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Gutiérrez Miguélez C, Rodríguez Villalba S, Villafranca Iturre E, Fuentemilla Urio N, Richart Sancho J, Córdoba Lago S, Pino Sorroche F, Gracia Lucio R, Herreros Martínez A, Najjari-Jamal D. Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies. Clin Transl Oncol 2023; 25:912-932. [PMID: 36445642 PMCID: PMC10025210 DOI: 10.1007/s12094-022-03016-1] [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: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
The present document includes consensus-based recommendations from the Brachytherapy Group (GEB) of the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for interstitial high-dose-rate (HDR) brachytherapy (BT) for gynaecologic malignancies. A nine-item survey-which included questions on experience with interstitial BT; indications and technique; applicator type; magnetic resonance imaging (MRI)-based planning; dose; fractionation schedule; and treatment planning-was sent to all radiation oncology departments (n = 174) in Spain in 2021. Responses were received from 36 centres (50% of all centres [n = 72] with a BT unit). The consensus-based recommendations presented here are based on a review of the available literature, professional experience among the group of experts, and in-person discussions held during the annual meeting of these two societies. We describe the results of the survey and the following: indications; contraindications; patient selection; description of applicators; role of imaging in planning; contouring; dose prescription; dosimetric reconstruction; optimisation; and dose indications for cancers of the cervix, vagina, and vulva. The various clinical scenarios in which interstitial BT is used in the treatment of gynaecological tumours are described in detail, including cervix intracavitary/interstitial hybrid HDR-BT; cervix perineal templates/freehand implants; primary vaginal malignancies/vaginal recurrences; and vulvar interstitial implants.
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Affiliation(s)
- Cristina Gutiérrez Miguélez
- Radiation Oncology Department, Institut Català d'Oncologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB) Catalonia, Hospitalet de Llobregat, Spain.
| | | | | | | | - Jose Richart Sancho
- Radiation Oncology Department, Hospital Clínica Benidorm, Benidorm, Spain
- Radiation Oncology Department, Hospital Universitario San Juan, Alicante, Spain
| | - Sofía Córdoba Lago
- Radiation Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Francisco Pino Sorroche
- Radiophysics Department, Institut Català d'Oncologia, Hospitalet de Llobregat, Catalonia, Spain
| | - Ruth Gracia Lucio
- Radiophysics Department, Institut Català d'Oncologia, Hospitalet de Llobregat, Catalonia, Spain
| | | | - Dina Najjari-Jamal
- Radiation Oncology Department, Institut Català d'Oncologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB) Catalonia, Hospitalet de Llobregat, Spain
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Cordoba Largo S, Rodriguez Rodriguez I, Rodriguez Villalba S, Najjari Jamal D, Anchuelo Latorre J, Celada Alvarez F, Garcia Cabezas S, de la Fuente Alonso C, Couselo Paniagua L, Martinez Montesinos I, Villafranca Iturre E, Belinchon Olmeda B, Farga Albiol D, Navarrete Solano PA, Sanchez Belda M. Radiation therapy for vulvar cancer: consensus technical guidelines of the GINECOR working group of the Spanish Society of Radiation Oncology. Part 2: radiotherapy recommendations. Clin Transl Oncol 2023:10.1007/s12094-023-03101-z. [PMID: 36961728 DOI: 10.1007/s12094-023-03101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document provides an up-to-date review of the technical aspects in radiation treatment of vulvar cancer. METHODS A two-round modified Delphi study was conducted to reach consensus on the appropriateness of technical aspects of external beam radiotherapy and brachytherapy. Three clinical scenarios were proposed: adjuvant treatment of vulvar cancer, radiation treatment of locally advanced vulvar carcinoma and locoregional recurrences. After the first round, an extensive analysis of current medical literature from peer-reviewed journal was performed to define evidence-based treatment options. In the second round, participants were asked to indicate their level of agreement with the preliminary recommendations according to the GRADE (Grade of Recommendation, Assessment, Development, and Evaluation) criteria, as follows: strongly agree; agree; neither agree nor disagree; disagree and strongly disagree. RESULTS The main recommendations on external beam radiotherapy and brachytherapy, both in adjuvant setting and local advanced disease are summarized. Recommendations include treatment technique, treatment volume, and doses in target and organs at-risk. Taking into consideration the different clinical scenarios of recurrent disease, the radiation treatment should be individualized. CONCLUSIONS In the absence of robust clinical data, these recommendations may help to select the optimal radiotherapy approach for this relatively rare cancer.
