Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation

Shelley, C.; Barraclough, Lisa H; Nelder, Claire; Otter, Sophie; Stewart, Alexandra J.

doi:10.1016/j.clon.2021.06.007

Cited by 36 publications

(21 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, this approach has the benefit of decreasing the volume of OARs exposed to higher doses of RT and the use of image-guided IMRT has been associated with a decrease in GI and hematological toxicities compared with IMRT alone [ 38 ]. Other adaptive RT technologies have emerged over the past few years to further improve image guidance during EBRT delivery, notably the “plan of the day” approach or the “online adaptive RT” that include same day replanning and are the subject of a recently published review article [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

Advances in Radiation Oncology for the Treatment of Cervical Cancer

Faye

Alfieri

2022

Current Oncology

View full text Add to dashboard Cite

Background: Over the past two decades, there has been significant advancement in the management of cervical cancer, particularly in the domain of definitive chemoradiotherapy for locally advanced cervical cancer (LACC). Indeed, radiation treatment paradigms have shifted from a two-dimensional (2D) approach solely based on anatomical bony landmarks, to an image-guided three-dimensional (3D) approach, with the goal of delivering doses more precisely to clinical targets with an increased sparing of organs-at-risk. Methods: This is a narrative review on the advances in radiation technologies for the treatment of cervical cancer. Using the PubMed database, we identified articles published in English up until November 18, 2021 on the treatment of LACC with external beam radiotherapy (EBRT) and brachytherapy. A search of the Clinicaltrials.gov and Clinicaltrialsregister.eu retrieved information on ongoing clinical trials on the topic of combined immunotherapy and radiotherapy in cervical cancer. Results: We highlight the historical evolution from the use of 2D radiotherapy to 3D-conformal radiotherapy, and then intensity modulated radiotherapy (IMRT) for the delivery of EBRT. We also discuss advances in brachytherapy, notably the transition to 3D image-guided adaptive brachytherapy (3D-IGABT). In this context, we highlight large cohort studies that were recently constructed and have shown significant improvement in local control and treatment-related toxicities with 3D-IGABT. Finally, we discuss other advances in the field, notably the use of stereotactic body radiotherapy (SBRT) as a substitute to brachytherapy, and the addition of immunotherapy to chemoradiation. Conclusions: The use of IG-IMRT and 3D-IGABT have considerably improved treatment outcomes and toxicity profiles for patients with LACC, and are now considered the gold standard in many countries. The use of SBRT boost as a replacement for brachytherapy has been associated with increased toxicity and decreased efficacy and should be used with caution in the context of clinical trials. New experimental approaches include the addition of immunotherapy to chemoradiation regimens.

show abstract

Section: Methodsmentioning

confidence: 99%

Advances in Radiation Oncology for the Treatment of Cervical Cancer

Faye

Alfieri

2022

Current Oncology

View full text Add to dashboard Cite

show abstract

“…Recently, remarkable progress has been made in radical radiotherapy for cervical cancer treatment. It is widely considered that cervical cancer patients, including elderly patients, can benefit from concurrent chemoradiotherapy (CCRT) compared with radical radiotherapy ( 12 , 37 , 38 ). Additionally, it is striking that sequential chemoradiation, rather than CCRT, can improve oncological outcomes in women with early-stage cervical cancer after radical operation ( 39 , 40 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of oncological outcomes in elderly early-stage cervical cancer patients treated with radical surgery or radiotherapy: A real-world retrospective study with propensity score matching

