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Ito K, Nakajima Y, Ogawa H, Furusawa A, Murofushi KN, Kito S, Kino N, Yasugi T, Uno T, Karasawa K. Phase I/II study of stereotactic body radiotherapy boost in patients with cervical cancer ineligible for intracavitary brachytherapy. Jpn J Radiol 2024:10.1007/s11604-024-01566-8. [PMID: 38625476 DOI: 10.1007/s11604-024-01566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) boost is a promising treatment for cervical cancer patients who are ineligible for intracavitary brachytherapy (ICBT). The aim of this multicenter, single-arm, phase I/II study was to prospectively evaluate the efficacy and toxicity of SBRT boost. MATERIALS AND METHODS ICBT-ineligible patients with untreated cervical cancer were enrolled. Patients underwent whole-pelvic radiotherapy (45 Gy in 25 fractions) with SBRT boost to the primary lesion. In the phase I dose-escalation cohort (3 + 3 design), patients were treated with SBRT boost of 21 or 22.5 Gy in three fractions. Although dose-limiting toxicity was not confirmed, a dose of 21 Gy was selected for the phase II cohort because it was difficult to reproduce the pelvic organs position in two patients during the phase I trial. The primary endpoint was 2-year progression-free survival. RESULTS Twenty-one patients (phase I, n = 3; phase II, n = 18) were enrolled between April 2016 and October 2020; 17 (81%) had clinical stage III-IV (with para-aortic lymph node metastases) disease. The median (range) follow-up was 40 (10-84) months. The initial response was complete response in 20 patients and partial response in one patient. The 2-year locoregional control, progression-free survival, and overall survival rates were 84%, 67%, and 81%, respectively. Grade ≥ 3 toxicity was confirmed in one patient each in the acute (diarrhea) and late (urinary tract obstruction) phases. CONCLUSION These findings suggested that a SBRT boost is more effective than the conventional EBRT boost and can be an important treatment option for ICBT-ineligible patients with cervical cancer. STUDY REGISTRATION This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000036845).
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Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
- Department of Radiological Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya-ku, Tokyo, 154-8525, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Akiko Furusawa
- Department of Gynecology, Shizuoka Cancer Center Hospital, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiko Nemoto Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satoshi Kito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Nao Kino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Toshiharu Yasugi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chou-ku, Chiba, 260-8677, Japan
| | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Parisi S, Sciacca M, Ferrantelli G, Chillari F, Critelli P, Venuti V, Lillo S, Arcieri M, Martinelli C, Pontoriero A, Minutoli F, Ercoli A, Pergolizzi S. Locally advanced squamous cervical carcinoma (M0): management and emerging therapeutic options in the precision radiotherapy era. Jpn J Radiol 2024; 42:354-366. [PMID: 37987880 DOI: 10.1007/s11604-023-01510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography-magnetic resonance imaging) PET-MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.
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Affiliation(s)
- S Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - M Sciacca
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - G Ferrantelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy.