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Affiliation(s)
- Sofia Cordoba Largo
- Department of Radiation Oncology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
| | | | | | - Dina Najjari Jamal
- Department of Radiation Oncology, Catalan Institut of Oncology, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Anchuelo Latorre
- Department of Radiation Oncology, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Sonia Garcia Cabezas
- Department of Radiation Oncology, Reina Sofía, University Hospital, Córdoba, Spain
| | | | - Luz Couselo Paniagua
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | - Dolores Farga Albiol
- Department of Radiation Oncology, Consorcio Hospital General de Valencia, Valencia, Spain
| | | | - Maria Sanchez Belda
- Department of Radiation Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Cordoba Largo S, Rodriguez Rodriguez I, Rodriguez Villalba S, Najjari Jamal D, Anchuelo Latorre J, Celada Álvarez F, Garcia Cabezas S, de la Fuente Alonso C, Couselo Paniagua L, Martínez Montesinos I, Villafranca Iturre E, Belinchón Olmeda B, Farga Albiol D, Navarrete Solano PA, Sánchez Belda M. Radiation therapy for vulvar cancer: consensus guidelines of the GINECOR working group of the Spanish Society of Radiation Oncology. Part 1: clinical recommendations. Clin Transl Oncol 2023:10.1007/s12094-023-03095-8. [PMID: 36961727 DOI: 10.1007/s12094-023-03095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). Given the lack of prospective data on the management of vulvar carcinoma, this document provides an up-to-date review of radiotherapy treatment in vulvar cancer and a series of consensus-based recommendations from a group of experts. METHODS A two-round, online modified Delphi study was conducted to reach consensus treatment recommendations in three clinical settings: 1) adjuvant treatment, 2) locally-advanced vulvar cancer (LAVC), and 3) recurrent disease. After the first round, we comprehensively reviewed the available medical literature from peer-reviewed journals to assess and define the evidence-based treatment options. In the second round, participants were asked to indicate their level of agreement with the preliminary recommendations according to the GRADE (Grade of Recommendation, Assessment, Development, and Evaluation) criteria, as follows: strongly agree; agree; neither agree nor disagree; disagree; strongly disagree. RESULTS The main recommendations were as follows: 1) following surgical resection, adjuvant radiotherapy is recommended with the presence of adverse risk factors (primarily positive margins and lymph node involvement); 2) radiotherapy (with or without chemotherapy) should be considered in LAVC; and 3) in recurrent disease, radiotherapy should be individualised on a case-by-case basis. A high level of agreement over 80% was reached. CONCLUSIONS In the absence of robust clinical data, these final recommendations may help to select the optimal radiotherapy approach for this relatively rare cancer.
