locally advanced cervical cancer: new trends and controversial issues. Radiat Oncol J 2018; 36:254-264. [PMID: 30630264 PMCID: PMC6361251 DOI: 10.3857/roj.2018.00500] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/17/2018] [Indexed: 01/21/2023] Open
Abstract
This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.
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Affiliation(s)
- Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
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15
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Ko HC, Huang JY, Miller JR, Das RK, Wallace CR, De Costa AMA, Francis DM, Straub MR, Anderson BM, Bradley KA. Novel use of ViewRay MRI guidance for high-dose-rate brachytherapy in the treatment of cervical cancer. Brachytherapy 2018; 17:680-688. [DOI: 10.1016/j.brachy.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 10/14/2022]
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16
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Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer. J Contemp Brachytherapy 2018; 10:17-25. [PMID: 29619052 PMCID: PMC5881591 DOI: 10.5114/jcb.2018.73955] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose The purpose of this study was to analyze the effect of 2D conventional brachytherapy (CBT) compared to 3D MRI-guided brachytherapy (IGBT) with and without the use of interstitial needles on local control, overall survival, and toxicity in patients treated for cervical cancer with radiation or chemoradiation. Material and methods A retrospective analysis was performed of biopsy-proven FIGO IB-IVA cervical cancer patients, treated with primary radiation or chemoradiation, followed by brachytherapy (BT) between January 1997 and July 2016. Endpoints were local control, overall survival, and toxicity. Results Of 126 patients included, 35 have been treated with CBT, 31 with IGBT without needles (IC), and 60 with IGBT with needles (ICIS). External beam radiotherapy (EBRT) had mostly been delivered concurrently with chemotherapy (weekly cisplatin). Overall local control was 93% after 1 year, and 88% after 3 years. Overall 3-year survival was 75%, and 5-year survival was 66%. The 3D technique (IGBT cohorts) showed a trend for an improved local control and overall survival (p = 0.05) compared to the 2D technique (CBT cohort). A decrease in toxicity was observed from 17% (2D cohort) to 12% (3D cohort). The use of interstitial needles was associated with a higher high-risk clinical target volume (HR-CTV) dose (11.3 Gy vs. 9.9 Gy) and a lower D2cc bladder dose (10.9 Gy vs. 14.7 Gy, both p < 0.01). Conclusions In cervical cancer treatment, the use of a 3D brachytherapy technique (MRI-guided with or without interstitial needles) showed a trend towards an increased local control and improved overall survival with reduced toxicity, compared to the conventional 2D brachytherapy technique. The use of interstitial needles allowed dose sculpting, resulting in delivery of higher doses to the HR-CTV, while reducing radiation doses to organs at risk, such as the bladder.
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17
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Dankulchai P, Lohasammakul S, Petsuksiri J, Nakkrasae P, Tuntipumiamorn L, Kakanaporn C, Chansilpa Y. Dosimetric analysis and preliminary clinical result of image-guided brachytherapy with or without hybrid technique for cervical cancer using VariSource titanium ring applicator with “Siriraj Ring Cap”. Brachytherapy 2017; 16:1199-1204. [DOI: 10.1016/j.brachy.2017.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/24/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022]
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18
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Ohno T, Noda SE, Okonogi N, Murata K, Shibuya K, Kiyohara H, Tamaki T, Ando K, Oike T, Ohkubo Y, Wakatsuki M, Saitoh JI, Nakano T. In-room computed tomography-based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study. JOURNAL OF RADIATION RESEARCH 2017; 58:543-551. [PMID: 27986859 PMCID: PMC5766167 DOI: 10.1093/jrr/rrw121] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/24/2016] [Indexed: 05/20/2023]
Abstract
Herein, we investigate the long-term clinical outcomes for cervical cancer patients treated with in-room computed tomography-based brachytherapy. Eighty patients with Stage IB1-IVA cervical cancer, who had undergone treatment with combined 3D high-dose rate brachytherapy and conformal radiotherapy between October 2008 and May 2011, were retrospectively analyzed. External beam radiotherapy (50 Gy) with central shielding after 20-40 Gy was performed for each patient. Cisplatin-based chemotherapy was administered concurrently to advanced-stage patients aged ≤75 years. Brachytherapy was delivered in four fractions of 6 Gy per week. In-room computed tomography imaging with applicator insertion was performed for treatment planning. Information from physical examinations at diagnosis, and brachytherapy and magnetic resonance imaging at diagnosis and just before the first brachytherapy session, were referred to for contouring of the high-risk clinical target volume. The median follow-up duration was 60 months. The 5-year local control, pelvic progression-free survival and overall survival rates were 94%, 90% and 86%, respectively. No significant differences in 5-year local control rates were observed between Stage I, Stage II and Stage III-IVA patients. Conversely, a significant difference in the 5-year overall survival rate was observed between Stage II and III-IVA patients (97% vs 72%; P = 0.006). One patient developed Grade 3 late bladder toxicity. No other Grade 3 or higher late toxicities were reported in the rectum or bladder. In conclusion, excellent local control rates were achieved with minimal late toxicities in the rectum or bladder, irrespective of clinical stage.
