A Phase II Trial of Stereotactic Ablative Radiation Therapy as a Boost for Locally Advanced Cervical Cancer

Albuquerque, Kevin; Tumati, Vasu; Lea, Jayanthi; Ahn, Chul; Richardson, Debra L.; Miller, David S.; Timmerman, Robert

doi:10.1016/j.ijrobp.2019.10.042

Cited by 76 publications

(57 citation statements)

References 32 publications

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“… For patients with endometrioid histology, hormonal therapy may be used to delay RT start. SBRT delivered to a dose of 20–30 Gy in 4–5 fractions may be used as a boost in patients who cannot tolerate or refuse brachytherapy [ 58 , 59 ]. However, the consensus panel recommends that brachytherapy boosts remain the standard of care and should always be preferred over SBRT boosts.…”

Section: Resultsmentioning

confidence: 99%

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Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations

Elledge

Beriwal

Chargari

et al. 2020

Gynecologic Oncology

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Objective To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. Methods An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. Results Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. Conclusions The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.

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Section: Resultsmentioning

confidence: 99%

“…However, the consensus panel recommends that brachytherapy boosts remain the standard of care and should always be preferred over SBRT boosts. The potential risks of increased toxicity and inferior local control associated with SBRT boosts should be discussed with the patient prior to treatment [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations

Elledge

Beriwal

Chargari

et al. 2020

Gynecologic Oncology

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“…used 54 Gy to the whole pelvis with a boost to 66 Gy in 33 fractions to gross disease with an 80% local control rate without severe toxicity as an alternative to brachytherapy (BED 10 = 79.20 Gy) 25 . On the contrary, a recent UT Southwestern study demonstrated a 70% 2‐yr local control rate after replacing brachytherapy with an SBRT boost; however, there was a progression‐free survival rate of only 47% and the study had to be stopped early due to excess toxicities 26 . Our method of delivering ultra‐high doses of radiation may be an alternative to brachytherapy by providing a high BED 10 that could improve local control even more than previous studies, while also respecting normal tissue constraints, particularly in the setting of deep‐seated metastatic tumors that are often not candidates for brachytherapy approaches.…”

Section: Discussionmentioning

confidence: 99%

Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra‐High DoSes (ICARUS)

Rokni

Pointer

George

et al. 2021

J Applied Clin Med Phys

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Immune checkpoint inhibitors improve survival in metastatic diseases for some cancers. Multisite SBRT with pembrolizumab (SBRT + Pembro) was shown to be safe with promising local control using biologically effective doses (BEDs) = 95-120 Gy. Increased BED may improve response rate; however, SBRT doses are limited by surrounding organs at risk (OARs). The purpose of this work was to develop and validate methods for safe delivery of ultra-high doses of radiation (BED 10 > 300) to be used in future clinical trials. Methods and Materials: The radiation plans from 15 patients enrolled on a phase I trial of SBRT + pembro were reanalyzed. Metastatic disease sites included liver (8/ 15), inguinal region (1/15), pelvis (2/15), lung (1/15), abdomen (1/15), spleen (1/15), and groin (1/15). Gross tumor volumes (GTVs) ranged from 80 to 708 cc. Following the same methodology used in the Phase I trial on which these patients were treated, GTVs > 65 cc were contracted to a 65 cc subvolume (SubGTV) resulting in only a portion of the GTV receiving prescription dose. Volumetric modulated arc therapy (VMAT) was used to plan treatments BED 10 = 360 Gy. Plans utilizing both 6FFF and 10FFF beams were compared to clinical plans delivering BED 10 = 112.50 Gy. The target primary goal was V100% > 95% with a secondary goal of V70% > 99% and OAR objectives per the trial. To demonstrate feasibility, plans were delivered to a diode array phantom and evaluated for fidelity using gamma analysis. Results: All 30 plans met the secondary coverage goal and satisfied all OAR constraints. The primary goal was achieved in 12/15 of the 6FFF plans and 13/15 of the 10FFF plans. Average gamma analysis passing rate using criteria of 3% dose difference

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“…10 In addition to its dose limitations, replacing brachytherapy with EBRT boost is associated with increased toxicity. Albuquerque et al 11 recently showed that the percent rectal circumference receiving 15 Gy (PRC15) from stereotactic ablative radiation therapy boost was associated with high-grade toxicity and recommended limiting the PRC15 to less than 62%. Two-year cumulative grade !3 rectal toxicity was 26.7%.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance–Guided Radiation Therapy to Boost Cervical Cancer When Brachytherapy Is Not Available: A Case Report

Sayan

Mustafayev

Atalar

et al. 2020

Advances in Radiation Oncology

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A Phase II Trial of Stereotactic Ablative Radiation Therapy as a Boost for Locally Advanced Cervical Cancer

Cited by 76 publications

References 32 publications

Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations

Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations

Radiation treatment planning study to investigate feasibility of delivering Immunotherapy in Combination with Ablative Radiosurgery to Ultra‐High DoSes (ICARUS)

Magnetic Resonance–Guided Radiation Therapy to Boost Cervical Cancer When Brachytherapy Is Not Available: A Case Report

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