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Romano KD, Petroni G, Ward K, Zheng W, Mistro M, Libby B, McLaughlin C, Showalter TN, Janowski EM. A randomized trial evaluating a novel hydrogel packing system compared to standard packing during image-guided high-dose rate brachytherapy boost for cervical cancer. Brachytherapy 2024; 23:248-256. [PMID: 38519352 PMCID: PMC11098690 DOI: 10.1016/j.brachy.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The purpose of this prospective randomized trial was to compare the use of a novel vaginal hydrogel packing system (BrachyGel) to standard vaginal packing (VP) during high dose rate (HDR) brachytherapy (BT) for locally advanced cervical cancer (LACC). METHODS This cross-over study included LACC patients receiving HDR BT boost (intracavitary +/- interstitial). All patients received alternating gauze or BrachyGel VP on Arms A and B. Patients, physicians, and physicists evaluated BT characteristics via a 4-point Likert scale. Adverse events (AEs) were prospectively collected and scored per CTCAE. RESULTS The 20 patients enrolled. The mean bladder D2cc difference between gauze and BrachyGel in Arm A was 0.117 Gray (Gy) and in Arm B 0.013 Gy. The mean difference in rectum D2cc in Arm A and Arm B was -0.189 Gy and -0.191 Gy, respectively. The mean dose to 90% of the high-risk clinical target volume (HR-CTV) for gauze compared to BrachyGel was -0.032 Gy (95% CI: 0.472, 0.409). Patient-reported discomfort was similar with BrachyGel and gauze ("mild/moderate" 70.0% vs 74.0%, respectively). The clarity of VP was similar between BrachyGel and gauze (86.8% vs 89.7%, respectively). The completeness of VP was more frequently "excellent/good" with BrachyGel (79.0%) compared to gauze (56.4%). The ease of packing was more frequently "extremely easy" with BrachyGel (21.2% vs 0%). No serious AEs were reported. CONCLUSION This randomized trial found no clinically significant difference in OAR or HR-CTV dosimetry between BrachyGel and standard VP. BrachyGel performed well compared to gauze for the patient and physician use experience.
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Affiliation(s)
- Kara D Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA.
| | - Gina Petroni
- School of Public Health Sciences, Division of Biostatistics, University of Virginia, Charlottesville, Virginia, USA
| | - Kristi Ward
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Wendy Zheng
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew Mistro
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Bruce Libby
- H. Lee Moffitt Cancer Center, Department of Radiation Oncology, Tampa, Florida, USA
| | - Christopher McLaughlin
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Einsley M Janowski
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
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Xue X, Liang D, Wang K, Gao J, Ding J, Zhou F, Xu J, Liu H, Sun Q, Jiang P, Tao L, Shi W, Cheng J. A deep learning-based 3D Prompt-nnUnet model for automatic segmentation in brachytherapy of postoperative endometrial carcinoma. J Appl Clin Med Phys 2024:e14371. [PMID: 38682540 DOI: 10.1002/acm2.14371] [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: 10/26/2023] [Revised: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE To create and evaluate a three-dimensional (3D) Prompt-nnUnet module that utilizes the prompts-based model combined with 3D nnUnet for producing the rapid and consistent autosegmentation of high-risk clinical target volume (HR CTV) and organ at risk (OAR) in high-dose-rate brachytherapy (HDR BT) for patients with postoperative endometrial carcinoma (EC). METHODS AND MATERIALS On two experimental batches, a total of 321 computed tomography (CT) scans were obtained for HR CTV segmentation from 321 patients with EC, and 125 CT scans for OARs segmentation from 125 patients. The numbers of training/validation/test were 257/32/32 and 87/13/25 for HR CTV and OARs respectively. A novel comparison of the deep learning neural network 3D Prompt-nnUnet and 3D nnUnet was applied for HR CTV and OARs segmentation. Three-fold cross validation and several quantitative metrics were employed, including Dice similarity coefficient (DSC), Hausdorff distance (HD), 95th percentile of Hausdorff distance (HD95%), and intersection over union (IoU). RESULTS The Prompt-nnUnet included two forms of parameters Predict-Prompt (PP) and Label-Prompt (LP), with the LP performing most similarly to the experienced radiation oncologist and outperforming the less experienced ones. During the testing phase, the mean DSC values for the LP were 0.96 ± 0.02, 0.91 ± 0.02, and 0.83 ± 0.07 for HR CTV, rectum and urethra, respectively. The mean HD values (mm) were 2.73 ± 0.95, 8.18 ± 4.84, and 2.11 ± 0.50, respectively. The mean HD95% values (mm) were 1.66 ± 1.11, 3.07 ± 0.94, and 1.35 ± 0.55, respectively. The mean IoUs were 0.92 ± 0.04, 0.84 ± 0.03, and 0.71 ± 0.09, respectively. A delineation time < 2.35 s per structure in the new model was observed, which was available to save clinician time. CONCLUSION The Prompt-nnUnet architecture, particularly the LP, was highly consistent with ground truth (GT) in HR CTV or OAR autosegmentation, reducing interobserver variability and shortening treatment time.