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Affiliation(s)
- Tatsuya Ohno
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
- Corresponding author. Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Tel:
+81-27-220-8378; Fax: +81-27-220-8379;
| | - Shin-Ei Noda
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Noriyuki Okonogi
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
- Research Center for Charged Particle Therapy, National
Institute of Radiological Sciences, 4-9-1 Anagawa,
Chiba 263-8555, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Yu Ohkubo
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Masaru Wakatsuki
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
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The use of trans-applicator intracavitary ultrasonography in brachytherapy for cervical cancer: phantom study of a novel approach to 3D image-guided brachytherapy. J Contemp Brachytherapy 2017; 9:151-157. [PMID: 28533804 PMCID: PMC5437077 DOI: 10.5114/jcb.2017.66588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/20/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess the feasibility of applying trans-applicator intracavitary ultrasonography to image-guided brachytherapy for cervical cancer. Material and methods For this experiment, a phantom was created and included a polyethylene tube, intended to simulate a tandem applicator, which was inserted into chicken meat and embedded in agar, along with magnetic resonance imaging (MRI)-compatible ovoid applicators. Three-dimensional images of the phantom were obtained using computed tomography (CT), MRI (T2-weighted), and intracavitary ultrasonography sectional images acquired at 1 mm slice intervals. Intracavitary ultrasonography images were acquired from within the simulated tandem applicator using a radial transducer. Magnetic resonance imaging and intracavitary ultrasonography images were manually registered onto CT images. The chicken meat was contoured as the target volume independently on the CT, MRI, and intracavitary ultrasonography images, and the Dice similarity coefficient was used to compare the target volumes. The dose distributions of a sample brachytherapy plan were also evaluated. Results Computed tomography, MRI, and intracavitary ultrasonography all visualized the three-dimensional phantom volumes. Intracavitary ultrasonography images depicted the meat with high echoic signals and a border clearly distinguishable from the surrounding agar. The Dice similarity coefficient values for the target volumes on CT vs. MRI, CT vs. intracavitary ultrasonography, and MRI vs. intracavitary ultrasonography were 0.966, 0.965, and 0.971, respectively, indicating similar contouring with the three modalities. Among the modalities, the differences in D50, D90, D98, and D100 values were 1.8%, 2.9%, 3.7%, and 2.9%, respectively. Conclusions Three-dimensional reconstructed trans-applicator intracavitary ultrasonographic images clearly depicted meat tissue within the phantom, and could thus be used for brachytherapy planning. This study proves the concept of trans-applicator intracavitary ultrasonography for intracavitary brachytherapy. Further research such as development of intracavitary ultrasonography system, 3D reconstruction method, ultrasonography-compatible applicators, and ultrasonography-based target concept is warranted to assess the potential clinical application.
