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Wang Z, Guo X, Zhao H. Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer. BMC Cancer 2024; 24:707. [PMID: 38851692 PMCID: PMC11162573 DOI: 10.1186/s12885-024-12486-1] [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: 02/06/2024] [Accepted: 06/07/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE This study aimed to establish the dose-response relationship between volume base dose and tumor local control for vaginal cancer, including primary vaginal cancer and recurrent gynecologic malignancies in the vagina. MATERIALS AND METHODS We identified studies that reported volume base dose and local control by searching the PubMed, the Web of Science, and the Cochrane Library Database through August 12, 2023. The regression analyses were performed using probit model between volume based dose versus clinical outcomes. Subgroup analyses were performed according to stratification: publication year, country, inclusion time of patients, patients with prior radiotherapy, age, primaries or recurrent, tumor size, concurrent chemoradiotherapy proportion, dose rate, image modality for planning, and interstitial proportion. RESULTS A total of 879 patients with vaginal cancer were identified from 18 studies. Among them, 293 cases were primary vaginal cancer, 573 cases were recurrent cancer in the vagina, and 13 cases were unknown. The probit model showed a significant relationship between the HR-CTV (or CTV) D90 versus the 2-year and 3-year local control, P values were 0.013 and 0.014, respectively. The D90 corresponding to probabilities of 90% 2-year local control were 79.0 GyEQD2,10 (95% CI: 75.3-96.6 GyEQD2,10). CONCLUSIONS A significant dependence of 2-year or 3-year local control on HR-CTV (or CTV) D90 was found. Our research findings encourage further validation of the dose-response relationship of radical radiotherapy for vaginal cancer through protocol based multicenter clinical trials.
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Affiliation(s)
- Zhiqiang Wang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, PR China
| | - Xin Guo
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, PR China
| | - Hongfu Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, PR China.
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Kamio Y, Roy MÈ, Morgan LA, Barkati M, Beauchemin MC, DeBlois F, Basaric B, Carrier JF, Bedwani S. The Montreal split ring applicator: Towards highly adaptive gynecological brachytherapy using 3D-printed biocompatible patient-specific interstitial caps. J Contemp Brachytherapy 2023; 15:453-464. [PMID: 38230395 PMCID: PMC10789156 DOI: 10.5114/jcb.2023.133676] [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: 08/19/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose The addition of interstitial (IS) needles to intra-cavitary (IC) brachytherapy applicators is associated with improved outcomes in locally advanced cervical cancers involving parametrial tumor extensions. The purpose of this work was to validate a clinical workflow involving 3D-printed caps for a commercial IC split ring applicator that enable using IS needle trajectories tailored to each treatment. Material and methods A dedicated software module was developed in this work allowing users to design patient-specific IS caps without knowledge of computer-aided design (CAD) software. This software module was integrated to 3D Brachy, a commercial software developed by Adaptiiv Medical Technologies Inc. For validation of the workflow, CAD models of ground truth caps with five IS needle trajectories were designed with Fusion 360™, 3D-printed, assembled with a split ring applicator, and CT-scanned with radio-opaque markers. 3D Brachy was then applied to generate a replica based on trajectories reconstructed from the radio-opaque markers. A comparison between ground truth and replicated IS needle trajectories was done using intersection points with planes at the level of the cervix (z = 0 cm) and a representative needle depth (z = 3 cm). Results Prototypes of interstitial caps 3D-printed in both BioMed Amber and BioMed Clear SLA resins were tested to be functional both pre- and post-sterilization for IS needles with obliquity angles ≤ 45°. Distance-to-agreement at z = 0 cm and 3 cm as well as deviations in pitch and yaw angles of the five IS needle trajectories were found to have mean values of 3.3 ±2.1 mm, 7.3 ±2.0 mm, 2.9° ±2.3°, and 7.0° ±7.0°, respectively. Conclusions The clinical workflow for image-guided adaptive cervical cancer brachytherapy using the Montreal split ring applicator was validated.