| | - F Chillari
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - P Critelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - V Venuti
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - S Lillo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M Arcieri
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - C Martinelli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - A Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - F Minutoli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
| | - A Ercoli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi'', University Hospital ``G. Martino'', Messina, Italy
| | - S Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria, 1, 98124, Messina, ME, Italy
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Dincer N, Ugurluer G, Mustafayev TZ, Serkizyan A, Aydin G, Güngör G, Yapici B, Atalar B, Özyar E. Dosimetric comparison of stereotactic MR-guided radiation therapy (SMART) and HDR brachytherapy boost in cervical cancer. Brachytherapy 2024; 23:18-24. [PMID: 38000958 DOI: 10.1016/j.brachy.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/21/2023] [Accepted: 09/10/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The standard of care in locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy followed by high-dose-rate brachytherapy (HDR-BT). Although previous studies compared HDR-BT with stereotactic body radiotherapy (SBRT), there is scarce data regarding the dosimetric outcomes of stereotactic MR-guided adaptive radiation therapy (SMART) boost in lieu of HDR-BT. METHODS AND MATERIALS In this single-institutional in-silico comparative study, LACC patients who were definitively treated with external beam radiotherapy followed by HDR-BT were selected. Target volumes and organs at risk (OARs) were delineated in MRI and HDR-planning CT. An HDR-BT and a SMART boost plan were generated with a prescribed dose of 28 Gy in four fractions for all patients. The HDR-BT and SMART boost plans were compared in regard to target coverage as well OARs doses. RESULTS Mean EQD2 D90 to HR-CTV and IR-CTV for HDR-BT plans were 89.7 and 70.5 Gy, respectively. For SMART, the mean EQD2 D90 to HR-PTV, HR-CTV, and IR-CTV were 82.9, 95.4, and 70.2 Gy, respectively. The mean D2cc EQD2 of bladder, rectum, and sigmoid colon for HDR-BT plans were 86.4, 70.7, and 65.7 Gy, respectively. The mean D2cc EQD2 of bladder, rectum, and sigmoid colon for SMART plans were 81.4, 70.8, and 73.6 Gy, respectively. All dose constraints in terms of target coverage and OARs constraints were met for both HDR-BT and SMART plans. CONCLUSIONS This dosimetric study demonstrates that SMART can be applied in cases where HDR-BT is not available or ineligible with acceptable target coverage and OAR sparing. However, prospective clinical studies are needed to validate these results.
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Affiliation(s)
- Neris Dincer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - Anatolia Serkizyan
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Gokhan Aydin
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Görkem Güngör
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Bulent Yapici
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
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Sagae S, Toita T, Matsuura M, Saito M, Matsuda T, Sato N, Shimizu A, Endo T, Fujii M, Gaffney DK, Small W. Improvement in radiation techniques for locally advanced cervical cancer during the last two decades. Int J Gynecol Cancer 2023; 33:1295-1303. [PMID: 37041022 PMCID: PMC10423558 DOI: 10.1136/ijgc-2022-004230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/17/2023] [Indexed: 04/13/2023] Open
Abstract
Since the National Cancer Institute (NCI) alert of concurrent chemoradiotherapy, radiotherapy has been changed from external beam radiotherapy plus brachytherapy to platinum-based concurrent chemoradiotherapy. Therefore, concurrent chemoradiotherapy plus brachytherapy has become a standard treatment for locally advanced cervical cancer. Simultaneously, definitive radiotherapy has been changed gradually from external beam radiotherapy plus low-dose-rate intracavitary brachytherapy to external beam radiotherapy plus high-dose-rate intracavitary brachytherapy. Cervix cancer is uncommon in developed countries; hence, international collaborations have been critical in large-scale clinical trials. The Cervical Cancer Research Network (CCRN), created from the Gynecologic Cancer InterGroup (GCIG), has investigated various concurrent chemotherapy regimens and sequential methods of radiation and chemotherapy. Most recently, many clinical trials of combining immune checkpoint inhibitors with radiotherapy have been ongoing for sequential or concurrent settings. During the last decade, the method of standard radiation therapy has changed from three-dimensional conformal radiation therapy to intensity-modulated radiation therapy for external beam radiotherapy and from two-dimensional to three-dimensional image-guided approaches for brachytherapy. Recent improvements include stereotactic ablative body radiotherapy and MRI-guided linear accelerator (MRI-LINAC) using adaptive radiotherapy. Here we review the current progress of radiation therapy during the last two decades.