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Commissioning of applicator-guided stereotactic body radiation therapy boost with high-dose-rate brachytherapy for advanced cervical cancer using radiochromic film dosimetry. Brachytherapy 2017; 16:893-902. [PMID: 28457741 DOI: 10.1016/j.brachy.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/21/2017] [Accepted: 03/21/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe an EBT3 GAFCHROMIC film-based dosimetry method to be used in commissioning of a combined HDR brachytherapy (HDRB) and stereotactic body radiation therapy (SBRT) boost for treatment of advanced cervical cancer involving extensive residual disease after external beam treatment. METHODS AND MATERIALS A cube phantom was designed to firmly fit an intrauterine tandem applicator and EBT3 radiochromic film pieces. A high-risk clinical target volume (CTVHR, Total) was contoured with an extended arm at one side. The HDRB treatment was planned to cover the proximal CTVHR, Total with 7 Gy and the distal volume, referred to as CTVHR, Distal, was planned by SBRT for dose augmentation. After HDRB treatment delivery, SBRT treatment was delivered within 1 hour by image guidance using the applicator geometry. Intentional 1D and 2D misalignments were introduced to evaluate the effect on target volumes. In addition, effect of film reirradiation at different time gaps and dose levels was evaluated. RESULTS Film dosimetric accuracy, with up to 2 hours gap between irradiations, was shown to be unaffected. A 2%/2 mm gamma analysis between measured and planned doses showed agreement of >99%. Misalignments of more than 2 mm between applicator and SBRT isocenter resulted in suboptimal dose-volume histogram affecting mostly D98% and D90% of CTVHR, Distal. CONCLUSIONS Visualizing how target dose-volume metrics are affected by minor misalignments between SBRT and HDRB dose gradients, in light of achievable phantom-based experimental quality assurance level, encourages the clinical applicability of this technique. Radiochromic film was shown to be a valuable tool to commission procedures combining two different treatment planning systems and modalities with varying dose rates and energy ranges.
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Rao YJ, Zoberi JE, Kadbi M, Grigsby PW, Cammin J, Mackey SL, Garcia-Ramirez J, Goddu SM, Schwarz JK, Gach HM. Metal artifact reduction in MRI-based cervical cancer intracavitary brachytherapy. Phys Med Biol 2017; 62:3011-3024. [DOI: 10.1088/1361-6560/62/8/3011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Romano K, Pugh K, Trifiletti D, Libby B, Showalter T. Transition from LDR to HDR brachytherapy for cervical cancer: Evaluation of tumor control, survival, and toxicity. Brachytherapy 2017; 16:378-386. [DOI: 10.1016/j.brachy.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/07/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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23
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Model assessment of individual tumor control rate and adverse effects in comparing locally advanced cervical cancer treatment using intracavitary with and without interstitial brachytherapy. J Contemp Brachytherapy 2017; 8:525-532. [PMID: 28115959 PMCID: PMC5241380 DOI: 10.5114/jcb.2016.64743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/24/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose This study assessed the modeled probability of tumor control and organ at risk toxicities in locally advanced cervical cancer in patients treated by external beam radiation plus brachytherapy using intracavitary combined with interstitial brachytherapy (IC/IS) vs. intracavitary brachytherapy (IC) alone. Material and methods Twenty cervical cancer patients with a mean HR-CTV volume of 47.4 cm3 and a mean width of 54 mm were planned with both IC/IS and IC brachytherapy alone. A probit model was utilized to model 3-year (3-yr) local control rate (LC), 3-yr cancer specific survival rate (CSS), and the adverse effect (AE) of the organ at risk by using a modeled data set from multiple institutions. Modeling results were used to estimate the LC, CSS, and AE of the treatments in this study. Results Using the IC/IS technique, an EQD2 increase of 12.3 Gy to D90 (from 76.1 Gy to 88.3 Gy) of HR-CTV is expected to increase 3-yr LC and 3-yr CSS by 12.5%, and 11.0%, respectively. Comparing IC/IS to IC alone, the expected G2+ AE were 7.7% vs. 7.9% for the bladder, and 5.9% vs. 6.8% for the rectum. Conclusions The IC/IS technique improved dose coverage to the HR-CTV without significantly increasing dose to 2 cm3 of the organ at risk (OAR) surrounding it. With different regimens of EBRT combined with BT, IC/IS can be used to increase the probability of LC and CSS, or decrease the risk of AE.
