American Brachytherapy Society recurrent carcinoma of the endometrium task force patterns of care and review of the literature

Kamrava, Mitchell; Beriwal, Sushil; Erickson, Beth; Gaffney, David K.; Jhingran, Anuja; Klopp, Ann H.; Park, Sang June; Viswanathan, Akila N.; Yashar, Catheryn M.; Lin, Lilie L.

doi:10.1016/j.brachy.2017.07.012

Cited by 26 publications

(26 citation statements)

References 52 publications

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“…The HR-CTV concept has not been standardised for vaginal brachytherapy and variations exist in its definition [29]. As such, HR-CTV was defined as per local institutional conventions, consisting mainly of the GTV plus a variable margin to account for areas of high risk for microscopic spread to adjacent vaginal tissue based on clinical suspicion of extension [30]. No attempt was made to treat the entire vagina if not mandated by the volume of HR-CTV in order to limit the target volumes in the salvage and re-irradiation settings.…”

Section: Brachytherapymentioning

confidence: 99%

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

et al. 2020

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Aims: Recurrent gynaecological tumours can cause significant morbidity with limited salvage options. This study investigates the strategy of salvage singlemodality interstitial brachytherapy (SM-ISBT) for recurrent gynaecological pelvic cancer at two specialised ISBT centres. Materials and methods: Patients who had received salvage SM-ISBT for pelvic recurrence of gynaecological cancers from September 2008 to January 2017 were included. None had distant metastasis at the time of recurrence. Local control, progression-free and overall survival and long-term toxicities were evaluated. Results: Twenty-six patients with a median follow-up of 24 months (range 2.5e106.3 months) after SM-ISBT were included. Primary cancer sites were endometrium (20), cervix (4), vulva (1) and vagina (1). All patients had prior whole-pelvic external beam irradiation and 16 had prior brachytherapy. The median disease-free survival prior to SM-ISBT was 20.3 months (interquartile range 9.9e30.5). SM-ISBT was delivered with high dose rate technique over three to six fractions. The median high-risk clinical target volume was 34.6 cm 3 , with a median D90 of 29.1 Gy (range 16.1e64.6). The median bladder, rectum and sigmoid D2cm 3 were 15.5, 18.7 and 3.7 Gy, respectively. After SM-ISBT, complete and partial responses were achieved in 17 (64%) and 5 (19%) patients, respectively. Two (7.4%) patients had grade 3 toxicities (both vaginal stenosis), with no grade 4 complications. Eighteen patients (69%) recurred, including local, regional and metastatic in 14 (54%), 8 (30%) and 5 (19%) patients, respectively. Two-year local control, progression-free survival and overall survival were 50, 38 and 78%, respectively. In follow-up, 12 patients (46%) remained in local control. Conclusions: Salvage SM-ISBT re-irradiation for pelvic recurrence of gynaecological malignancies was feasible and safe. With limited salvage options, the local control obtained in more than a quarter of patients seems reasonable. Further efforts are needed to establish a consensus about the optimal patient selection, dose fractionation, implant technique and combination with systemic therapies.

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Section: Brachytherapymentioning

confidence: 99%

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

et al. 2020

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“…After removing duplicate, not written in English, and off-topic studies, 44 full-length papers were assessed for eligibility criteria. Five review articles were found [17,19,[28][29][30], and their references were crossed-searched for eventual additional studies. In some cases, we found articles combining patients with and without a history of prior radiation therapy.…”

Section: Resultsmentioning

confidence: 99%

Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review

Bockel

Espenel

Sun

et al. 2021

Cancers

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Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for reirradiation in the context of local recurrences from gynecological malignancies. Methods: We conducted a large-scale literature research, and 15 original studies, responding to our research criteria, were finally selected. Results: Local control rates ranged from 44% to 71.4% at 2–5 years, and overall survival rates ranged from 39.5% to 78% at 2–5 years. Grade ≥3 toxicities ranged from 1.7% to 50%, with only one study reporting a grade 5 event. Results in terms of outcome and toxicities were highly variable depending on studies. Several studies suggested that local control could be improved with 2 Gy equivalent doses >40 Gy. Conclusion: IGBT appears to be a feasible alternative to salvage surgery in inoperable patients or patients refusing surgery, with an acceptable outcome for patients who have no other curative therapeutic options, however at a high cost of long-term grade ≥3 toxicities in some studies. We recommend that patients with local recurrence from gynecologic neoplasm occurring in previously irradiated fields should be referred to highly experienced expert centers. Centralization of data and large-scale multicentric international prospective trials are warranted. Efforts should be made to improve local control while limiting the risk of toxicities.

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“…Use of an interstitial applicator at BT showed improved RFS, although statistically not significant, compared with intracavitary approach. Optimal dose delivered at BT (HR-CTV D90 ≥ 75 Gy) [10], age, FIGO stage, LVSI, adjuvant RT, time to recurrence, or site of recurrence were not prognostic (data not shown). Table 4 presents prognostication using MRI characteristics (baseline) and tumor volumes (baseline and pre-BT).…”

Section: Prediction Of Survival Based On Mri Characteristics and Tumomentioning

confidence: 97%

“…Despite a favorable prognosis, approximately 10-20% of early stage ECs will relapse, most loco-regionally [7][8][9]. The recommended treatment for vaginal recurrence is salvage radiation therapy (RT) in the form of external beam RT (EBRT) followed by vaginal brachytherapy (BT), or surgical resection, although there are no randomized prospective studies to guide treatment for these women [10,11]. Diverse outcomes have been reported after salvage RT, with age, FIGO stage at diagnosis, grade, and histology shown to be prognostic for relapse and survival [10,12,13].…”

Section: Introductionmentioning

confidence: 99%

Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy

et al. 2020

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Purpose To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Methods Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2-and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher's exact test, respectively. Results Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1-0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1-0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1-99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Conclusion Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.

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American Brachytherapy Society recurrent carcinoma of the endometrium task force patterns of care and review of the literature

Cited by 26 publications

References 52 publications

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review

Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy

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