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Affiliation(s)
- Satoru Sagae
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Manabu Saito
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takuma Matsuda
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Nanaka Sato
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Ayumi Shimizu
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Toshiaki Endo
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Miho Fujii
- Women's Medical Center, Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, Illinois, USA
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Benkhaled S, Diakité K, Jullian N, Poeta S, Vandekerkhove C, Van Houtte P, Van Gestel D, De Caluwé A. Boost modalities in cervical cancer: dosimetric comparison between intracavitary BT vs. intracavitary + interstitial BT vs. SBRT. Radiat Oncol 2023; 18:105. [PMID: 37381016 DOI: 10.1186/s13014-023-02295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE / OBJECTIVE This study compares the dosimetric plans of three distinct boost modalities in cervical cancer (CC): intracavitary (IC) with tandem/ovoids brachytherapy (BT), IC + interstitial (IS) BT, and Stereotactic-Body-Radiotherapy (SBRT). The aim is to determine the dosimetric impact in terms of target coverage and organ at risk (OAR) doses. MATERIALS AND METHODS 24 consecutive IC + IS BT boost treatment plans were retrospectively identified. For each plan included, two additional plans were created: IC-BT and SBRT. Importantly, no planning target volume (PTV) or planning (organ at) risk volume (PRV) margins were generated, therefore all structures were identical for any boost modality. Two different normalizations were performed: (1) Normalization to the target: prescription of 7.1 Gy to the D90% (defined as the minimum dose covering 90%) of the high-risk clinical target volume (HR-CTV); (2) Normalization to the OARs. HR-CTV coverage and OARs sparing were compared. The equivalent doses in 2 Gy fractions (EQD2) of EBRT and BT for CTV-HR and OARs were calculated using the linear-quadratic model with α/β of 10 (EQD210) and 3 (EQD23), respectively RESULTS: A total of 72 plans were investigated. In the first normalization, the mean EQD23-D2cc (defined as the minimal dose of the 2 cc) of OAR was significantly higher in the IC-BT plans, and the bladder D2cc hard constraint could not be reached. IC + IS BT leads to a 1 Gy mean absolute decrease of bladder EQD23-D2cc (relative dose: -19%), allowing to reach the hard constraint. SBRT (without PTV) delivers the lowest EQD23-D2cc to the OAR. In the second normalization, IC-BT provides a significantly lower dose to the EQD210-D90% (6.62 Gy) and cannot achieve the coverage goal. SBRT (without PTV) yields the highest dose to the D90% of HR-CTV and a significantly lower EQD210-D50% and D30%. CONCLUSION The key dosimetric benefit of BT over SBRT without PTV is a significantly higher D50% and D30% in the HR-CTV, which increases the local and conformal dose to the target. IC + IS BT vs. IC-BT provides significantly better target coverage and a lower dose to the OARs, making it the preferred boost modality in CC.
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Affiliation(s)
- Sofian Benkhaled
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, UNIL-CHUV, Lausanne, Switzerland
| | - Kadiatou Diakité
- Department of Radiation-Oncology, National Center for Medical Oncology and Radiotherapy Alassane, Abidjan, Ivory Coast
| | - Nicolas Jullian
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Sara Poeta
- Department of Medical-Physics, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Vandekerkhove
- Department of Medical-Physics, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Paul Van Houtte
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwé
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium.