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Affiliation(s)
- Sofia Cordoba Largo
- Department of Radiation Oncology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
| | | | | | - Dina Najjari Jamal
- Department of Radiation Oncology, Catalan Institut of Oncology, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Anchuelo Latorre
- Department of Radiation Oncology, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Sonia Garcia Cabezas
- Department of Radiation Oncology, Reina Sofía, University Hospital, Córdoba, Spain
| | | | - Luz Couselo Paniagua
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | - Dolores Farga Albiol
- Department of Radiation Oncology, La Fe, University Hospital and Politécnico, Valencia, Spain
| | | | - María Sánchez Belda
- Department of Radiation Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Schiff JP, Mahmood M, Huang Y, Powell MA, Mutch D, Dyk PT, Lin AJ, Schwarz JK, Markovina ST, Grigsby PW. The impact of tumor size and histology on local control when utilizing high-dose-rate interstitial brachytherapy for gynecologic malignancies. Gynecol Oncol 2022; 165:486-492. [DOI: 10.1016/j.ygyno.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022]
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Tagliaferri L, Lancellotta V, Casà C, Fragomeni SM, Ferioli M, Gentileschi S, Caretto AA, Corrado G, Gui B, Colloca GF, Gambacorta MA, Morganti AG, Garganese G, Macchia G. The Radiotherapy Role in the Multidisciplinary Management of Locally Advanced Vulvar Cancer: A Multidisciplinary VulCan Team Review. Cancers (Basel) 2021; 13:cancers13225747. [PMID: 34830901 PMCID: PMC8616490 DOI: 10.3390/cancers13225747] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023] Open
Abstract
Locally advanced vulvar cancer (LAVC) is a challenging disease, requiring multidisciplinary management. The aim of this review is to propose an integrated clinical approach including radiotherapy (RT) in the multidisciplinary management of LAVC to customize the treatment. A review of the literature was conducted on PubMed, Scopus, and Cochrane library to acquire all relevant studies on RT in LAVC. Based on the available evidence, RT, with or without concurrent chemotherapy, has a relevant role as adjuvant and exclusive treatment or in the neoadjuvant setting. However, multicentric prospective trials are needed to define the best treatment options based on tumor and patient characteristics. A multidisciplinary and multidimensional assessment can also be useful to identify the most suitable approach, considering patients' age and comorbidities, in view of a better treatment personalization.
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Affiliation(s)
- Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
| | - Calogero Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
- Correspondence: ; Tel.: +39-063015-4981
| | - Simona Maria Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.M.F.); (S.G.); (G.C.)
| | - Martina Ferioli
- Radiation Oncology Center, IRCCS Azienda Ospedaliero Universitaria di Bologna, DIMES, Alma Mater Studiorum—Bologna University, 40138 Bologna, Italy; (M.F.); (A.G.M.)
| | - Stefano Gentileschi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.M.F.); (S.G.); (G.C.)
| | | | - Giacomo Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.M.F.); (S.G.); (G.C.)
| | - Benedetta Gui
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
| | - Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia—Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.T.); (V.L.); (B.G.); (G.F.C.); (M.A.G.)
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, IRCCS Azienda Ospedaliero Universitaria di Bologna, DIMES, Alma Mater Studiorum—Bologna University, 40138 Bologna, Italy; (M.F.); (A.G.M.)
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy;
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriella Macchia
- Unità Operativa di Radioterapia, Ospedale Gemelli Molise, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
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Clinical outcomes of distal vaginal and vulvar cancer treated with image-guided brachytherapy. J Contemp Brachytherapy 2021; 13:419-425. [PMID: 34484356 PMCID: PMC8407257 DOI: 10.5114/jcb.2021.108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate treatment outcomes with image-guided brachytherapy (IGBT) for distal vaginal and vulvar cancers. Material and methods Women treated for distal vaginal or vulvar malignancies utilizing IGBT were retrospectively reviewed, and acute and late toxicities were retrospectively graded. Descriptive statistical analysis was performed. Results Eighteen patients were included, out of which, twelve patients (66.7%) were with primary disease of the distal vagina and vulva, most commonly squamous cell carcinoma of the vulva (n = 8, 66.7%), and six with recurrent disease, most commonly recurrent endometrial carcinoma (n = 5, 83.3%). All patients received external beam radiation (EBRT) to a median dose of 45 Gy in 25 fractions, followed by IGBT (range of 15 to 27.5 Gy in 3 to 5 fractions). Mean follow-up was 20.6 months. Mean dose to high-risk clinical target volume (HR-CTV) D90 was 72.4 Gy. Mean D2cc for the rectum, bladder, and urethra were 50 Gy, 50.6 Gy, and 62.9 Gy, respectively. Five patients (27.8%) recurred. Three patients (16.7%) had local recurrence, 1 patient (5.6%) had distant recurrence only, and 1 patient (5.6%) had simultaneous regional and distant recurrence. Grade 3 acute toxicities included 1 (5.6%) vaginal stenosis, 6 (33.3%) dermatitis/mucositis, 2 (11.1%) vaginal pain, and 1 (5.6%) vaginal/vulvar infection. Grade 3 late toxicities comprised 3 (17.7%) cases of vaginal pain and 1 (5.9%) skin/vaginal necrosis. There were no grade 4 or higher toxicities. Conclusions Definitive radiation therapy in the form of EBRT and IGBT provides meaningful loco-regional control in women with distal vaginal and vulvar cancers, with mainly skin and vaginal toxicity.