Cheng²,

Cang³

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

ObjectiveTo compare the oncological outcomes of radical surgery and radical radiotherapy in elderly (over 65 years) patients with early-stage cervical cancer (IB-IIA).MethodsElderly patients with stage IB-IIA cervical cancer treated at Peking Union Medical College Hospital from January 2000 to December 2020 were retrospectively reviewed. All patients were divided into the radiotherapy group (RT group) and the operation group (OP group) according to their primary intervention. Propensity score matching (PSM) analysis was performed to balance the biases. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and adverse effects.ResultsA total of 116 patients were eligible for the study (47 in the RT group, and 69 in the OP group), and after PSM, 82 patients were suitable for further analysis (37 in the RT group, and 45 in the OP group). In the real-world setting, it was found that compared with radiotherapy, operation was more frequently selected for elderly cervical cancer patients with adenocarcinoma (P < 0.001) and IB1 stage cancer (P < 0.001). The 5-year PFS rates between the RT and OP groups were not significant (82.3% vs. 73.6%, P = 0.659), and the 5-year OS rate of the OP group was significantly better than that in the RT group (100% vs. 76.3%, P = 0.039), especially in patients with squamous cell carcinoma (P = 0.029) and tumor size of 2~4 cm with G2 differentiation (P = 0.046). There was no significant difference in PFS between the two groups (P = 0.659). In the multivariate analysis, compared with operation, radical radiotherapy was an independent risk factor of OS (hazard ratio = 4.970, 95% CI, 1.023~24.140, P = 0.047). No difference was observed in adverse effects between the RT and OP groups (P = 0.154) and in ≥grade 3 adverse effects (P = 0.852).ConclusionThe study found that surgery was more frequently selected for elderly cervical cancer patients with adenocarcinoma and IB1 stage cancer in the real-world setting. After PSM to balance the biases, it showed that compared with radiotherapy, surgery could improve the OS of elderly early-stage cervical cancer patients and was an independent protective factor of OS in elderly early-stage cervical cancer patients.

show abstract

“…Adaptive radiotherapy (ART) would be particularly useful for some complicated disease sites. 23 , 24 It has several important advantages, including a lower risk of late adverse effects and a potential improvement in disease-free survival, but it is necessary to spend considerable time and energy to explore the appropriate time of ART in NPC radiotherapy. Our results confirmed that most deviations in the calculation of the actual exposure dose to the target area and OARs of NPC patients are less than 5%,which is acceptable for most clinicians.…”

Section: Discussionmentioning

confidence: 99%

Accumulated Dose Deviation of Rotational and Residual Setup Errors on Nasopharyngeal Carcinoma Using MIM Treated by Helical Tomotherapy

Yao

et al. 2023

Technol Cancer Res Treat

View full text Add to dashboard Cite

Background To analyze the relationship between the rotational and residual setup errors and the dose deviation on nasopharyngeal carcinoma (NPC) treated by helical tomotherapy (HT). Methods From 25 July 2017 to 20 August 2019, 16 treated NPC patients were enrolled in the study. These patients were scanned with full target range megavoltage computed tomography (MVCT) every other day. Adaptive radiotherapy function application software MIM7.1.3 were used to accumulate the actual dose. The dose deviation with the initial plan dose of the patients’ target and organs at risk (OAR) were compared, and the correlation between the dose change and the setup errors (rotational setup errors and neck residual setup error) was analyzed. Results Translational setup errors increased farther away from the head. Statistically significant difference among 3 groups was achieved in the directions of left-right ( P < .001) and anteroposterior ( P < .001) by analysis of variance test. Compared with the initial plan dose, the actual accumulated dose of the target area decreased with the actual exposure dose of the OAR increased. However, most of the dosimetric parameters differed by less than 5%. No correlation was found between dose deviation values and the translational setup errors of target. However, sagittal rotational setup errors (pitch) had a positive relationship ( P < .05) with the avearge dose of PTVnd (L) ( r = 0.885), PTVnd(R) ( r = 0.547) PTV1( r = 0.633) and PTV2( r = 0.584). Transverse rotational setup errors (roll) had a positive relationship ( P < .05) with the avearge dose of PTVnd(R) ( r = 0.593), PTV1( r = 0.505) and PTV2( r = 0.662). Conclusions Dose deviation between the actual accumulated and initial plan is not negligible, but most indicators difference is less than 5%, NPC patients treated by HT with MVCT correction setup errors every other day did not need adaptive radiotherapy model unless got rapid tumor shrinkage or weight loss. Moreover, to minimize the dose deviation, more attention should be paid to the reduction of pitch, roll, and residual error of cervical vertebrae during body positioning.

show abstract

Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation

Cited by 36 publications

References 98 publications

Advances in Radiation Oncology for the Treatment of Cervical Cancer

Advances in Radiation Oncology for the Treatment of Cervical Cancer

Comparison of oncological outcomes in elderly early-stage cervical cancer patients treated with radical surgery or radiotherapy: A real-world retrospective study with propensity score matching

Accumulated Dose Deviation of Rotational and Residual Setup Errors on Nasopharyngeal Carcinoma Using MIM Treated by Helical Tomotherapy

Contact Info

Product

Resources

About