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Guberina M, Santiago Garcia A, Khouya A, Pöttgen C, Holubyev K, Ringbaek TP, Lachmuth M, Alberti Y, Hoffmann C, Hlouschek J, Gauler T, Lübcke W, Indenkämpen F, Stuschke M, Guberina N. Comparison of Online-Onboard Adaptive Intensity-Modulated Radiation Therapy or Volumetric-Modulated Arc Radiotherapy With Image-Guided Radiotherapy for Patients With Gynecologic Tumors in Dependence on Fractionation and the Planning Target Volume Margin. JAMA Netw Open 2023; 6:e234066. [PMID: 36947038 PMCID: PMC10034575 DOI: 10.1001/jamanetworkopen.2023.4066] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Importance Patients with newly diagnosed locally advanced cervical carcinomas or recurrences after surgery undergoing radiochemotherapy whose tumor is unsuited for a brachytherapy boost need high-dose percutaneous radiotherapy with small margins to compensate for clinical target volume deformations and set-up errors. Cone-beam computed tomography-based online adaptive radiotherapy (ART) has the potential to reduce planning target volume (PTV) margins below 5 mm for these tumors. Objective To compare online ART technologies with image-guided radiotherapy (IGRT) for gynecologic tumors. Design, Setting, and Participants This comparative effectiveness study comprised all 7 consecutive patients with gynecologic tumors who were treated with ART with artificial intelligence segmentation from January to May 2022 at the West German Cancer Center. All adapted treatment plans were reviewed for the new scenario of organs at risk and target volume. Dose distributions of adapted and scheduled plans optimized on the initial planning computed tomography scan were compared. Exposure Online ART for gynecologic tumors. Main Outcomes and Measures Target dose coverage with ART compared with IGRT for PTV margins of 5 mm or less in terms of the generalized equivalent uniform dose (gEUD) without increasing the gEUD for the organs at risk (bladder and rectum). Results The first 10 treatment series among 7 patients (mean [SD] age, 65.7 [16.5] years) with gynecologic tumors from a prospective observational trial performed with ART were compared with IGRT. For a clinical PTV margin of 5 mm, IGRT was associated with a median gEUD decrease in the interfractional clinical target volume of -1.5% (90% CI, -31.8% to 2.9%) for all fractions in comparison with the planned dose distribution. Online ART was associated with a decrease of -0.02% (90% CI, -3.2% to 1.5%), which was less than the decrease with IGRT (P < .001). This was not associated with an increase in the gEUD for the bladder or rectum. For a PTV margin of 0 mm, the median gEUD deviation with IGRT was -13.1% (90% CI, -47.9% to 1.6%) compared with 0.1% (90% CI, -2.3% to 6.6%) with ART (P < .001). The benefit associated with ART was larger for a PTV margin of 0 mm than of 5 mm (P = .004) due to spreading of the cold spot at the clinical target volume margin from fraction to fraction with a median SD of 2.4 cm (90% CI, 1.9-3.4 cm) for all patients. Conclusions and Relevance This study suggests that ART is associated with an improvement in the percentage deviation of gEUD for the interfractional clinical target volume compared with IGRT. As the gain of ART depends on fractionation and PTV margin, a strategy is proposed here to switch from IGRT to ART, if the delivered gEUD distribution becomes unfavorable in comparison with the expected distribution during the course of treatment.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Alina Santiago Garcia
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Aymane Khouya
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Kostyantyn Holubyev
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Toke Printz Ringbaek
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Manfred Lachmuth
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Yasemin Alberti
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christian Hoffmann
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julian Hlouschek
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Wolfgang Lübcke
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Frank Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Sato K, Seki T, Mizutani A, Muranaka Y, Hirota S, Nishi K, Yamazaki K, Nishii R, Nakanishi T, Tamai I, Kawai K, Kobayashi M. A single high-dose irradiation changes accumulation of methotrexate and gene expression levels of SLC and ABC transporters in cancer cells. Front Pharmacol 2023; 13:1069321. [PMID: 36712667 PMCID: PMC9874220 DOI: 10.3389/fphar.2022.1069321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Chemoradiotherapy is frequently used to treat cancer. Stereotactic body radiotherapy (SBRT) is a single high-dose radiotherapy used to treat a variety of cancers. The anticancer drug methotrexate (MTX) shows affinity for solute carrier (SLC) and ATP-binding cassette (ABC) transporters. This study investigated relationships between accumulation of methotrexate and gene expression levels of solute carrier and ATP-binding cassette transporters in cancer cells after a single and high-dose X-ray irradiation. Cancer cell lines were selected from lung and cervical cancer cell line that are commonly used for stereotactic body radiotherapy and effective with methotrexate. We examined expression levels of organic anion-transporting polypeptide (OATP)1B1, OATP1B3, OATP1B7, and organic anion transporter (OAT)1 as solute carrier transporters and multidrug resistance-associated protein (MRP)1 and MRP2 as ATP-binding cassette transporters, using real-time polymerase chain reaction and accumulation of 3H-MTX in cancer cells after 10-Gy irradiation, assuming stereotactic body radiotherapy. Cells were divided into three groups: Control without irradiation; 4 h after irradiation; and 24 h after irradiation. In control, gene expression levels of OAT1 in all cells was below the limit of measurement. After irradiation, gene expression levels of OATP1B1/1B3/1B7 showed changes in each cell line. Gene expression levels of MRP1/2 tended to increase after irradiation. Gene expression levels of OATP1B1/1B3/1B7 were much lower than those of MRP1/2. Accumulation of 3H-MTX tended to decrease over time after irradiation. Irradiation of cancer cells thus alters gene expression levels of both solute carrier transporters (OATP1B1/1B3/1B7) and ABC transporters (MRP1/2) and decreases accumulation of 3H-MTX in cancer cells over time due to elevated expression of MRP1/2.