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Lancellotta V, Macchia G, Garganese G, Fionda B, Fragomeni SM, D'Aviero A, Casà C, Gui B, Gentileschi S, Corrado G, Inzani F, Rovirosa A, Morganti AG, Gambacorta MA, Tagliaferri L. The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review. Clin Transl Oncol 2021; 23:1611-1619. [PMID: 33650029 DOI: 10.1007/s12094-021-02557-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. EVIDENCE ACQUISITION A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. EVIDENCE SYNTHESIS Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%). CONCLUSION IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.
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Affiliation(s)
- V Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - G Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - G Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Fionda
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - S M Fragomeni
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A D'Aviero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - C Casà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
| | - B Gui
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Gentileschi
- UOC Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Corrado
- UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Inzani
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Rovirosa
- Department of Radiation Oncology, Hospital Clinic I Universitari, Fonaments Clinics Department, University of Barcelona, Barcelona, Spain
| | - A G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M A Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Roma, Italy
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Interstitial brachytherapy for gynecologic malignancies: Complications, toxicities, and management. Brachytherapy 2021; 20:995-1004. [PMID: 33789823 DOI: 10.1016/j.brachy.2020.12.008] [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: 08/27/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022]
Abstract
From both a disease and management perspective, locally advanced gynecologic cancers present a significant challenge. Dose escalation with brachytherapy serves as a key treatment, providing conformal radiation while sparing at-risk organs. Intracavitary brachytherapy techniques have been shown to be effective, with improving tumor control and toxicity profiles with the advent of three-dimensional image planning. Despite this, the variations in tumor size, location, and pelvic anatomy may lead to suboptimal dosimetry with standard intracavitary applicators in some clinical scenarios. The addition of interstitial needles (interstitial brachytherapy (ISBT)) can improve the conformality of brachytherapy treatments by adding needles to peripheral (and central) regions of the target volume, improving the ability to escalate doses in these undercovered regions while sparing organs at risk. Interstitial brachytherapy can be delivered by intracavitary and interstitial hybrid applicators (ICBT/ISBT), perineal template (P-ISBT), or by free-hand technique. ISBT has however yet to be widely available because of concerns of complications and toxicities from this specialized treatment. However, with the increasing use of three-dimensional image-guided brachytherapy, there is an opportunity to increase the level of expertise in the gynecologic radiation oncology community with an improved understanding of the potential complications and morbidity. In this article, we review the acute and long-term toxicity in both ICBT/ISBT and P-ISBT using image-guided brachytherapy.
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Laliscia C, Cosio S, Morganti R, Mazzotti V, Fabrini MG, Paiar F, Gadducci A. Patterns of Failures and Clinical Outcome of Patients with Early-Stage, High-Risk, Node-Negative Endometrial Cancer Treated with Surgery Followed by Adjuvant Platinum-Based Chemotherapy and Vaginal Brachytherapy. Oncology 2019; 96:235-241. [PMID: 30904907 DOI: 10.1159/000492430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the clinical outcome of patients with high-risk early-stage endometrial cancer and negative pelvic nodes who received adjuvant platinum-based chemotherapy plus vaginal brachytherapy (VBT). METHODS This investigation assessed 80 patients who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for stage Ib-II, grade 2-3 endometrioid (n = 43) or stage Ia-II nonendometrioid (n = 37) endometrial cancer. RESULTS Five-year local control rate, 5-year disease-free survival, and 5-year overall survival were 97, 87, and 97%, respectively, for endometrioid carcinoma, and 66, 50, and 72%, respectively, for nonendometrioid carcinoma. CONCLUSIONS This retrospective study appears to show that adjuvant platinum-based chemotherapy plus VBT achieve very good results in endometrioid carcinoma. This combined treatment seems to be less effective in nonendometrioid carcinoma.
