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Van Damme A, Tummers P, De Visschere P, Van Dorpe J, Van de Vijver K, Vercauteren T, De Gersem W, Denys H, Naert E, Makar A, De Neve W, Vandecasteele K. Exclusion of non-Involved uterus from the target volume (EXIT-trial): An individualized treatment for locally advanced cervical cancer using modern radiotherapy and imaging techniques followed by completion surgery. Clin Transl Radiat Oncol 2024; 47:100793. [PMID: 38798749 PMCID: PMC11126536 DOI: 10.1016/j.ctro.2024.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background and purpose Chemoradiotherapy followed by brachytherapy is the standard of care for locally advanced cervical cancer (LACC). In this study, we postulate that omitting an iconographical unaffected uterus (+12 mm distance from the tumour) from the treatment volume is safe and that no tumour will be found in the non-targeted uterus (NTU) leading to reduction of high-dose volumes of surrounding organs at risk (OARs). Material and Methods In this single-arm phase 2 study, two sets of target volumes were delineated: one standard-volume (whole uterus) and an EXIT-volume (exclusion of non-tumour-bearing parts of the uterus with a minimum 12 mm margin from the tumour). All patients underwent chemoradiotherapy targeting the EXIT-volume, followed by completion hysterectomy. In 15 patients, a plan comparison between two treatment plans (PTV vs PTV_EXIT) was performed. The primary endpoint was the pathological absence of tumour involvement in the non-targeted uterus (NTU). Secondary endpoints included dosimetric impact of target volume reduction on OARs, acute and chronic toxicity, overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS). Results In all 21 (FIGO stage I: 2; II: 14;III: 3; IV: 2) patients the NTU was pathologically negative. Ssignificant reductions in Dmean in bladder, sigmoid and rectum; V15Gy in sigmoid and rectum, V30Gy in bladder, sigmoid and rectum; V40Gy and V45Gy in bladder, bowel bag, sigmoid and rectum; V50Gy in rectum were achieved. Median follow-up was 54 months (range 7-79 months). Acute toxicity was mainly grade 2 and 5 % grade 3 urinary. The 3y- OS, PFS and LRFS were respectively 76,2%, 64,9% and 81 %. Conclusion MRI-based exclusion of the non-tumour-bearing parts of the uterus at a minimum distance of 12 mm from the tumour out of the target volume in LACC can be done without risk of residual disease in the NTU, leading to a significant reduction of the volume of surrounding OARS treated to high doses.
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Affiliation(s)
- Axel Van Damme
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Departement of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Eline Naert
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Palagudi M, Para S, Golla N, Meduri KC, Duvvuri SP, Vityala Y, Sajja DC, Damineni U. Adverse Effects of Cancer Treatment in Patients With Cervical Cancer. Cureus 2024; 16:e54106. [PMID: 38487144 PMCID: PMC10938271 DOI: 10.7759/cureus.54106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND In lower- to middle-income countries such as India, the literature on the adverse effects (AEs) of cancer treatment in patients with cervical cancer is very limited. This knowledge gap provides an opportunity to investigate and improve the quality of life for women with cervical cancer. OBJECTIVE The purpose of this study was to assess the AEs of various cancer treatment combinations in patients with cervical cancer. METHODS This observational, retrospective study analysed 1,030 women with cervical cancer, with a descriptive cross-sectional design, based on a review of medical records from patients who were followed up during the morbidity consultation conducted by a multidisciplinary team of doctors. The AEs of cancer treatment for women with cervical cancer were recorded in these medical records between October 14, 2019, and November 21, 2022, at 10 major public tertiary hospitals in India. RESULTS This study analysed 1,030 women with cervical cancer aged between 21 and 80 years (mean age: 48.8 ± 13.9 years; p=0.30). Patients between the ages of 36-50 years reported the most AEs (30.2%; 95% confidence interval (CI): 29.1-32.8) among other age groups. Combined radiation therapy and chemotherapy (CT) was the type of cancer treatment in which there were more AEs, presenting in 56.0% (95% CI: 55-60.1) of patients. Adverse effects associated with the gastrointestinal system were observed in the majority (92.5%, 95% CI: 90.2-96.9) of cervical cancer patients. CONCLUSION Exposure to different cancer treatments, particularly combination therapy, induces AEs in patients during and after cervical cancer treatment.
