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Espenel S, Kissel M, Garcia MA, Schernberg A, Gouy S, Bockel S, Limkin E, Fabiano E, Meillan N, Magné N, Leary A, Pautier P, Morice P, Fumagalli I, Haie-Meder C, Chargari C. Implementation of image-guided brachytherapy as part of non-surgical treatment in inoperable endometrial cancer patients. Gynecol Oncol 2020; 158:323-330. [PMID: 32475773 DOI: 10.1016/j.ygyno.2020.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study assessed outcomes of inoperable endometrial cancer (IEC) patients treated with definitive external beam radiation therapy (EBRT) followed by a 3D image-guided brachytherapy boost. METHODS All consecutive patients treated with EBRT followed by 3D image-guided brachytherapy for IEC were retrospectively included. EBRT delivered a dose of 45Gy. Then, patients had an uterovaginal brachytherapy guided by 3D imaging. Clinical target volume (CTVBT) included the whole uterus and the initial disease extent. Gross tumour volume (GTVres) included the residual disease at time of brachytherapy. RESULTS Twenty-seven patients were identified. Causes of inoperability were comorbidities (37%) or tumour loco regional extent (63%). Including EBRT and brachytherapy, the median D90 (minimal dose delivered to 90% of the volume) was 60.7 GyEQD2 (IQR = 56.4-64.2) for the CTVBT, and was 73.6 GyEQD2 (IQR = 64.1-83.7) for the GTVres. The median overall treatment time was 50 days (IQR = 46-54). The mean follow-up was 36.5 months (SD = 30.2). The cumulative incidence of local, pelvic and distant failures was 19% (n = 5), 7% (n = 2) and 26% (n = 7), respectively. Five-year overall survival was 63% (95% CI = 43-91). Late urinary and gastro intestinal toxicities ≥ grade 2 were reported in four (15%) and two patients (7%) respectively. No vaginal toxicity ≥ grade 2 was reported. CONCLUSIONS EBRT followed by intracavitary brachytherapy seems to be an effective option for IEC. The implementation of 3D concepts at time of brachytherapy may contribute to high local control probability and low toxicity profile. Large scale retrospective or prospective data are needed to confirm these early data.
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Affiliation(s)
- S Espenel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M Kissel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - M A Garcia
- Department of Public Health, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France
| | - A Schernberg
- Department of Radiation Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - S Gouy
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - S Bockel
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Limkin
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - E Fabiano
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Meillan
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - N Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez, France.
| | - A Leary
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Pautier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - P Morice
- Department of Surgery, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France.
| | - I Fumagalli
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - C Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
| | - C Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Paris Saclay University, Kremlin Bicêtre, 63 Rue Gabriel Péri, 94270 Le Kremlin-Bicêtre, France; Institut de Recherche Biomédicale des Armées, D19, 91220 Brétigny sur Orge, France.
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De Felice F, Caiazzo R, Benevento I, Musio D, Rubini F, Tombolini V. Pulsed-Dose Rate Brachytherapy for the Treatment of Endometrial Cancer. Oncology 2017; 92:311-316. [PMID: 28334713 DOI: 10.1159/000461584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022]
Abstract
Endometrial cancer (EC) is the most frequent gynecologic malignancy. The aim of this review is to outline clinical practice recommendations, to suggest a technical solution, and to advise doses selection for pulsed-dose rate (PDR) brachytherapy in EC. Electronic bibliographic databases, including PubMed, clinicaltrials.gov, and the American Society of Clinical Oncology (ASCO) Meeting Library, were searched for articles in English. Clinical guidelines and systematic reviews were also considered. The appropriate therapeutic approach should consider risk factors for tumor relapse and PDR brachytherapy and have a convincing role in this multidisciplinary scenario. Performing PDR brachytherapy in EC requires robust training and experience.
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Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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Mazeron R, Dumas I, Martin V, Martinetti F, Benhabib-Boukhelif W, Gensse MC, Chargari C, Guemnie-Tafo A, Haie-Méder C. [ Pulsed-dose rate brachytherapy in cervical cancers: why, how?]. Cancer Radiother 2014; 18:447-51. [PMID: 25155782 DOI: 10.1016/j.canrad.2014.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
The end of the production of 192 iridium wires terminates low dose rate brachytherapy and requires to move towards pulsed-dose rate or high-dose rate brachytherapy. In the case of gynecological cancers, technical alternatives exist, and many teams have already taken the step of pulsed-dose rate for scientific reasons. Using a projector source is indeed a prerequisite for 3D brachytherapy, which gradually installs as a standard treatment in the treatment of cervical cancers. For other centers, this change implies beyond investments in equipment and training, organizational consequences to ensure quality.
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Affiliation(s)
- R Mazeron
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - I Dumas
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - V Martin
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - F Martinetti
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - W Benhabib-Boukhelif
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - M-C Gensse
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - C Chargari
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - A Guemnie-Tafo
- Département de physique médicale, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - C Haie-Méder
- Département d'oncologie-radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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