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Affiliation(s)
- Xian Xue
- Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Dazhu Liang
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Kaiyue Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Jianwei Gao
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Jingjing Ding
- Department of Radiotherapy, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fugen Zhou
- Department of Aero-space Information Engineering, Beihang University, Beijing, China
| | - Juan Xu
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Hefeng Liu
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Quanfu Sun
- Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Ping Jiang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Laiyuan Tao
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Wenzhao Shi
- Digital Health China Technologies Co., LTD, Beijing, China
| | - Jinsheng Cheng
- Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
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Portocarrero-Bonifaz A, Syed S, Kassel M, McKenzie GW, Shah VM, Forry BM, Gaskins JT, Sowards KT, Avula TB, Masters A, Silva SR. Dosimetric and toxicity comparison between Syed-Neblett and Fletcher-Suit-Delclos Tandem and Ovoid applicators in high dose rate cervix cancer brachytherapy. Brachytherapy 2024:S1538-4721(24)00045-X. [PMID: 38643046 DOI: 10.1016/j.brachy.2024.03.003] [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: 12/20/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To compare patient and tumor characteristics, dosimetry, and toxicities between interstitial Syed-Neblett and intracavitary Fletcher-Suit-Delclos Tandem and Ovoid (T&O) applicators in high dose rate (HDR) cervical cancer brachytherapy. METHODS A retrospective analysis was performed for cervical cancer patients treated with 3D-based HDR brachytherapy from 2011 to 2023 at a single institution. Dosimetric parameters for high-risk clinical target volume and organs at risk were obtained. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS A total of 115 and 58 patients underwent Syed and T&O brachytherapy, respectively. Patients treated with Syed brachytherapy were more likely to have larger tumors and FIGO stage III or IV disease. The median D2cc values to the bladder, small bowel, and sigmoid colon were significantly lower for Syed brachytherapy. Patients treated with Syed brachytherapy were significantly more likely to be free of acute gastrointestinal (44% vs. 21%, p = 0.003), genitourinary (58% vs. 36%, p = 0.01), and vaginal toxicities (60% vs. 33%, p = 0.001) within 6 months following treatment compared to patients treated with T&O applicators. In contrast, Syed brachytherapy patients were more likely to experience late gastrointestinal (68% vs. 49%, p = 0.082), genitourinary (51% vs. 35%, p = 0.196), and vaginal toxicities (70% vs. 57%, p = 0.264). CONCLUSIONS Syed-Neblett and T&O applicators are suitable for HDR brachytherapy for cervical cancer in distinct patient populations. Acute toxicities are more prevalent with T&O applicators, while patients treated with Syed-Neblett applicators are more likely to develop late toxicities.