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Affiliation(s)
- Concetta Laliscia
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy,
| | - Stefania Cosio
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Valentina Mazzotti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Maria Grazia Fabrini
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Department of New Technologies and Translational Research, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Angiolo Gadducci
- Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Laliscia C, Gadducci A, Fabrini MG, Barcellini A, Parietti E, Pasqualetti F, Morganti R, Mazzotti V, Cafaro I, Paiar F. Definitive radiotherapy for recurrent vulvar carcinoma after primary surgery: a two-institutional Italian experience. TUMORI JOURNAL 2019; 105:225-230. [DOI: 10.1177/0300891618811279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To assess the clinical outcome of patients treated with radiotherapy (RT) for recurrent squamous cell carcinoma of the vulva after primary surgery. Methods: Fifty-six patients developed recurrent disease after surgery, consisting of deep total vulvectomy with inguino-femoral lymphadenectomy in 44 (78.6%) and deep partial vulvectomy with inguino-femoral lymphadenectomy in 12 (21.4%). All patients underwent RT at the Divisions of Radiotherapy, University of Pisa and ASST Cremona, between 1992 and 2016. Forty-three patients (76.8%) underwent external beam RT and 13 (23.2%) were treated with exclusive high-dose rate brachytherapy. Results: Five-year progression-free survival (PFS) and overall survival (OS) were 19% and 43%, respectively. Primary tumor size ⩽4 cm, early FIGO stage, and negative lymph node status were significantly associated with better PFS ( p = .005, p = .020 and p = .036, respectively) and OS ( p < .0001, p = .023 and p = .008, respectively). Patients with more than 1 positive lymph node at primary surgery had significantly worse PFS ( p = .028) and OS ( p = .001). Patients with local recurrence had significantly better PFS and OS ( p = .022, p = .002, respectively). RT total dose >54 Gy was associated with a lower risk of recurrence. Conclusions: Primary tumor size, FIGO stage, nodal status, and site of recurrent disease were significant predictors of clinical outcome in patients treated with RT for recurrent squamous cell carcinoma of the vulva.
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Affiliation(s)
- Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Maria Grazia Fabrini
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Amelia Barcellini
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Emanuela Parietti
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Francesco Pasqualetti
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Italy
| | - Valentina Mazzotti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Italy
| | - Ines Cafaro
- Department of Radiotherapy and Nuclear Medicine, Radiation Oncology ASST Cremona, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Italy
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11
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Lancellotta V, Kovács G, Tagliaferri L, Perrucci E, Colloca G, Valentini V, Aristei C. Age Is Not a Limiting Factor in Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2178469. [PMID: 29581964 PMCID: PMC5822774 DOI: 10.1155/2018/2178469] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/04/2017] [Accepted: 12/25/2017] [Indexed: 01/23/2023]
Abstract
This review examines the role of interventional radiotherapy (IRT otherwise known as brachytherapy) in cancer treatment for elderly patients. Despite their advanced age and associated comorbidities, elderly patients should receive definitive cancer therapies, including surgery and radiotherapy (RT). In fact, RT becomes first-line option for patients who are not eligible for surgery (due to comorbidities, anticoagulant drugs, and risk of disfigurement) or those who refuse it. It emerged from this review of the literature as effective, simple, safe, and comfortable and was associated with good local control, low toxicity rates, and excellent cosmesis and provided a cost benefit. IRT may be used as sole treatment for small cancers or as a useful adjunct to surgery or external beam radiotherapy (EBRT) in more advanced (or lymph node positive) cases, especially when the aim is local control with adequate preservation of normal tissue function. As palliative treatment, IRT preserves quality of life and/or improves survival. It is to be hoped that this review will serve as a helpful guide for members of multidisciplinary teams that are involved in treating elderly patients with cancer.
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Affiliation(s)
- Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH-CL, Lübeck, Germany
| | - Luca Tagliaferri
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giuseppe Colloca
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Gruppo Italiano di Oncologia Geriatrica (GIOGER), Roma, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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12
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Giannelli F, Chiola I, Belgioia L, Garelli S, Pastorino A, Marcenaro M, Mammoliti S, Costantini S, Bizzarri N, Vellone V, Barra S, Corvò R. Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report. J Contemp Brachytherapy 2017; 9:572-578. [PMID: 29441103 PMCID: PMC5807991 DOI: 10.5114/jcb.2017.71554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022] Open
Abstract
Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.