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Affiliation(s)
- Mahesh Palagudi
- Department of General Medicine, P.E.S. Institute of Medical Sciences and Research, Kuppam, IND
| | - Sneha Para
- Department of General Medicine, Maheshwara Medical College and Hospital, Hyderabad, IND
| | - Nagasree Golla
- Department of General Medicine, I. K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, KGZ
| | | | - Sai Praneeth Duvvuri
- Department of General Medicine, Maheshwara Medical College and Hospital, Hyderabad, IND
| | - Yethindra Vityala
- Department of Research, AJ Research Centre, AJ Institute of Medical Sciences and Research Centre, Mangalore, IND
- Department of Pathology, International Higher School of Medicine, International University of Kyrgyzstan, Bishkek, KGZ
| | | | - Ujwala Damineni
- Department of General Medicine, Maheshwara Medical College and Hospital, Hyderabad, IND
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Jääskeläinen E, Anttila M, Palmgren JE, Kärkkäinen H. The impact of different treatment protocols on achieved radiation doses of high-dose-rate brachytherapy for locally advanced cervical cancer: a comparison between 2 fractions in 1 application and separate applications for each fraction. J Contemp Brachytherapy 2022; 14:446-451. [PMID: 36478700 PMCID: PMC9720687 DOI: 10.5114/jcb.2022.120765] [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] [Received: 06/03/2022] [Accepted: 10/08/2022] [Indexed: 03/26/2024] Open
Abstract
PURPOSE To compare radiation doses achieved by image-guided brachytherapy for locally advanced cervical carcinoma implemented with two different protocols. MATERIAL AND METHODS Medical records of 117 patients with locally advanced cervical carcinoma treated with brachytherapy from 2009 to 2018 at our institution were retrospectively reviewed. All patients had received previous external beam radio/chemotherapy. We performed magnetic resonance image-guided adaptive high-dose-rate brachytherapy delivered by intra-cavitary/interstitial applicators. Dose prescription was 7 Gy for four fractions within two weeks. Original schedule of brachytherapy was two fractions delivered on consecutive days with one applicator insertion; this process was repeated one week later (group 1, 54 patients). From 2015 onwards, another protocol of brachytherapy was mainly used, separately performing applicator insertions for each of the four administered fractions (group 2, 63 patients). RESULTS The high-risk clinical target volume (HR-CTV) D90 planning aim (PA) of ≥ 85 Gy (hard constraint) was not achieved in 9 cases out of 54 (17%) in group 1 compared with only 2 out of 63 cases (3%) in group 2 (p = 0.022). A difference between the two groups was also found in the fulfillment of PA 90 Gy (soft constraint) (p = 0.027). We conducted a sub-group analysis of target volume groups and observed that the differences were most pronounced with very large tumors (> 50 cm3). In these patients, PA 85 Gy was only fulfilled in 67% cases when treatment involved two applications, but in all cases with four separate applicator insertions (p = 0.010). CONCLUSIONS In our experience, by performing an applicator insertion for each of the fractions, it is possible to correct the non-optimal position of the applicator immediately, and to deliver better doses for consecutive fractions. As a result, the planning aim is more often achieved, especially for large tumors.
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Affiliation(s)
- Ester Jääskeläinen
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
| | - Jan-Erik Palmgren
- Radiotherapy Department, Kuopio University Hospital, Kuopio, Finland
| | - Henna Kärkkäinen
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
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Tharavichitkul E, Jia-Mahasap B, Muangwong P, Chakrabandhu S, Klunklin P, Onchan W, Tippanya D, Nobnop W, Watcharawipha A, Kittidachanan K, Galalae RM, Chitapanarux I. Survival outcome of cervical cancer patients treated by image-guided brachytherapy: a 'real world' single center experience in Thailand from 2008 to 2018. JOURNAL OF RADIATION RESEARCH 2022; 63:657-665. [PMID: 35719089 PMCID: PMC9303615 DOI: 10.1093/jrr/rrac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/30/2022] [Indexed: 06/15/2023]
Abstract
The objective of our study was to evaluate the survival outcome of cervical cancer patients treated using image-guided brachytherapy (IGBT). From 2008 to 2018, 341 patients with cervical cancer were treated by radical radiotherapy. IGBT (by computed tomography [CT] or transabdominal ultrasound [TAUS]) was used to treat all of these patients. The characteristic data and patient status after treatment were recorded. All data were evaluated for survival outcome analysis. From a total of 341 patients, 295 patients were analyzed and 46 patients were excluded due to data missing in the survival outcomes. At the median follow-up time of 48 months (IQR 30-80 months), The 4-year local control, progression-free survival and overall survival rates were 89.5%, 74.9% and 69.1%, respectively. For overall survival, the size (> 5 cm), pathology (non-SCCA), stage (stage III-IV by FIGO 2009), lymph node (LN) (presented) and overall treatment time (OTT) (> 56 days) showed statistical significance in univariate analysis while non-SCCA pathology, advanced stage, presented LN and longer OTT showed statistical significance in multivariate analysis. In conclusion, our analysis reports a 4-year overall survival rate of 69.1%. Non-SCCA pathology, advanced stage disease, LN presence and longer OTT showed worse prognostic factors in multivariate analysis.