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Affiliation(s)
- Andres Portocarrero-Bonifaz
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY; Physics Department, Pontificia Universidad Catolica del Peru, Lima, Peru.
| | - Salman Syed
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Maxwell Kassel
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Grant W McKenzie
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Vishwa M Shah
- Department of Gynecologic Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Bryce M Forry
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Jeremy T Gaskins
- Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY
| | - Keith T Sowards
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Thulasi Babitha Avula
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Adrianna Masters
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
| | - Scott R Silva
- Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
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Gao Y, Gonzalez Y, Nwachukwu C, Albuquerque K, Jia X. Predicting treatment plan approval probability for high-dose-rate brachytherapy of cervical cancer using adversarial deep learning. Phys Med Biol 2024; 69:095010. [PMID: 38537309 PMCID: PMC11023000 DOI: 10.1088/1361-6560/ad3880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/18/2024]
Abstract
Objective.Predicting the probability of having the plan approved by the physician is important for automatic treatment planning. Driven by the mathematical foundation of deep learning that can use a deep neural network to represent functions accurately and flexibly, we developed a deep-learning framework that learns the probability of plan approval for cervical cancer high-dose-rate brachytherapy (HDRBT).Approach.The system consisted of a dose prediction network (DPN) and a plan-approval probability network (PPN). DPN predicts organs at risk (OAR)D2ccand CTVD90%of the current fraction from the patient's current anatomy and prescription dose of HDRBT. PPN outputs the probability of a given plan being acceptable to the physician based on the patients anatomy and the total dose combining HDRBT and external beam radiotherapy sessions. Training of the networks was achieved by first training them separately for a good initialization, and then jointly via an adversarial process. We collected approved treatment plans of 248 treatment fractions from 63 patients. Among them, 216 plans from 54 patients were employed in a four-fold cross validation study, and the remaining 32 plans from other 9 patients were saved for independent testing.Main results.DPN predicted equivalent dose of 2 Gy for bladder, rectum, sigmoidD2ccand CTVD90%with a relative error of 11.51% ± 6.92%, 8.23% ± 5.75%, 7.12% ± 6.00%, and 10.16% ± 10.42%, respectively. In a task that differentiates clinically approved plans and disapproved plans generated by perturbing doses in ground truth approved plans by 20%, PPN achieved accuracy, sensitivity, specificity, and area under the curve 0.70, 0.74, 0.65, and 0.74.Significance.We demonstrated the feasibility of developing a novel deep-learning framework that predicts a probability of plan approval for HDRBT of cervical cancer, which is an essential component in automatic treatment planning.
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Affiliation(s)
- Yin Gao
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Yesenia Gonzalez
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Xun Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United States of America
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Cancer-Associated Fibroblasts Exposed to High-Dose Ionizing Radiation Promote M2 Polarization of Macrophages, Which Induce Radiosensitivity in Cervical Cancer. Cancers (Basel) 2023; 15:cancers15051620. [PMID: 36900416 PMCID: PMC10001412 DOI: 10.3390/cancers15051620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/09/2023] Open
Abstract
Radiotherapy, including brachytherapy, is a major therapeutic regimen for cervical cancer. Radioresistance is a decisive factor in radiation treatment failure. Tumor-associated macrophages (TAMs) and cancer-associated fibroblasts (CAFs) in the tumor microenvironment are critical factors in the curative effects of cancer therapies. However, the interactions between TAMs and CAFs in the context of ionizing radiation are not fully understood. This study was undertaken to investigate whether M2 macrophages induce radioresistance in cervical cancer and to explore the TAMs' phenotypic transformation after IR and its underlying mechanisms. The radioresistance of cervical cancer cells was enhanced after being co-cultured with M2 macrophages. TAMs tended to undergo M2 polarization after high-dose irradiation, which was strongly associated with CAFs in both mouse models and patients with cervical cancer. Additionally, cytokine and chemokine analysis was performed to find that high-dose irradiated CAFs promoted macrophage polarization towards the M2 phenotype through chemokine (C-C motif) ligand 2. Collectively, our results highlight the crucial role that high-dose irradiated CAFs play in the regulation of M2 phenotype polarization, which ultimately induces radioresistance in cervical cancer.
