A volumetric analysis of GTVD and CTVHR as defined by the GEC ESTRO recommendations in FIGO stage IIB and IIIB cervical cancer patients treated with IGABT in a prospective multicentric trial (EMBRACE)

Jastaniyah, Noha; Yoshida, Kenji; Tanderup, Kari; Lindegaard, Jacob Christian; Sturdza, Alina; Kirisits, Christian; Šegedin, Barbara; Mahantshetty, Umesh; Rai, Bhavana; Jürgenliemk-Schulz, I.M.; Haie-Méder, Christine; Banerjee, Susovan; Pötter, Richard

doi:10.1016/j.radonc.2016.05.029

Cited by 45 publications

(31 citation statements)

References 20 publications

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“…However, 5-year local parametrial control has not significantly differed from that noted for the cervix. The FIGO Cancer Report [1] and EMBRACE [2] studies pointed out that parametrial doses should not be lower than 60-65 izoGy 2.0 as noted for the left parametrium in the present study.…”

Section: Discussionsupporting

confidence: 49%

“…Studies on radiotherapy efficacy related to initial cervix (GTV CRX ) and left and right parametria (GTV LP , GTV RP ) volumes has been incidentally explored, although Dubben et al [11] convincingly documented cervix target volume as being the only significant predictor for treatment outcome. In the EMBRACE trial [2], the importance of volumetric staging was quantified in a group of 481 patients with cervix cancer in stage IIB and IIIB. All data was divided into five volumetric subgroups with a mean GTV in the range of 12.6-79.4 cm 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Uterine cervix cancer in the stage IIB or IIIB (FIGO) develops in about 50-60% of patients and in about 25% of them periaortal lymph nodes metastases develop during 5-year follow-up [1,2]. The EMBRACE trial [2] has shown interstage overlapping of parametrial involvement in stage IIB and IIIB, and intra-stage heterogeneity. Brachytherapy (HDR) combined with external irradiation (3D-IMRT) are used as a standard treatment modality.…”

Section: Introductionmentioning

confidence: 99%

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The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

Telka

Maciejewski

Hawrylewicz

et al. 2020

Nowotwory. Journal of Oncology

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Introduction. The impact of volumetric staging of cervix and parametria on treatment outcome after combined BRT and IMRT of 135 cervix cancer patients in stage IIB and IIIB is analysed. Material and methods. Cervical GTV CRX and parametrial (GTV LP, RP) volumes are subdivided into four subgroups. BRT with 30 Gy in three fractions was combined with IMRT 48 Gy in 24 fractions. For GTV CRX ≤35 cm 3 5-year local control (LC) was 100%, which decreased to 87% for GTV CRX ≥130 cm 3. Results. Cervix and parametrial local recurrence were not higher than 3%. Major failures were periaortal nodes metastases (PNM) occurring during 5-year follow-up. Dose of ≥60 izoGy 2.0 effectively prevented the PNM. Underdosage <55 izoGy 2.0 (GTV RP) resulted in an increasing PNM from 7% to 53%, strongly correlated with enlarging GTV CRX from 5 cm 3 to >130 cm 3. Conclusion. Although cervix and parametria volumetric status are highly heterogeneous, they turned out to be better prognostic predictors than traditional TNM grading.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

Telka

Maciejewski

Hawrylewicz

et al. 2020

Nowotwory. Journal of Oncology

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“…Other metrics of the EMBRACE study cohort besides NF (e.g. tumour remission and morbidity) are subject of separate analyses [18][19][20][21][22][23][24][25]. Limited data exist on nodal disease at diagnosis and on nodal failure as a separate factor characterizing treatment outcomes for LACC.…”

Section: Discussionmentioning

confidence: 99%

Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort

Nomden

Pötter

Leeuw

et al. 2019

Radiotherapy and Oncology

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To investigate the patterns of nodal failure in patients enrolled in the international multicentre EMBRACE study. Materials/Methods: Nodal disease at diagnosis (NÀ, N+) and nodal failure were analysed per region (NF) (pelvic (parametrial, common iliac, internal/external iliac), inguinal and para-aortic (PAO)) in 1338 patients. Treatment consisted of chemo-radiation and MRI guided brachytherapy. PAO radiotherapy and/or nodal boost was left to the treating centre. At time of diagnosis 52% of patients had pathologic nodes. Frequency analyses were performed in relation to patient, primary tumour and nodal disease characteristics, and treatment related factors. Results: Median follow up was 34 months and 83% of NF occurred within 24 months. At diagnosis 99% of the N+ patients had pathologic nodes in the pelvis and 14% in the PAO. NF pelvic and NF PAO were reported in 55% and 68% of patients with NF, respectively. Overall NF was reported in 152 patients (11%); 7 and 16% for N-and N+ patients. Of the patients with NF, 41% were located outside the elective target (39% PAO), 40% inside and 35% inside the nodal boost target. Twelve percent of N+ patients that received a nodal boost had a NF inside the nodal boost target. Conclusion: Within the EMBRACE study cohort the overall number of patients developing nodal failure is low, significantly lower for NÀ compared to N+ patients. Pathological nodes at diagnosis are mainly located in the pelvis, whereas nodal failures are more often reported in the PAO region. About 40% of all nodal failures were reported outside the treatment targets.

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“…Ten centres use needles for dose optimisation, and one is planning to do so in the near future. The use of needles improves adequate target coverage and is related to improved local control without exceeding the dose constraints for OAR [28,29]. In the future, tumour coverage might be further improved with the possibility of using 'angulated' needle positions.…”

Section: Discussionmentioning

confidence: 99%

Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer

Boer

Jürgenliemk-Schulz

Westerveld

et al. 2017

Radiotherapy and Oncology

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A volumetric analysis of GTVD and CTVHR as defined by the GEC ESTRO recommendations in FIGO stage IIB and IIIB cervical cancer patients treated with IGABT in a prospective multicentric trial (EMBRACE)

Cited by 45 publications

References 20 publications

The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

The impact of cervical (GTVCRX) and parametrial (GTVLP, GTVRP) volumetric status on efficacy of radiotherapy for uterine cervix cancer in stage IIB and IIIB

Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort

Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer

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