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Affiliation(s)
- Ekkasit Tharavichitkul
- Corresponding author. The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. Email;
| | - Bongkot Jia-Mahasap
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pooriwat Muangwong
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Somvilai Chakrabandhu
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pitchayaponne Klunklin
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wimrak Onchan
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Damrongsak Tippanya
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wannapa Nobnop
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Anirut Watcharawipha
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kittikun Kittidachanan
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ravan M Galalae
- MedAustron Ion Therapy Center, Wiener Neustadt 2700, Austria
- Faculty of Medicine, Christian-Albrechts-University, Kiel 24118, Germany
| | - Imjai Chitapanarux
- The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Northern Thailand Radiation Oncology Group, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Otal A, Celada F, Chimeno J, Vijande J, Pellejero S, Perez-Calatayud MJ, Villafranca E, Fuentemilla N, Blazquez F, Rodriguez S, Perez-Calatayud J. Review on Treatment Planning Systems for Cervix Brachytherapy (Interventional Radiotherapy): Some Desirable and Convenient Practical Aspects to Be Implemented from Radiation Oncologist and Medical Physics Perspectives. Cancers (Basel) 2022; 14:cancers14143467. [PMID: 35884528 PMCID: PMC9318845 DOI: 10.3390/cancers14143467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used by commercially available treatment planning systems (TPSs) in exclusive magnetic resonance imaging-based (MRI) cervix BT with interstitial component treatments. Practical aspects and improvements to be implemented into the TPSs are discussed. This review is based on the clinical expertise of a group of radiation oncologists and medical physicists and on interactive demos provided by the software manufacturers. The TPS versions considered include all the new tools currently in development for future commercial releases. The specialists from the supplier companies were asked to propose solutions to some of the challenges often encountered in a clinical environment through a questionnaire. The results include not only such answers but also comments by the authors that, in their opinion, could help solve the challenges covered in these questions. This study summarizes the possibilities offered nowadays by commercial TPSs, highlighting the absence of some useful tools that would notably improve the planning of MR-based interstitial component cervix brachytherapy.
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Affiliation(s)
- Antonio Otal
- Medical Physics Department, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Correspondence: ; Tel.: +34-973248100
| | - Francisco Celada
- Radiotherapy Department, La Fe Hospital, 46026 Valencia, Spain; (F.C.); (M.-J.P.-C.)
| | - Jose Chimeno
- Medical Physics Department, Hospital San Juan, 03550 Alicante, Spain;
| | - Javier Vijande
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Department of Atomic, Molecular and Nuclear Physics, University of Valencia, 46010 Valencia, Spain
- Instituto de Física Corpuscular, IFIC (UV-CSIC), 46010 Valencia, Spain
| | - Santiago Pellejero
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | | | - Elena Villafranca
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | - Naiara Fuentemilla
- Radiation Oncology Department, Hospital Universitario de Navarra, 31008 Navarre, Spain; (S.P.); (E.V.); (N.F.)
| | - Francisco Blazquez
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
| | - Silvia Rodriguez
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
| | - Jose Perez-Calatayud
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), 46010 Valencia, Spain; (J.V.); (J.P.-C.)
- Radiotherapy Department, La Fe Hospital, 46026 Valencia, Spain; (F.C.); (M.-J.P.-C.)
- Radiotherapy Department, Hospital Clínica Benidorm, 03501 Alicante, Spain; (F.B.); (S.R.)