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Affiliation(s)
- Yuji Kamio
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada
- Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
| | - Marie-Ève Roy
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | | | - Maroie Barkati
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | | | - François DeBlois
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada
- Département de Physique, Université de Montréal, Montréal, QC, Canada
| | - Borko Basaric
- Adaptiiv Medical Technologies Inc., Halifax, NS, Canada
| | - Jean-François Carrier
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada
- Département de Physique, Université de Montréal, Montréal, QC, Canada
| | - Stéphane Bedwani
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada
- Département de Physique, Université de Montréal, Montréal, QC, Canada
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Kamrava M, Leung E, Bachand F, Beriwal S, Chargari C, D'Souza D, Erickson B, Fokdal L, Han K, Harkenrider M, Lin L, Mahantshetty U, Nesvacil N, Ravi A, Schmid M, Vigneault E, Westerveld H, Yashar C, Nout R. GEC-ESTRO (ACROP)-ABS-CBG Consensus Brachytherapy Target Definition Guidelines for Recurrent Endometrial and Cervical Tumors in the Vagina. Int J Radiat Oncol Biol Phys 2023; 115:654-663. [PMID: 36191741 DOI: 10.1016/j.ijrobp.2022.09.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Representatives from the Gynecologic Groupe European de Curietherapie-European Society for Radiation Therapy and Oncology (GYN GEC-ESTRO), the American Brachytherapy Society (ABS), and the Canadian Brachytherapy Group (CBG) met to develop international consensus recommendations for target definitions for image-guided adaptive brachytherapy for vaginal recurrences of endometrial or cervical cancer. METHODS AND MATERIALS Seventeen radiation oncologists and 2 medical physicists participated. Before an in-person meeting each participant anonymously contoured 3 recurrent endometrial/cervical cancer cases. Participants contoured the residual gross primary tumor volume (GTV-Tres), a high-risk clinical target volume (CTV-THR), and an intermediate-risk clinical target volume (CTV-TIR), on T2-weighted magnetic resonance images (MRIs). All contours were drawn using Falcon EduCase. Contours were reviewed at an in-person meeting during which a consensus document was created defining agreed-upon target definitions (Trial 1). After establishing these definitions, the group was sent one of the cases again (recurrent cervical cancer vaginal recurrence) and asked to contour the targets again (Trial 2). The Computerized Environment for Radiation Research (CERR) software (The Mathworks, Natwick, MA) was used to analyze the contours. Kappa statistics were generated to assess level of agreement between contours. A conformity index (CI), defined as the ratio between the intersection and union volume of a given pair of contours, was calculated. A simultaneous truth and performance level estimation (STAPLE) contour was created for the CTV-THR and CTV-TIR for the postmeeting case. RESULTS Consensus definitions for GTV-Tres, CTV-THR, and CTV-TIR were established. Kappa statistics (Trial 1/Trial 2) for GTV-Tres, CTV-THR, and CTV-TIR were 0.536/0.583, 0.575/0.743 and 0.522/0.707. Kappa statistics for Trial 2 for the CTV-THR and CTV-TIR showed "substantial" agreement while the GTV-Tres remained at moderate agreement. CONCLUSIONS This consensus provides recommendations to facilitate future collaborations for MRI-guided adaptive brachytherapy target definitions in endometrial/cervical vaginal recurrences.
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Affiliation(s)
| | - Eric Leung
- Sunnybrook Odette Cancer Center, Ontario
| | | | - Sushil Beriwal
- Allegheny Health Network, Pittsburgh, Pennsylvania and Varian Medical Systems, Palo Alto, California
| | - Cyrus Chargari
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | | | | | | | - Kathy Han
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Ontario, Canada
| | | | - Lilie Lin
- MD Anderson Cancer Center, Houston, Texas
| | | | - Nicole Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Max Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Eric Vigneault
- Centre Hospitalier Universitaire de Québec, Quebec, Canada
| | | | | | - Remi Nout
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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