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Affiliation(s)
- Kakeru Sato
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Seki
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Asuka Mizutani
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuka Muranaka
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shiho Hirota
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kodai Nishi
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kana Yamazaki
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ryuichi Nishii
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Takeo Nakanishi
- Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan
| | - Ikumi Tamai
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Keiichi Kawai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan,Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Masato Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan,*Correspondence: Masato Kobayashi,
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Gultekin M, Yilmaz MT, Yuce Sari S, Yildiz D, Ozyigit G, Yildiz F. Stereotactic body radiotherapy boost in patients with cervical cancer. J OBSTET GYNAECOL 2022; 42:3033-3040. [PMID: 35653802 DOI: 10.1080/01443615.2022.2081790] [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] [Indexed: 01/06/2023]
Abstract
Our aim was to evaluate the oncological outcomes of stereotactic body radiotherapy (SBRT) boost in patients with cervical cancer. The data of 21 patients who received SBRT boost after definitive radiotherapy (RT) or chemoradiotherapy (CRT) between March 2012 and April 2019 were retrospectively evaluated. External beam radiotherapy (EBRT) was applied to patients with a total dose of 50.4 Gy in 28 fractions. Kaplan-Meier method was used for survival analysis (IBM SPSS 23 software) and p < .05 value was considered significant. After definitive RT or CRT, there was a complete response in 9 (43%) patients, partial response in 11 (52%) patients and stable disease in 1 (5%) patient. The median follow-up period was 28 months (range, 7.5-88 months). Two-years cancer-specific survival rate was 80%. While 2-year LC rate was 75% in patients with residual tumour size <4 cm, it was 50% when there was ≥4 cm residual tumour after definitive CRT (p = .1). The treatment was well-tolerated and no acute or late toxicity was observed. Although brachytherapy (BRT) is an essential part of the treatment in locally advanced cervical cancer, SBRT may be used in patients with small residual disease who are not candidate for BRT. IMPACT STATEMENTCervical cancer is one of the most common cancers in the world, and external beam radiotherapy (EBRT) and brachytherapy (BRT) are the main treatment options. However, in rare cases where BRT is not feasible, it has been questioned whether stereotactic body radiotherapy (SBRT) as an alternative to BRT.What is already known on this subject? Nowadays, BRT still appears to be the gold standard treatment. However, studies with a small number of patients and short follow-up periods in the literature show that SBRT can be a good alternative in cases where BRT cannot be performed.What do the results of this study add? Our study is one of the series with the largest number of patients in the literature and with the longest follow-up period. In this area where there is no prospective study, we think that retrospective data with high patient numbers are enlightening.What are the implications of these findings for clinical practice and/or further research? Our study shows that SBRT is an alternative option in cases with small residual disease where BRT cannot be applied, and it provides a basis for a prospective randomised study.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Demet Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Shenker R, Stephens SJ, Davidson B, Chino J. Role of stereotactic body radiotherapy in gynecologic radiation oncology. Int J Gynecol Cancer 2022; 32:372-379. [DOI: 10.1136/ijgc-2021-002466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT, also referred to as stereotactic ablative radiotherapy (SABR)) has been used in the treatment of primary and metastatic solid tumors, and increasingly so in gynecologic oncology. This review article aims to summarize the current literature describing the utility of SBRT in the primary, recurrent, and limited metastatic settings for gynecologic malignancies. The use of SBRT in both retrospective and prospective reports has been associated with adequate control of the treated site, particularly in the setting of oligometastatic disease. It is not, however, recommended as an alternative to brachytherapy for intact disease unless all efforts to use brachytherapy are exhausted. While phase I and II trials have established the relative safety and potential toxicities of SBRT, there remains a dearth of phase III randomized evidence, including the use of immunotherapy, in order to better establish the role of this technique as a method of improving more global outcomes for our patients with gynecologic cancers.