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Hermesse J, Pleyers C, Gennigens C, De Cuypere M, Lovinfosse P, Seidel Statistician L, Coucke P, Kridelka F. Outcome analysis of HDR compared to PDR IGABT in locally advanced cervical cancer: a single-center cohort analysis. Strahlenther Onkol 2023; 199:141-148. [PMID: 35943555 DOI: 10.1007/s00066-022-01982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE This monocentric study aimed to assess the impact of technical advancement in brachytherapy (BT) on local control (LC) and cancer-specific survival (CSS) in locally advanced cervical cancer (LACC). METHODS Since 2010, 211 patients with LACC have been treated with 45/50.4 Gy or 60 Gy radiochemotherapy (RTCT) followed by image-guided adaptive brachytherapy (IGABT) at the authors' institution. In 2013, combined intracavitary and interstitial brachytherapy (BT IC/IS) was implemented and in 2018, pulsed-dose-rate BT (PDR-BT) was replaced by high-dose-rate BT (HDR-BT). LC, CSS, and morbidity according to the RTOG/EORTC scoring system were analyzed. Dose-volume parameters for the high-risk clinical target volume (HRCTV) and organs at risk (OAR) were reported. RESULTS While 27 (12.8%) patients died of LACC, complete local remission was achieved in 199 (94.3%). Local relapse decreases with a high D95 in the HRCTV (hazard ratio, HR = 0.85, p = 0.0024). D95 in the HRCTV is lower after 60 Gy even if interstitial BT is used. Mean D95 in the HRCTV is 78.2 Gy, 83.3 Gy, and 83.4 Gy with PDR-BT IC, PDR-BT IC/IS, and HDR-BT IC/IS, respectively, after 45/50.4 Gy. D2 cc of OARs is significantly reduced by using interstitial BT. The mean rectum and sigmoid D2 cc are about 61.5 Gy with PDR-BT IC/IS and significantly decreased with HDR-BT IC/IS. This translates into a low fistula incidence. A very low rate of severe gastrointestinal (3.4%) and genitourinary (2.3%) toxicity was observed with HDR-BT IC/IS. CONCLUSION This large monocentric study provides further evidence that implementation of BT IC/IS has an impact on D95 in the HRCTV, LC, and CSS. There are no differences between HDR and PDR in terms of efficacy, D95 in the HRCTV, and toxicity grade ≥ 3.
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Affiliation(s)
- Johanne Hermesse
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium. .,Department of Radiotherapy Oncology, Centre François Baclesse, Esch sur Alzette, Luxembourg. .,CHU Sart Tilman, Avenue de l'hôpital 1, 4000, Liège, Belgium. .,Centre François Baclesse, 51 Rue Emile Mayrisch, 4240, Esch sur Alzette, Luxembourg.
| | - Clémence Pleyers
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Christine Gennigens
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | | | - Pierre Lovinfosse
- Department of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | | | - Philippe Coucke
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Frédéric Kridelka
- Department of Gynecology, University Hospital of Liège, Liège, Belgium
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The influence of the used applicators on organ and target doses for cervical cancer patients treated with HDR brachytherapy. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Introduction: The aim of this work was to study the influence of the applicators used for cervical cancer patients treated with high dose-rate brachytherapy (HDR-BT) in the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland on doses in the tumour volumes and organs at risk.
Material and methods: The treatment was carried out using Iridium-192 in 4 fractions (7.5 Gy each) given in weekly intervals. Two types of applicators were used for comparison: fletcher and ring. The standard dose distribution parameters, read from the system Oncentra Brachy (version 4.5, Elekta), for bladder, rectum, and sigmoid (D2 cc) and tumour (HRCTV D100, D98, D90) were studied. Patients were divided into two groups (240 treatment plans) depending on the type of applicator used and into four groups according to the tumour volumes (HR-CTV < 25 cm3 or HR-CTV ≥ 25 cm3). The collected data were analysed using the PQStatSoftware (version 1.8.2).
Results: The treatment plans prepared with all types of applicators fulfil the dose distribution requirements, however, the dose delivered to the tumour using the ring applicator was found to be the highest. For the bladder and sigmoid the optimal dose distribution was obtained when using the fletcher applicator, while for the rectum the ring applicator gave the smallest dose value. The D2 cc parameter for sigmoid obtained for fletcher treatment has smaller values in the case of patients with small tumour volume and for this type of applicator was observed a statistically significant difference when compared with the ring.
Conclusions: The ring applicator gives the optimal parameters of the dose distribution independently on the tumour volume with respect to the fletcher applicator, which is however more often used in clinical practice.