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Cho LP, Manuel M, Catalano P, Lee L, Damato AL, Cormack RA, Buzurovic I, Bhagwat M, O'Farrell D, Devlin PM, Viswanathan AN. Outcomes with volume-based dose specification in CT-planned high-dose-rate brachytherapy for stage I-II cervical carcinoma: A 10-year institutional experience. Gynecol Oncol 2016; 143:545-551. [PMID: 27720445 DOI: 10.1016/j.ygyno.2016.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine prognostic factors for progression-free survival (PFS) and overall survival (OS) for stage I-II cervical-cancer patients treated using computed-tomography (CT)-planned high-dose-rate (HDR) intracavitary brachytherapy (BT). METHODS A total of 150 patients were treated for Stage I-II cervical cancer using CT-planned BT between 4/2004 and 10/2014. Of these, 128 were eligible for inclusion. Kaplan-Meier local control (LC), pelvic control (PC), overall survival (OS), and PFS estimates were calculated. RESULTS After a median follow-up of 30months, the 2-year LC rate was 96%, PFS was 88%, and OS was 88%. Overall, 18 patients (14%) experienced any recurrence (AR), 8 had distant recurrence only and 10 had a combination of local, pelvic, regional, and distant recurrence. No patients had LR only. A prognostic factor for AR was tumor size >4cm (p=0.01). Patients with tumors >4cm were 3.3 times more likely to have AR than those with tumors ≤4cm (hazard ratio [HR]=3.3; 95% confidence interval [CI] 1.28-9.47). Point A was 85% of prescription for tumors < 4 cm and decreased approximately 3% over 5 fractions compared to 90% of prescription for tumors > 4 cm that decreased approximately 4% over 5 fractions. Two patients (2%) experienced grade≥2 late toxicity. There were no acute or late grade≥3 toxicities. CONCLUSION CT-planned BT resulted in excellent local control and survival. Large tumor size was associated with an increased risk of recurrence outside the radiation field and worse PFS and OS. A volume-optimized plan treated a smaller area than a point A standard plan for patients with Stage I-II cervical cancer that have received chemoradiation. Given the outstanding LC achieved with modern therapy including chemoradiation, HDR, and image-based BT, further efforts to combat spread outside the radiation field with novel therapies are warranted.
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Affiliation(s)
- Linda P Cho
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States.
| | - Matthias Manuel
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Paul Catalano
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Larissa Lee
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Antonio L Damato
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Robert A Cormack
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Ivan Buzurovic
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mandar Bhagwat
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Desmond O'Farrell
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Akila N Viswanathan
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Feasibility study of toxicity outcomes using GEC-ESTRO contouring guidelines on CT based instead of MRI-based planning in locally advanced cervical cancer patients. Brachytherapy 2016; 16:126-132. [PMID: 27816539 DOI: 10.1016/j.brachy.2016.