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10
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Bhatia RK, Lichter KE, Gurram L, MacDuffie E, Lombe D, Sarria GR, Grover S. Gynecologic radiation therapy in low and middle income countries during the COVID-19 pandemic. Int J Gynecol Cancer 2022; 32:446-450. [PMID: 35256435 PMCID: PMC9997715 DOI: 10.1136/ijgc-2021-003039] [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: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has forever affected healthcare and posed an incredible challenge to our society to care for our sick. Patients with cancer were found early on to have higher rates of complications with COVID-19. Radiation therapy is an integral part of treatment for many types of gynecologic cancer and adaptation on its utilization during the pandemic varied across the globe. In this review, we detail certain guidelines for the use of radiation in gynecologic cancers during the pandemic as well as real world accounts of how different countries adapted to these guidelines or created their own based on individualized resources, staffing, government restrictions, and societal norms. Critically, this review demonstrates the breadth of fractionation schemes and technologies used when resources were limited but highlights the importance of long term follow-up for many of our patients during this time.
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Affiliation(s)
- Rohini K Bhatia
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lavanya Gurram
- Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Emily MacDuffie
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Hadi I, Eze C, Schönecker S, von Bestenbostel R, Rogowski P, Nierer L, Bodensohn R, Reiner M, Landry G, Belka C, Niyazi M, Corradini S. MR-guided SBRT boost for patients with locally advanced or recurrent gynecological cancers ineligible for brachytherapy: feasibility and early clinical experience. Radiat Oncol 2022; 17:8. [PMID: 35033132 PMCID: PMC8760788 DOI: 10.1186/s13014-022-01981-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background and purpose Chemoradiotherapy (CRT) followed by a brachytherapy (BT) boost is the standard of care for patients with locally advanced or recurrent gynecological cancer (LARGC). However, not every patient is suitable for BT. Therefore, we investigated the feasibility of an MR-guided SBRT boost (MRg-SBRT boost) following CRT of the pelvis. Material and methods Ten patients with LARGC were analyzed retrospectively. The patients were not suitable for BT due to extensive infiltration of the pelvic wall (10%), other adjacent organs (30%), or both (50%), or ineligibility for anesthesia (10%). Online-adaptive treatment planning was performed to control for interfractional anatomical changes. Treatment parameters and toxicity were evaluated to assess the feasibility of MRg-SBRT boost. Results MRg-SBRT boost was delivered to a median total dose of 21.0 Gy in 4 fractions. The median optimized PTV (PTVopt) size was 43.5ccm. The median cumulative dose of 73.6Gy10 was delivered to PTVopt. The cumulative median D2ccm of the rectum was 63.7 Gy; bladder 72.2 Gy; sigmoid 65.8 Gy; bowel 59.9 Gy (EQD23). The median overall treatment time/fraction was 77 min, including the adaptive workflow in 100% of fractions. The median duration of the entire treatment was 50 days. After a median follow-up of 9 months, we observed no CTCAE ≥ °II toxicities. Conclusion These early results report the feasibility of an MRg-SBRT boost approach in patients with LARGC, who were not candidates for BT. When classical BT-OAR constraints are followed, the therapy was well tolerated. Long-term follow-up is needed to validate the results.