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Shewalkar B, Khan A, Yerlekar D, Patel J, Khadilkar H, Sakthivel R, Kataruka R. Dose-Escalated Intensity-Modulated Radiotherapy for the Management of Locally Advanced Cervical Cancer. Cureus 2022; 14:e25965. [PMID: 35855254 PMCID: PMC9285639 DOI: 10.7759/cureus.25965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
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Gadda IR, Khan NA, Wani SQ, Baba MH. To evaluate the use of tandem and cylinder as an intracavitary brachytherapy device for carcinoma of the cervix with regard to local control and toxicities. J Cancer Res Ther 2022; 18:740-746. [PMID: 35900548 DOI: 10.4103/jcrt.jcrt_243_21] [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: 11/04/2022]
Abstract
Introduction Brachytherapy always remains a keystone in the treatment of gynecological carcinoma for both definitive and adjuvant treatments. Due to the rapid fall-off nature of brachytherapy, the target gets a high dose with a low dose to the normal organs nearby and thereby increasing the tumor control probability. Aims and Objectives This study aims at the evaluation of local control and toxicities in the carcinoma of the cervix using tandem and cylinder as brachytherapy applicator. Materials and Methods The study was conducted between January 2014 and December 2018 in a tertiary care hospital. Thirty-one patients who fulfilled our set criterion of Clinical stage IB3-IVA, Performance status Eastern Cooperative Oncology Group 0-2 were selected. All patients were treated initially with external beam radiotherapy and later by high dose rate intracavitary brachytherapy after completion of external beam radiation therapy (EBRT). A dose of 18-21 Gy was delivered to the residual disease in three sessions with a 1-week interval between each session. The dose was optimized in such a way that the organs at risk (OAR), namely bladder and rectum received doses within their tolerance levels. The patients were continuously monitored using Common Terminology Criteria for Adverse Events version 5.0 for both acute and late toxicities and by imaging for local control. Statistical analysis using SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to evaluate the results. Continuous variables were expressed as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages. Results Out of the 31 patients, 5 (16.1%) experienced radiation-induced Grade 1 skin changes which were due to EBRT, 1 (3.2%) had Grade 1 G. I. T toxicity, 1 (3.2%) had Grade 1 radiation-induced vaginal mucositis after brachytherapy. At 6-8-week follow-up, all the patients showed no evidence of disease on radiological imaging. At 3 months of follow-up, 1 (3.2%) patient had radiation-induced proctitis of Grades 2 and 3 (9.7%) had radiation-induced cystitis of Grades 1 and 1 (3.2%) had Grade 2 cystitis. At 6 months of follow-up, 1 (3.2%) had Grade 1, 1 (3.2%) had Grade 2, and 1 (3.2%) had Grade 3 radiation-induced proctitis. At 3 months of follow-up, 29 (93.5%) patients had no evidence of disease, while 2 (6.5%) were having residual disease on imaging. At 6 months of follow-up, all the patients were disease-free. At 12 months of follow-up, 26 (83.9%) patients were disease-free, 1 (3.2%) had local recurrence, 2 (6.5%) had distant metastasis, and 2 (6.5%) had expired. At 24 months of follow-up, 26 patients were disease-free. Acute and late toxicities were similar to those used in the treatment of carcinoma cervix by standard brachytherapy applicators. Local control was achieved in 83.87% of cases. Two-year survival was 93.5%. Conclusion We observed that the tandem and cylinder applicator is an acceptable applicator to be used for intracavitary brachytherapy. It is safe and simple besides this; the toxicities and local control are similar to the other standard applicators used in brachytherapy in carcinoma cervix. However, the required dose prescription to point A was not possible in all the patients due to limitations of OARs. Furthermore, long-term follow-up is needed to see the patterns of failure, recurrence-free survival, overall survival, and long-term toxicities in the treated patients.
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Affiliation(s)
- Irfan Rasool Gadda
- Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nazir Ahmad Khan
- Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shaqul Qamar Wani
- Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Misba Hamid Baba
- Department of Radiological Physics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Georgescu DE, Patrascu T, Georgescu TF, Tulin A, Mosoia L, Bacalbasa N, Stiru O, Georgescu MT. Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer. In Vivo 2021; 35:2495-2501. [PMID: 34182536 DOI: 10.21873/invivo.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival. PATIENTS AND METHODS Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence. RESULTS Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients. CONCLUSION The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.
