Materials/Methods: 84 plans in total for 17 patients inserted with the ring and tandem (R&T) applicator only were evaluated. All the plans were computed tomography (CT) based and each patient received 6Gy per fraction with the exception of three patient who had 6.5Gy per fraction for four fractions. Each patient had both CT and magnetic resonance Imaging (MRI) during the second fraction for an improved delineation of clinical target volume (CTV) and organs at risk (OAR) (i.e., bladder, rectum, sigmoid and bowel). In scenario A, FSP was used i.e., dwell positions and times were re-optimized for each fraction. In scenario B, SP was used i.e., the same dwell positions and times were used for all fractions. A comparison of the CTV coverage, international commission on radiological units and measurement (ICRU) points, D 2cc (dose to 2cc volume) and D 1cc (dose to 1cc volume) of OAR was carried out to evaluate the two scenarios. Results: The CTV coverage for FSP ranged from 92.5% to 99.5% while that of SP ranged from 88.3 to 99.9%. Only one patient's CTV coverage using SP was below the 90% minimum coverage limit. The OAR D2cc were marginally higher for SP but most were within the dose constraints. The mean of the ratios of D 2cc FSP/D 2cc SP for the bladder, rectum, sigmoid and bowel are 0.97, 0.97, 0.99 and 0.98 respectively. A similar trend was obtained for the D 1cc FSP/D 1cc SP. Conclusion: This study has shown that there is virtually no difference between SP and FSP when using the R&T applicator. The doses to OAR are comparable and most are within the dose limit and also the minimum dose coverage of the CTV was achieved.
ObjectivePelvic magnetic resonance imaging (MRI) is a key exam used for the initial assessment of loco-regional involvement of cervical cancer. In patients with locally advanced cervical cancer, MRI is used to evaluate the early response to radiochemotherapy before image-guided brachytherapy, the prognostic impact of which we aimed to study.MethodsPatients with locally advanced cervical cancer treated using concomitant radiochemotherapy followed by closure treatment between January 2010 and December 2015 were included in this study. Clinical, anatomopathological, radiological, therapeutic, and follow-up data were evaluated.ResultsAfter applying the inclusion and exclusion criteria to the initially chosen 310 patients, 232 were included for evaluation (median follow-up period, 5.3 years). The median age was 50 years (range, 25–83 years), and the median tumor size was 47.5 mm (range, 0–105 mm). Based on the International Federation of Gynaecology and Obstetrics classification system, 9 patients were in stage IB2; 20, IB3; 2, IIA; 63, IIB; 4, IIIA; 7, IIIB; and 127, IIIC1 or higher. The re-evaluation MRI was performed at the median dose of 55.5 Gy, and median reduction in tumor size was 55.2% (range, −20–100%). There was a difference between the disease-free and overall survival rates of the patients with a tumor response greater or lesser than 50%. The risk of recurrence or death reduced by 39% in patients with a tumor size reduction >50%. The overall 5-year survival rate of patients with a response greater and lesser than 50% were 77.7% and 61.5%, respectively. The 5-year disease-free survival rate for these two groups of patients were 68.8% and 51.5%, respectively.ConclusionOur study confirms the prognostic impact of tumor size reduction using MRI data obtained after radiochemotherapy in patients with locally advanced cervical cancer.
Semi-quantitative MR perfusion parameters have an excellent reproducibility and are associated with the degree of histologic tumor necrosis in musculoskeletal sarcomas. The utility of permeability parameters for determining tumor grade needs further investigations.
Our study aims to evaluate the comparability of primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) patients. This single-center retrospective study includes all patients treated for advanced stages high-grade serous ovarian carcinomas (HGSOC) between 2007 and 2017. Preoperative characteristics and postoperative outcomes were compared after a propensity score matching analysis. Of the 221 patients included, 38% underwent PDS, and 62% received NACT. There was no age difference at diagnosis; however, CA125 levels, PCI score levels, and rates of stage IV were higher in the NACT group. There were no differences concerning the rate and the severity of complications (p = 0.29). The propensity score distribution showed a broad distinction between PDS patients and NACT patients with no significant overlap. Survival analyses demonstrate, after a median follow-up of 66.5 months, an overall survival (OS) of 105.9 and progression-free survival (PFS) of 29.2 months in the PDS group, compared to OS of 52.8 and PFS of 18.9 months in the NACT group. Advanced HGSOC is a heterogeneous population, in which inoperable patients should be differentiated from PDS patients based on many factors, primarily tumor burden.
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