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Affiliation(s)
| | - Ilaria Chiola
- Health Science Department (DISSAL), University of Genova
| | - Liliana Belgioia
- Radiation Oncology Department, Policlinico San Martino Hospital
- Health Science Department (DISSAL), University of Genova
| | | | | | | | | | | | | | - Valerio Vellone
- Pathological Anatomy Department, Policlinico San Martino Hospital, Genova, Italy
| | - Salvina Barra
- Radiation Oncology Department, Policlinico San Martino Hospital
| | - Renzo Corvò
- Radiation Oncology Department, Policlinico San Martino Hospital
- Health Science Department (DISSAL), University of Genova
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13
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Hughes KE, McLaughlin CM, Fields EC. High-Dose Rate Salvage Interstitial Brachytherapy: A Case-Based Guide to the Treatment of Therapeutically Challenging Recurrent Vulvar Cancer. Front Oncol 2017; 7:224. [PMID: 28979888 PMCID: PMC5611395 DOI: 10.3389/fonc.2017.00224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/04/2017] [Indexed: 11/13/2022] Open
Abstract
Vulvar cancer is a rare gynecological malignancy with incidence rates steadily increasing over the past 10 years. Despite aggressive treatment, recurrent disease is common. Vulvar cancer recurrence poses a significant therapeutic challenge as most patients have been previously treated with surgery and/or radiation limiting the options for additional treatment. There are no consensus guidelines for the treatment of recurrent disease. Current literature supports the use of salvage interstitial brachytherapy. However, the total sample size is small. The goal of this case report is to review the current literature and to provide a guide for the use of salvage interstitial brachytherapy for recurrent disease by describing, in detail, the techniques used to treat two patients with unique cases of vulvar cancer recurrences in women with advanced disease and multiple medical comorbidities.
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Affiliation(s)
- Kelly Eileen Hughes
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Christopher M McLaughlin
- Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Emma C Fields
- Radiation Oncology, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
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14
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Rao YJ, Hui C, Chundury A, Schwarz JK, DeWees T, Powell MA, Mutch DG, Grigsby PW. Which patients with inoperable vulvar cancer may benefit from brachytherapy in addition to external beam radiation? A Surveillance, Epidemiology, and End Results analysis. Brachytherapy 2017; 16:831-840. [PMID: 28533162 DOI: 10.1016/j.brachy.2017.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/26/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE It is unknown whether brachytherapy after external beam radiation (EBRT + BT) results in improved outcomes compared with EBRT alone for patients with inoperable vulvar cancer. The purpose of this study was to compare survival outcomes for patients who received these treatment modalities. METHODS AND MATERIALS Data between 1973 and 2011 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients with Federation of International Gynecologists and Obstetricians stage I-IVA vulvar cancer treated with definitive EBRT + BT or EBRT alone were included. Patients with prior surgical resection were excluded. Disease-specific survival (DSS) and overall survival were compared using the Kaplan-Meier method and Cox proportional hazard models. RESULTS A total of 649 patients were analyzed, of which 617 received EBRT alone and 32 received EBRT + BT. Median follow-up was 33 months in surviving patients. The use of brachytherapy declined from 16% of cases treated in 1973-1980 to 4% in 2001-2011 (p = 0.04). EBRT + BT vs. EBRT alone was not significantly associated with improved DSS (45% vs. 33% at 5 years) or overall survival (34% vs. 24% at 5 years) on univariate or multivariate analyses. On post hoc subgroup analyses, brachytherapy consolidation was associated with higher 5-year DSS in a composite subgroup that included patients with stage IVA disease, tumor >4 cm, or node-positive disease (52% vs. 27%, p = 0.02). CONCLUSIONS Utilization of BT consolidation with EBRT for vulvar cancer is declining in the United States. EBRT + BT is not associated with improved survival compared with EBRT alone in the overall group of patients. Certain subgroups of patients might benefit from brachytherapy, but this hypothesis requires validation in future studies.