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/21/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To report late rectal and bladder toxicity outcomes of a CT-based image-guided brachytherapy (IGBT) technique for treatment of cervical cancer. METHODS AND MATERIALS Between 2008 and 2014, 95 women with International Federation of Gynecology and Obstetrics stage IB to IVA cervical carcinoma treated with definitive concurrent cisplatin-based chemotherapy and external beam radiation therapy 50.4 Gy in 28 fractions followed by planned prescription dose of 7 Gy × 4 fractions of high-dose-rate IGBT was retrospectively reviewed. At each implantation, all patients had a urinary catheter in situ and received bowel enema before undergoing planning CT simulation. A high-risk clinical target volume (HRCTV) as per GEC-ESTRO guidelines and the entire cervix, rectum, and bladder was contoured on the simulation CT according to Radiation Therapy Oncology Group Gynaecology Contouring Atlas. Reported doses to HRCTV and organs at risk were recorded. Toxicities were recorded using National Cancer Institute Common Terminology Criteria for Adverse Events version 3. RESULTS The median followup time was 29 months. The mean HRCTV equivalent dose in 2 Gy fractions (EQD2) of external beam radiation therapy combined with brachytherapy was 80 Gy (standard deviation [SD], 11), and the rectal doses to 2 cm3 (D2cc) EQD2 and bladder D2cc EQD2 were 74 Gy (SD, 6) and 79 Gy (SD, 15), respectively. Twenty-two patients (23%) had grade 2 proctitis and 10 patients (11%) had grade 3 proctitis. Four patients (4%) had grade 2 cystitis and two patients (2%) had grade 3 cystitis. No patients had ≥ grade 4 toxicity. CONCLUSIONS Despite CT-based brachytherapy planning, reported organ at risk toxicity was still significant compared with reported MRI-based planning series. Coimplementation of interstitial IGBT using the European Study on MRI-guided Brachytherapy in Locally Advanced Cervical Cancer (EMBRACE) protocol or using intensity-modulated radiation therapy during the external beam phase treatment might help to limit these late toxicities.
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Image-guided adaptive brachytherapy in locally advanced cervical cancer: recent advances and perspectives. Curr Opin Oncol 2016; 28:419-28. [DOI: 10.1097/cco.0000000000000309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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van Dyk S, Narayan K, Bernshaw D, Kondalsamy-Chennakesavan S, Khaw P, Lin MY, Schneider M. Clinical outcomes from an innovative protocol using serial ultrasound imaging and a single MR image to guide brachytherapy for locally advanced cervix cancer. Brachytherapy 2016; 15:817-824. [PMID: 27593599 DOI: 10.1016/j.brachy.2016.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/12/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to report clinical outcomes in a series of patients who underwent serial ultrasound and a single MRI to plan and verify intracavitary brachytherapy. METHODS AND MATERIALS Data for patients who were referred for curative intent radiotherapy for International Federation of Gynecology and Obstetrics (FIGO) Stage 1-1V cervix cancer between January 2007 and March 2012 were analyzed. All patients received external beam radiotherapy with concurrent chemotherapy and sequential high-dose rate brachytherapy. Brachytherapy was planned and verified using serial ultrasound imaging and a single MRI. RESULTS Data from 191 patients were available for analyses. The median (range) followup time was 5.08 (0.25-8.25) years. Five-year local control, failure-free survival, cancer-specific survival, and overall survival were 86%, 57.3%, 70% and 63%, respectively. Mean (standard deviation) combined external beam radiotherapy and brachytherapy target doses, equivalent to doses in 2 Gy fractions were 80.4 Gy10 (3.89), median (range) 80 (49-96) Gy10. Grade 3 or greater gastrointestinal, genitourinary, or vaginal late toxicity occurred in 3%, 1.6%, and 2% of patients, respectively. Survival, patterns of failure, and late complication rates were similar to published series of MRI/CT-based brachytherapy practices. CONCLUSIONS This large study demonstrates that favorable treatment outcomes can be obtained using a pragmatic and innovative combination of ultrasound and MR imaging.