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Affiliation(s)
- Dragos Eugen Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Traian Patrascu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Teodor Florin Georgescu
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; .,Department of General Surgery, Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania
| | - Liviu Mosoia
- Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Central Military Emergency Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai-Teodor Georgescu
- Department of Radiotherapy II, "Prof. Dr. Alex. Trestioreanu" Institute of Oncology, Bucharest, Romania.,Discipline of Oncology, Department 8 (Radiology, Oncology, Haematology), "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Glaser SM, Mohindra P, Mahantshetty U, Beriwal S. Complications of intracavitary brachytherapy for gynecologic cancers and their management: A comprehensive review. Brachytherapy 2021; 20:984-994. [PMID: 33478905 DOI: 10.1016/j.brachy.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Intracavitary gynecologic brachytherapy in the form of tandem-based brachytherapy and vaginal cylinder-based brachytherapy represents a fundamental component of the treatment of women with cervical or uterine cancer due to the ability to deliver a therapeutic dose of radiation with sharp dose falloff. This results in highly effective treatment in terms of oncologic outcomes with an overall favorable toxicity profile. Still, complications and side effects of brachytherapy do exist. While advances in brachytherapy techniques have led to a significant decrease in the rates of toxicity, a thorough understanding of the potential complications is crucial to ensuring optimal outcomes for women with gynecologic cancer undergoing brachytherapy. Use of equivalent dose at 2 Gy per fraction (EQD2) models has allowed incorporation of external beam radiotherapy dose to the brachytherapy dose leading to development of consolidated dose constraints for organs-at-risk in the modern era. This manuscript offers a comprehensive review of potential complications associated with intracavitary brachytherapy for gynecologic cancer including predictive factors, mitigation tactics, and management strategies.
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Affiliation(s)
- Scott M Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
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Pinzi V, Landoni V, Cattani F, Lazzari R, Jereczek-Fossa BA, Orecchia R. IMRT and brachytherapy comparison in gynaecological cancer treatment: thinking over dosimetry and radiobiology. Ecancermedicalscience 2019; 13:993. [PMID: 32010217 PMCID: PMC6974373 DOI: 10.3332/ecancer.2019.993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background The role of radiotherapy and brachytherapy in the management of locally advanced cervical and endometrial cancer is well established. However, in some cases, intracavitary brachytherapy (ICBRT) is not recommended or cannot be carried out. We aimed to investigate whether external-beam irradiation delivered by means of intensity-modulated radiation therapy (IMRT) might replace ICBRT in gynaecological cancer when the standard ICBRT boost delivering cannot be administered for technical or clinical reasons. Materials and methods Fifteen already delivered treatments for gynaecological cancer patients were analysed. The treatments were performed through 3-dimensional conformal radiotherapy (3D-CRT) to the whole-pelvis up to the dose of 45–50.4 Gy followed by a boost dose administered with ICBRT in high-dose-rate or pulsed-dose-rate modality. For each patient, IMRT plans were elaborated to mimic the ICBRT. We analysed the ICBRT boost versus IMRT boost in terms of dosimetric and radiobiological aspects. Results Mean conformity index value calculated on boost volume was 0.73 for ICBRT and 0.97 for IMRT. Mean conformation number was 0.24 for ICBRT boost and 0.78 for IMRT boost. Mean normal tissue complication probability (NTCP) values for 3D-CRT plus ICBRT and for IMRT (pelvis plus boost) were, respectively, 28% and 5% for rectum; 1.5% and 0.1% for urinary bladder and 8.9% and 6.1% for bowel. Conclusions Our findings suggest that IMRT may represent a viable alternative in delivering the boost in patients diagnosed with gynaecological cancer not amenable to ICBRT.
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Affiliation(s)
- Valentina Pinzi
- Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Valeria Landoni
- Laboratory of Medical Physics and Expert System, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Rome, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Roberta Lazzari
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology of University of Milan, 20122 Milan, Italy
| | - Roberto Orecchia
- Scientific Directory of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
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Callaghan CM, Adams Q, Flynn RT, Wu X, Xu W, Kim Y. Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques. Int J Radiat Oncol Biol Phys 2019; 105:206-221. [DOI: 10.1016/j.ijrobp.2019.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/27/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
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