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Ling DC, Vargo JA, Burton SA, Heron DE, Beriwal S. Salvage Curative-Intent Reirradiation Stereotactic Body Radiation Therapy for Isolated Pelvic and/or Paraortic Recurrences of Gynecologic Malignancies. Pract Radiat Oncol 2019; 9:418-425. [PMID: 31150869 DOI: 10.1016/j.prro.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the feasibility of stereotactic body radiation therapy (SBRT) for isolated nodal recurrences of gynecologic malignancies within a previously irradiated area. METHODS AND MATERIALS A retrospective review was performed on 20 patients who underwent 21 curative-intent reirradiation SBRT treatments for locoregional recurrences of gynecologic malignancies. Disease control and survival outcomes were analyzed with the Kaplan-Meier method and log-rank test. Treatment toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.03. RESULTS All patients had an isolated pelvic, paraortic, or intra-abdominal nodal recurrence, with the exception of 1 patient who had a concurrent paraortic and right acetabulum metastasis, both of which were irradiated with SBRT. Primary sites included cervix (30.0%), uterus (55.0%), vulva (5.0%), vagina (5.0%), and ovary (5.0%). Median prior external beam radiation therapy dose was 45 Gy. Recurrences were in field in 14 (66.7%) and marginal in 7 (33.3%). SBRT was directed to the pelvis in 13 cases (61.9%) and to paraortic or celiac nodes in 8 (38.1%). The most common SBRT regimen was 40 to 45 Gy in 5 fractions (n = 12). At a median follow-up of 31.2 months, 3-year actuarial in-field local control, distant progression-free survival, and overall survival were 61.4%, 44.0%, and 51.9%, respectively. At the time of last follow-up, 9 (45.0%) patients remained alive without evidence of disease. Actuarial 3-year risk of grade ≥2 and grade ≥3 late toxicities was 38.1% and 14.3%, respectively. CONCLUSIONS SBRT for isolated pelvic or intra-abdominal recurrences of gynecologic malignancies within a previously irradiated field is feasible with an acceptable toxicity rate. With this approach, about half of patients achieved durable disease-free survival.
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Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven A Burton
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Fields EC, McGuire WP, Lin L, Temkin SM. Radiation Treatment in Women with Ovarian Cancer: Past, Present, and Future. Front Oncol 2017; 7:177. [PMID: 28871275 PMCID: PMC5566993 DOI: 10.3389/fonc.2017.00177] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023] Open
Abstract
Ovarian cancer is the most lethal of the gynecologic cancers, with 5-year survival rates less than 50%. Most women present with advanced stage disease as the pattern of spread is typically with dissemination of malignancy throughout the peritoneal cavity prior to development of any symptoms. Prior to the advent of platinum-based chemotherapy, radiotherapy was used as adjuvant therapy to sterilize micrometastatic disease. The evolution of radiotherapy is detailed in this review, which establishes radiotherapy as an effective therapy for women with micrometastatic disease in the peritoneal cavity after surgery, ovarian clear cell carcinoma, focal metastatic disease, and for palliation of advanced disease. However, with older techniques, the toxicity of whole abdominal radiotherapy and the advancement of systemic therapies have limited the use of radiotherapy in this disease. With newer radiotherapy techniques, including intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT), and low-dose hyperfractionation in combination with targeted agents, radiotherapy could be reconsidered as part of the standard management for this deadly disease.
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Affiliation(s)
- Emma C Fields
- Division of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States
| | - William P McGuire
- Internal Medicine, Virginia Commonwealth University, Richmond VA, United States
| | - Lilie Lin
- Division of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah M Temkin
- Division of Gynecologic Oncology, Virginia Commonwealth University, Main Hospital, Richmond, VA, United States
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Zanfagnin V, Ferrero A, Biglia N, Aletti G, Gill SE, Makdisi PB, Multinu F, Mariani A. The role of surgery in recurrent endometrial cancer. Expert Rev Anticancer Ther 2016; 16:741-50. [DOI: 10.1080/14737140.2016.1190650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Annamaria Ferrero
- Academic Division of Obstetrics and Gynecology, Mauriziano Umberto I Hospital, Turin, Italy
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynecology, Mauriziano Umberto I Hospital, Turin, Italy
| | | | - Sarah E. Gill
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter B. Makdisi
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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Kunos CA, Sherertz TM, Mislmani M, Ellis RJ, Lo SS, Waggoner SE, Zanotti KM, Herrmann K, Debernardo RL. Phase I Trial of Carboplatin and Gemcitabine Chemotherapy and Stereotactic Ablative Radiosurgery for the Palliative Treatment of Persistent or Recurrent Gynecologic Cancer. Front Oncol 2015; 5:126. [PMID: 26097831 PMCID: PMC4456851 DOI: 10.3389/fonc.2015.00126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/20/2015] [Indexed: 12/30/2022] Open
Abstract
Background We conducted a phase I trial to determine the safety of systemic chemotherapy prior to abdominopelvic robotic stereotactic ablative radiotherapy (SABR) in women with persistent or recurrent gynecologic cancers. Methods Patients were assigned to dose-finding cohorts of day 1 carboplatin (AUC 2 or 4) and gemcitabine (600 or 800 mg/m2) followed by day 2 to day 4 Cyberknife SABR (8 Gy × three consecutive daily doses). Toxicities were graded prospectively by common terminology criteria for adverse events, version 4.0. SABR target and best overall treatment responses were recorded according to response evaluation criteria in solid tumors, version 1.1. Findings The maximum tolerated dose of chemotherapy preceding SABR was carboplatin AUC 4 and gemcitabine 600 mg/m2. One patient experienced manageable, dose-limiting grade 4 neutropenia, grade 4 hypokalemia, and grade 3 nausea attributed to study treatment. One patient had a late grade 3 rectovaginal fistula 16 months after trial therapy. Among 28 SABR targets, 22 (79%) showed a partial response and 6 (21%) remained stable. Interpretation Systemic chemotherapy may be given safely prior to abdominopelvic robotic SABR with further investigation warranted.