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Affiliation(s)
- Sylvia van Dyk
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
| | - Kailash Narayan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | - Pearly Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Ming Yin Lin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
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Zolciak-Siwinska A, Gruszczynska E, Bijok M, Jonska-Gmyrek J, Dabkowski M, Staniaszek J, Michalski W, Kowalczyk A, Milanowska K. Computed Tomography–Planned High-Dose-Rate Brachytherapy for Treating Uterine Cervical Cancer. Int J Radiat Oncol Biol Phys 2016; 96:87-92. [DOI: 10.1016/j.ijrobp.2016.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/01/2016] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
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Mazeron R, Castelnau-Marchand P, Escande A, Rivin Del Campo E, Maroun P, Lefkopoulos D, Chargari C, Haie-Meder C. Tumor dose-volume response in image-guided adaptive brachytherapy for cervical cancer: A meta-regression analysis. Brachytherapy 2016; 15:537-42. [PMID: 27371991 DOI: 10.1016/j.brachy.2016.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Image-guided adaptive brachytherapy is a high precision technique that allows dose escalation and adaptation to tumor response. Two monocentric studies reported continuous dose-volume response relationships, however, burdened by large confidence intervals. The aim was to refine these estimations by performing a meta-regression analysis based on published series. METHODS AND MATERIALS Eligibility was limited to series reporting dosimetric parameters according to the Groupe Européen de Curiethérapie-European SocieTy for Radiation Oncology recommendations. The local control rates reported at 2-3 years were confronted to the mean D90 clinical target volume (CTV) in 2-Gy equivalent using the probit model. The impact of each series on the relationships was pondered according to the number of patients reported. RESULTS An exhaustive literature search retrieved 13 series reporting on 1299 patients. D90 high-risk CTV ranged from 70.9 to 93.1 Gy. The probit model showed a significant correlation between the D90 and the probability of achieving local control (p < 0.0001). The D90 associated to a 90% probability of achieving local control was 81.4 Gy (78.3-83.8 Gy). The planning aim of 90 Gy corresponded to a 95.0% probability (92.8-96.3%). For the intermediate-risk CTV, less data were available, with 873 patients from eight institutions. Reported mean D90 intermediate-risk CTV ranged from 61.7 to 69.1 Gy. A significant dose-volume effect was observed (p = 0.009). The D90 of 60 Gy was associated to a 79.4% (60.2-86.0%) local control probability. CONCLUSION Based on published data from a high number of patients, significant dose-volume effect relationships were confirmed and refined between the D90 of both CTV and the probability of achieving local control. Further studies based on individual data are required to develop nomograms including nondosimetric prognostic criteria.
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Affiliation(s)
- Renaud Mazeron
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Laboratory of Molecular Radiotherapy, INSERM 1030, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
| | - Pauline Castelnau-Marchand
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Alexandre Escande
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Eleonor Rivin Del Campo
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Pierre Maroun
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Dimitri Lefkopoulos
- Laboratory of Molecular Radiotherapy, INSERM 1030, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Department of Medical Physics, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Laboratory of Molecular Radiotherapy, INSERM 1030, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Effets Biologiques des Rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Christine Haie-Meder
- Department of Radiation Oncology, Brachytherapy Service, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Al Feghali KA, Elshaikh MA. Why brachytherapy boost is the treatment of choice for most women with locally advanced cervical carcinoma? Brachytherapy 2016; 15:191-9. [DOI: 10.1016/j.brachy.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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Fields EC, Weiss E. A practical review of magnetic resonance imaging for the evaluation and management of cervical cancer. Radiat Oncol 2016; 11:15. [PMID: 26830954 PMCID: PMC4736634 DOI: 10.1186/s13014-016-0591-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is a leading cause of mortality in women worldwide. Staging and management of cervical cancer has for many years been based on clinical exam and basic imaging such as intravenous pyelogram and x-ray. Unfortunately, despite advances in radiotherapy and the inclusion of chemotherapy in the standard plan for locally advanced disease, local control has been unsatisfactory. This situation has changed only recently with the increasing implementation of magnetic resonance image (MRI)-guided brachytherapy. The purpose of this article is therefore to provide an overview of the benefits of MRI in the evaluation and management of cervical cancer for both external beam radiotherapy and brachytherapy and to provide a practical approach if access to MRI is limited.
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Affiliation(s)
- Emma C Fields
- Virginia Commonwealth University, Richmond, VA, USA.