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Affiliation(s)
- Yuan James Rao
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Caressa Hui
- Saint Louis University School of Medicine, Saint Louis, MO
| | - Anupama Chundury
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
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15
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Castelnau-Marchand P, Escande A, Mazeron R, Bentivegna E, Cavalcanti A, Gouy S, Baratiny C, Maroun P, Morice P, Haie-Meder C, Chargari C. Brachytherapy as part of the conservative treatment for primary and recurrent vulvar carcinoma. Brachytherapy 2017; 16:518-525. [PMID: 28262516 DOI: 10.1016/j.brachy.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE There are only scarce data on the place of brachytherapy (BT) for treatment of vulvar carcinoma. Our institutional experience of interstitial BT for vulvar carcinoma patients is reported. METHODS AND MATERIALS Clinical records of patients receiving low-dose-rate or pulsed-dose-rate BT as part of the primary treatment for primary/recurrent vulvar squamous cell carcinoma or as part of postoperative treatment between 2000 and 2015 were included. Patients, tumors, and treatment characteristics as well as clinical outcome were examined. RESULTS A total of 26 patients treated with BT were identified. BT was delivered as part of primary intent treatment for locally advanced/recurrent cancer in 11 patients and as part of postoperative treatment in 15 patients. Median age at time of BT was 63 years (range, 41-88 years). Pulsed-dose-rate and low-dose-rate were used in 15 patients and 11 patients, respectively. BT was performed as a boost to the tumor bed following external beam radiotherapy (n = 13) or as the sole irradiation modality (n = 13). Total median dose at the level of primary tumor was 60 GyEQD2 (range, 55-60 GyEQD2). With mean followup of 41 months (range, 5 months-11.3 years), 11 patients experienced tumor relapse, and in two of them, site of relapse was only local. Three-year estimated disease-free survival and overall survival rates were 57% (95% confidence interval: 45-69%) and 81% (95% confidence interval: 72-90%), respectively. All toxicities were Grade 2 or less. CONCLUSIONS Interstitial BT used as part of the primary or postoperative treatment of vulvar carcinoma is feasible with a satisfactory toxicity profile. Prognosis remains, however, dismal, with a high frequency of failures in patients with locally advanced tumors.
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Affiliation(s)
- P Castelnau-Marchand
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Escande
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - R Mazeron
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - E Bentivegna
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - A Cavalcanti
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - S Gouy
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Baratiny
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Maroun
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - P Morice
- Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Haie-Meder
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France
| | - C Chargari
- Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; French Military Health Services Academy, Paris, France; Institut de Recherche Biomédicale des Armées, Brétigny sur Orge, France.
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16
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Clinical outcome of high-dose-rate interstitial brachytherapy in vulvar cancer: A single institutional experience. Brachytherapy 2016; 16:153-160. [PMID: 27876410 DOI: 10.1016/j.brachy.2016.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/13/2016] [Accepted: 10/10/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE With an aim to evaluate and report high dose date interstitial brachytherapy (HDR-ISBT) in vulvar cancers, we undertook this retrospective analysis. METHODS AND MATERIALS Histologically proven vulvar cancers treated with HDR-ISBT between 2001 and 2016 were analyzed. Radiotherapy details, clinical outcome in terms of local control rates, survivals, and toxicities were evaluated. RESULTS A total of 38 patients received HDR-ISBT, with definitive radiation in 29 (76.3%), adjuvant postoperative in six (15.8%) and salvage radiation in three (7.9%) patients. Of them, 29 patients received brachytherapy boost and nine patients ISBT alone. BT procedure included freehand plastic tube technique in 23 (single [n = 5] or multiple plane [n = 18]), 13 patients with template based and two patients combined approach. Patients with brachytherapy alone received median EQD2 of 38.4 Gy10 (35.5-46.7 Gy10), as boost received median 23.3 Gy10 (13-37.3 Gy10). At 3-month post-treatment response evaluation, 30 patients achieved clinically complete response, two patients partial response and six maintained postoperative status. With a median follow-up of 30 months, 29 (76.3%) were disease free, and 9 (23.7%) patients had relapsed disease with four patients expired due to disease and two died of other causes. The 5-year overall survival, disease free survival, and local control rates were 82%, 51%, and 77%, respectively. CONCLUSIONS HDR-ISBT in vulvar cancer is a feasible and a viable option with acceptable and comparable outcomes.
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