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Li F, Shi D, Bu M, Lu S, Zhao H. Four-Dimensional Image-Guided Adaptive Brachytherapy for Cervical Cancer: A Systematic Review and Meta-Regression Analysis. Front Oncol 2022; 12:870570. [PMID: 35860574 PMCID: PMC9291247 DOI: 10.3389/fonc.2022.870570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe ICRU/GEC-ESTRO released the ICRU Report No. 89, which introduced the concept of four-dimensional brachytherapy and ushered in a new era of brachytherapy for cervical cancer. The purpose of this study was to evaluate the local control and late toxicity of four-dimensional brachytherapy in cervical cancer through a systematic review and to reveal the dose-response relationship between the volumetric dose paraments and the local control rate via a probit model.Material and MethodsWe identified studies that reported the HR-CTV D90 and local control probabilities by searching the PubMed Database, the Web of Science Core Collection and the Cochrane Library Database through February 1st, 2022. Regression analyses were performed between the HR-CTV D90 and the local control probability using a probit model.ResultsNineteen studies enrolling 3,616 patients were included. The probit model showed a significant relationship between the HR-CTV D90 value and IR-CTV D90 Vs. the local control probability, P < 0.001 and P = 0.003, respectively. The D90 for HR-CTV and IR-CTV corresponding to a probability of 90% local control was 79.1 GyEQD2,10 (95% CI:69.8 – 83.7 GyEQD2,10) and 66.5 GyEQD2,10 (95% CI: 62.8 - 67.9 GyEQD2,10), respectively. The limits for the prescribed dose of 85 GyEQD2,10 for HR-CTV D90 theoretically warranted a 92.1% (95% CI: 90.2% - 95.3%) local control rate, and 87.2% (95% CI: 82.4% - 91.8%) local control probability was expected for 65 GyEQD2,10 to IR-CTV D90. The probit model showed no significant relationship between the D2cc to organs at risk and the probability of grade 3 and above gastrointestinal or genitourinary toxicity.ConclusionsFour-dimensional brachytherapy takes into account uncertain factors such as tumour regression, internal organ motion and organ filling, and provides a more accurate and more therapeutic ratio delivery through adaptive delineation and replanning, replacement of the applicator, and the addition of interstitial needles. The dose volume effect relationship of four-dimensional brachytherapy between the HR-CTV D90 and the local control rate provides an objective planning aim dose.
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Affiliation(s)
- Fei Li
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dan Shi
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingwei Bu
- Department of Radiation Oncology, Guowen Medical Corporation Changchun Hospital, Changchun, China
| | - Shuangchen Lu
- Department of Radiation Oncology, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Hongfu Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Hongfu Zhao,
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Engineer R, Chopra S, Shukla R, Mahantshetty U, Phurailatpam R, Ghadi Y, Gupta S, Shrivastava SK. Computed Tomography-Based Interstitial Brachytherapy for Recurrent Cervical Carcinoma in the Vaginal Apex. Clin Oncol (R Coll Radiol) 2021; 34:e1-e6. [PMID: 34716084 DOI: 10.1016/j.clon.2021.09.012] [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: 06/23/2020] [Revised: 06/30/2021] [Accepted: 09/17/2021] [Indexed: 11/03/2022]
Abstract
AIMS To determine the factors influencing the outcomes of patients with recurrences post-hysterectomy for cervical cancers treated with external beam radiotherapy (EBRT) and interstitial brachytherapy. MATERIALS AND METHODS This prospective study accrued 90 patients between October 2008 and May 2014. All patients had had a prior hysterectomy and were diagnosed with recurrent vaginal apex cancers with squamous cell carcinomas. All underwent EBRT of 50 Gy (2 Gy/fraction) using tomotherapy-based image-guided intensity-modulated radiotherapy with concurrent chemotherapy of weekly cisplatin (40 mg/m2) followed by high dose rate interstitial brachytherapy boost of 20 Gy (4 Gy/fraction twice a day). Local relapse, disease-free and overall survival were determined. RESULTS At a median follow-up of 74 months (4-123 months), 10/90 (11%) patients had local failure as the first site of relapse and 12/90 (13.3%) had first distant relapse. Only one patient had synchronous local and distant relapse. The 7-year local relapse-free, disease-free and overall survival were 87.6, 68.3 and 68.3%, respectively. Grade 2 and 3 rectal toxicity were seen in 5.6 and 3.1% of patients, respectively. Among these, two (2.2%) patients underwent temporary diversion colostomy due to vaginal sigmoid and rectovaginal fistula. Grade 2 and 3 bladder toxicity were seen in 5.6 and 1.1% of patients, respectively. In summary, the lateral disease extent (P = 0.048) and the presence of nodal disease at diagnosis (P = 0.08) had a statistically significant or borderline impact on local relapse without any impact on disease-free survival. Tumour size in itself did not affect overall survival. CONCLUSION With the integration of EBRT and interstitial brachytherapy, most vaginal apex recurrences can be salvaged. An excellent local control and survival is achievable using intensity-modulated radiotherapy with image guidance and concurrent chemotherapy followed by high dose rate interstitial brachytherapy.
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Affiliation(s)
- R Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
| | - S Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - R Shukla
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - U Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - R Phurailatpam
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India
| | - Y Ghadi
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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