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Moving from standardized to personalized boxes and pears in radiation planning for cervical cancer. Curr Opin Obstet Gynecol 2015; 28:18-23. [PMID: 26694828 DOI: 10.1097/gco.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We reviewed the most recent literature on advancements in external beam radiation therapy, brachytherapy, and stereotactic body radiation therapy (SBRT) in the treatment of cervical cancer. RECENT FINDINGS There is a growing transition from three-dimensional-conformal radiation therapy to intensity modulated radiation therapy, and from point A-based two-dimensional prescriptions to three-dimensional volume-based prescriptions in image-guided brachytherapy (IGBT). These advances allow dose-escalation to at-risk regions while sparing normal tissues. Implementation of these techniques is resulting in improved local control and decreased toxicity in patients. With increased local control, the predominant pattern of recurrence is now distant failure, opening the door for SBRT as an emerging treatment option for select patients with limited numbers of metastases (oligometastatic state). SUMMARY The integration of IGBT, as well as dose sculpting with intensity modulated radiation therapy, is improving outcomes in women with locally advanced cervical cancer. The clinical evidence strongly supports moving away from point A-based prescriptions and adopting IGBT techniques. The existing data supporting SBRT for gynecologic oligometastases are more limited and require further research before widespread adoption; however, evidence from other disease sites is promising.
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Castelnau-Marchand P, Chargari C, Maroun P, Dumas I, Del Campo ER, Cao K, Petit C, Martinetti F, Tafo-Guemnie A, Lefkopoulos D, Morice P, Haie-Meder C, Mazeron R. Clinical outcomes of definitive chemoradiation followed by intracavitary pulsed-dose rate image-guided adaptive brachytherapy in locally advanced cervical cancer. Gynecol Oncol 2015; 139:288-94. [PMID: 26364808 DOI: 10.1016/j.ygyno.2015.09.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report the outcomes and late toxicities of patients with locally advanced cervical cancer treated with concomitant chemoradiation (CRT) followed by intracavitary image-guided adaptive brachytherapy (IGABT). METHODS Data from consecutive patients with histologically proven stage IB-IVA cervical cancer treated with curative intent in a single institution were analyzed. After pelvic +/- para-aortic external-beam radiation therapy, they received pulsed-dose rate IGABT following GEC-ESTRO recommendations. RESULTS Two hundred and twenty-five patients were enrolled. Sixty-five percent were stage≥IIB according to FIGO classification. Ninety-five percent received CRT. Mean D90 to HR and IR-CTV were 80.4+/-10.3Gy and 67.7+/-6.1Gy. After a median follow-up of 38.8months, 3-year local control and overall survival rates were 86.4% and 76.1%, respectively. A trend for a detrimental effect of tumor stage on local control rates was observed with 3-year local control rates of 100% for stages IB1 and IIA, 90.5 for IB2, 85.8% for IIB, 50% for IIIA, 77.1 for IIIB, and 66.7% for IVA tumors (p=0.06). Local control rates at 3years were 95.6% in the group of patients with D90 of HR-CTV≥85Gy, 88.8% in those with D90 between 80 and 85Gy, and 80% when D90<80Gy (p=0.018). Eighteen severe late gastrointestinal and urinary effects affecting 14 patients were reported corresponding with a crude incidence of 6.6%. CONCLUSIONS CRT followed by IGABT provides high local control rates with limited toxicity. Reaching high doses is mandatory to achieve local control and interstitial brachytherapy is necessary in advanced diseases.
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Affiliation(s)
| | - Cyrus Chargari
- Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France; Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France
| | - Pierre Maroun
- Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France
| | - Isabelle Dumas
- Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
| | | | - Kim Cao
- Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France
| | - Claire Petit
- Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France
| | - Florent Martinetti
- Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
| | - Alain Tafo-Guemnie
- Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
| | - Dimitri Lefkopoulos
- Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France; Medical Physics, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
| | - Philippe Morice
- Gynecological Surgery, Gustave Roussy Cancer Campus, 94805 Villejuif Cedex, France
| | | | - Renaud Mazeron
- Radiation Oncology, Gustave Roussy Camper Campus, 94805 Villejuif Cedex, France; Molecular Radiotherapy INSERM 1030, Gustave Roussy Cancer campus, 94805 Villejuif Cedex, France.
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