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Affiliation(s)
- Charles A Kunos
- Department of Radiation Oncology, Summa Cancer Institute, Summa Health System , Akron, OH , USA
| | - Tracy M Sherertz
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Mazen Mislmani
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Rodney J Ellis
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Simon S Lo
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Steven E Waggoner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Kristine M Zanotti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Karin Herrmann
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Robert L Debernardo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Case Comprehensive Cancer Center, Cleveland Clinic , Cleveland, OH , USA
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Macchia G, Deodato F, Cilla S, Torre G, Corrado G, Legge F, Gambacorta MA, Tagliaferri L, Mignogna S, Scambia G, Valentini V, Morganti AG, Ferrandina G. Volumetric intensity modulated arc therapy for stereotactic body radiosurgery in oligometastatic breast and gynecological cancers: feasibility and clinical results. Oncol Rep 2014; 32:2237-43. [PMID: 25175950 DOI: 10.3892/or.2014.3412] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/04/2014] [Indexed: 11/06/2022] Open
Abstract
In the present study, the preliminary results of the first stereotactic body radiosurgery (SRS) experience with volumetric intensity modulated arc therapy (VMAT) in oligometastatic breast and recurrent gynecological tumors (OBRGT) are reported in terms of feasibility, toxicity and efficacy. Patients were treated in a head-first supine treatment position on a customized body frame immobilization shell. SRS-VMAT treatment plans were optimized using the ERGO++ treatment planning system. Response assessment was performed 8-12 weeks after treatment by morphologic imaging modalities, or if feasible, also by functional imaging. Thirty-six lesions in 24 consecutive patients (median age, 63 years; range, 40-81) were treated: 13.9% had primary or metastatic lung lesions, 30.5% had liver metastases, 36.1% had bone lesions, 16.7% had lymph node metastases and 2.8% had a primary vulvar melanoma. The median dose was 18 Gy (BED2 Gy, α/β: 10=50.4 Gy), the minimal dose was 12 Gy (BED2 Gy, α/β: 10=26.4 Gy) and the maximal dose was 28 Gy (BED2 Gy, α/β: 10=106.4 Gy). Seven patients (29.2%) experienced acute toxicity, which however was grade 2 in only 1 case. Moreover, only 3 patients (12.5%) developed late toxicity of which only 1 was grade 2. Objective response rate was 77.7% including 16 lesions achieving complete response (44.4%) and 12 lesions achieving partial response (33.3%). The median duration of follow-up was 15.5 months (range, 6-50). Recurrence/progression within the SRS-VMAT treated field was observed in 6 patients (total lesions=7) with a 2-year inside SRS-VMAT field disease control expressed on a per lesion basis of 69%. Recurrence/progression of disease outside the SRS-VMAT field was documented in 15 patients; the 2-year outside SRS-VMAT field metastasis‑free survival, expressed on a per patient basis, was 35%. Death due to disease was documented in 6 patients and the 2-year overall survival was 58%. Although the maximum tolerated dose was not reached, SRS-VMAT resulted in positive early clinical results in terms of tumor response, local control rate and toxicity.
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Affiliation(s)
- Gabriella Macchia
- Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Torre
- Palliative Therapy Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giacomo Corrado
- Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Legge
- Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | - Luca Tagliaferri
- Department of Radiation, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Samantha Mignogna
- Palliative Therapy Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giovanni Scambia
- Department of Gynaecologic Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Radiation, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio G Morganti
- Radiotherapy Oncology Unit, Fondazione di Ricerca e Cura ̔Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Ferrandina
- Gynaecologic Oncology Unit, Fondazione di Ricerca e Cura 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy
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