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Affiliation(s)
- Indrawati Hadi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Rieke von Bestenbostel
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner site Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner site Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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12
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Lu DJ, Atkins KM, Small W, Kamrava M. Evaluation of sociodemographic and baseline patient characteristic differences in cervical cancer patients treated with either external beam or brachytherapy boost. Brachytherapy 2021; 21:22-28. [PMID: 34895839 DOI: 10.1016/j.brachy.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Chemoradiation is considered the standard of care for locally advanced cervical cancer. While brachytherapy (BT) boost is associated with improved survival and less toxicity compared to external beam radiation therapy (EBRT) boost, it is unclear why many patients do not receive a BT boost. In this study, we compared sociodemographic and baseline patient characteristics between patients receiving EBRT boost versus BT boost. METHODS We analyzed patients in the National Cancer Database diagnosed between 2004 and 2016 with FIGO stage IIB-IVA cervical cancer treated with nonpalliative doses of chemoradiation. Logistic regression analysis was utilized to evaluate BT utilization over time and by other clinicopathological and sociodemographic factors. RESULTS Overall, 5764 patients were evaluated, of which 4937 (86%) underwent BT boost. Using multivariable logistic regression, higher FIGO stage was a significant predictor for utilization of EBRT versus BT boost, with odds ratio 2.92 (95% confidence interval [CI] 2.04-4.16; p < 0.001), 2.68 (95%CI 2.22-3.24; p < 0.001), and 4.51 (95%CI 3.05-6.67; p < 0.001) for IIIA, IIIB, and IVA, respectively, compared to IIB. Increased utilization of EBRT boost was also associated with community cancer facility types, lower income (based on zip code), earlier year of diagnosis, and higher comorbidity score. CONCLUSIONS In FIGO stage IIB-IVA cervical cancer patients treated with nonpalliative doses of chemoradiation, overall utilization of BT is 86%. Higher FIGO stage, community cancer facilities, lower income, earlier year of diagnosis, and higher comorbidity score were significant predictors of EBRT boost utilization. Future studies are needed to better understand reasons for this as higher FIGO stage patients are the mostly likely to benefit from a BT boost.
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Affiliation(s)
- Diana J Lu
- Cedars-Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA.
| | - Katelyn M Atkins
- Cedars-Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Mitchell Kamrava
- Cedars-Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA
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13
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Lee TH, Song C, Kim IA, Kim JS, Kim YB, Kim K, No JH, Suh DH, Chung JB, Eom KY. Stereotactic ablative body radiotherapy boost for cervical cancer when brachytherapy boost is not feasible. Radiat Oncol 2021; 16:148. [PMID: 34384450 PMCID: PMC8359558 DOI: 10.1186/s13014-021-01877-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the treatment efficacy and safety of stereotactic ablative body radiotherapy (SABR) boost for cervical cancer patients not amenable to brachytherapy. METHODS A retrospective review of the medical records from single institution of 25 eligible patients was performed. The patients underwent pelvic radiotherapy (RT) in 25 or 28 fractions with a median dose of 45 Gy (range 44-50.4 Gy). SABR boost was delivered after pelvic RT, with a median dose of 25 Gy (range 20-33 Gy), and a median fraction number of 5 (range 4-6). 21 patients with a follow-up period of more than one year were included in the toxicity analysis, and hematuria and hematochezia that occurred later than 3 months after the RT were graded. RESULTS The median follow-up period after radiotherapy was 2.85 years (range 0.33-6.60). The 3-year local control, locoregional control, disease-free survival, and overall survival rates were 80.9%, 75.8%, 40.9%, and 77.1%, respectively. 5 patients experienced grade 3 toxicity (3 genitourinary, 3 gastrointestinal), and no grade 4-5 toxicity was reported. Univariate analysis showed that cumulative D2cc in equivalent dose in 2 Gy fractions (EQD2) of rectum was marginally predictive for any grade of hematochezia (P = 0.051). Cumulative D2cc EQD2 of bladder was not predictive for hematuria. In the receiver operating characteristic (ROC) curve analysis, the optimal threshold of cumulative rectal D2cc EQD2 was 81.2 Gy for any grade of hematochezia. CONCLUSION SABR boost for cervical cancer was effective and tolerable. Although it cannot substitute brachytherapy, it can be a treatment option when brachytherapy is not possible.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin-Beom Chung
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
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14
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Facondo G, Vullo G, DE Sanctis V, Valeriani M, Ascolese AM, Massaro M, Anzellini D, Osti MF. Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:53-60. [PMID: 35403131 PMCID: PMC8962763 DOI: 10.21873/cdp.10008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 04/13/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Standard treatment for locally advanced cervical cancer is external beam radiotherapy followed by brachytherapy (BT). Stereotactic body radiation therapy (SBRT) is a possible option for treating patients ineligible for BT. PATIENTS AND METHODS From October 2012 to July 2020, nine women with cervical cancer received SBRT to high-risk volumes. The Kaplan-Meier method was used to estimate the rates of overall and disease-free survival. RESULTS The median age was 52 years; 88% of patients had squamous carcinoma. Reasons for forgoing BT were cervical canal stenosis, treatment refusal and hematological disease. The median boost dose was 18 Gy and the median dose per fraction was 6 Gy. Median follow-up was 16 months. The median survival was 24 months, the actuarial 2-year OS rate was 70%, and median disease-free survival was 11 months. One grade 3 late vaginal toxicity was reported. No acute nor late grade 4 toxicities were observed. CONCLUSION SBRT boost in patients with cervical cancer ineligible for BT led to acceptable survival outcomes and a safe toxicity profile.
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Affiliation(s)
- Giuseppe Facondo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Gianluca Vullo
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Vitaliana DE Sanctis
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maurizio Valeriani
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Anna Maria Ascolese
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Maria Massaro
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Dimitri Anzellini
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Medicine and Surgery and Translational Medicine,Sapienza University of Rome, Radiotherapy Oncology, St. Andrea Hospital, Rome, Italy
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15
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Stereotactic body radiotherapy for the treatment of gynecologic malignancies: Passing fancy or here to stay? Gynecol Oncol 2021; 161:642-644. [PMID: 33867142 DOI: 10.1016/j.ygyno.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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Parashar B, Chen WC, Herman JM, Potters L. Disease Site-Specific Guidelines for Curative Radiation Treatment During 'Limited Surgery' and 'Hospital Avoidance': A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic. Cureus 2020; 12:e8190. [PMID: 32440386 PMCID: PMC7237057 DOI: 10.7759/cureus.8190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has resulted in an unprecedented situation where the standard of care (SOC) management for cancers has been altered significantly. Patients with potentially curable cancers are at risk of not receiving timely SOC multidisciplinary treatments, such as surgery, chemotherapy, radiation therapy, or combination treatments. Hospital resources are in such high demand for COVID-19 patients that procedures, such as surgery, dentistry, interventional radiology, and other ancillary services, are not available for cancer patients. Our tertiary care center is considered the center of the epicenter in the USA. As a result, all non-emergent surgeries have been suspended in order to provide hospital beds and other resources for COVID-19 patients. Additionally, ambulatory efforts to avoid treatment-related morbidity are critical for keeping patients out of emergency departments and hospitals. In this review article, we discuss evidence-based radiation therapy approaches for curable cancer patients during the COVID-19 pandemic. We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy.
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Affiliation(s)
- Bhupesh Parashar
- Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - William C Chen
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - Joseph M Herman
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - Louis Potters
- Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
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17
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Kamrava M, Chino JP, Beriwal S. SAbR as an Alternative Boost Modality for Cervical Cancer: A Cautionary Exercise. Int J Radiat Oncol Biol Phys 2020; 106:472-474. [DOI: 10.1016/j.ijrobp.2019.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
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