Clinical outcome of combined intracavitary / interstitial brachytherapy using a hybrid applicator in locally advanced cervical cancer

Rogowski, Paul; Rottler, Maya; Walter, Franziska; Saicic, Stefan; Niyazi, Maximilian; Well, Justus; Nierer, Lukas; Trillsch, Fabian; Burges, Alexander; Mahner, Sven; Belka, Claus; Corradini, Stefanie

doi:10.1016/j.ygyno.2022.06.019

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…our series are comparable to existing literature on IC/IS brachytherapy (Table 4) [13,[15][16][17][18][19][20][21][22]. Other mono-institutional studies have demonstrated similar promising data regarding oncologic outcomes of brachytherapy with hybrid applicators [16,17,23,24]. Rivera et al published their experience of hybrid tandem and ovoids with Utrecht applicator in 71 patients treated between 2010 and 2017 [19].…”

supporting

confidence: 86%

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Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

Sommat,

Yap,

Chert Yeo

et al. 2023

jcb

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Purpose To report outcomes of using image-guided hybrid intra-cavitary/interstitial applicators under moderate sedation for locally advanced cervical cancer patients in our institution. Material and methods A total of 69 fractions of brachytherapy with hybrid applicators were performed in 33 patients from January 2017 to April 2021. All patients underwent MRI pelvis 1 week pre-brachytherapy to determine suitability for interstitial brachytherapy and pre-plan needle placement. All insertion of applicators were performed under moderate sedation with midazolam and/or fentanyl. Fifty-eight (84.1%) fractions were planned with CT alone. Clinical outcomes, dose volume parameters, and toxicities were analyzed. Results The median follow-up was 28 months. A total of 320 needles (median, 5 needles per fraction) were implanted, with a median insertion depth of 3 cm (range, 1.5-4 cm). The median high-risk clinical target volume (HR-CTV) during initial brachytherapy was 34.5 cc (range, 17.8-74.7 cc). The median total EQD 2 D 2cc of the rectum, bladder, sigmoid, and small intestine colon was 71.8 Gy, 81.5 Gy, 69 Gy, and 58.3 Gy, respectively. The 2-year local control and overall survival were 80.7% and 77.7%, respectively. Larger volume HR-CTV was significantly associated with worse local control (HR = 1.08, p = 0.005) and overall survival (HR = 1.04, p = 0.015). None of the patients required in-patient admission or blood transfusion post-procedure. Late grade 3 gastrointestinal and genitourinary toxicities were observed in 4 patients (12.2%). Conclusions Hybrid applicators inserted under moderate sedation are feasible and safe. Image-guided interstitial brachytherapy with CT planning aided by MRI performed 1 week pre-brachytherapy is associated with favorable outcomes and modest toxicities.

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supporting

confidence: 86%

“…Other mono-institutional studies have demonstrated similar promising data regarding oncologic outcomes of brachytherapy with hybrid applicators [ 16 , 17 , 23 , 24 ]. Rivera et al .…”

Section: Discussionmentioning

confidence: 72%

Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

Sommat,

Yap,

Chert Yeo

et al. 2023

jcb

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“…In their series, they implanted a median of seven [3][4][5][6][7][8][9][10][11][12][13][14][15] needles with four oblique needles [1][2][3][4][5][6][7]. Rogowski et al (20) published their series of 44 patients treated consecutively for LACC by RCT and IC/IS IGABT with the Venezia applicator. They showed that the D90 HR-CTV of 92.3 Gy EQD2 (72.2-100.8) with D 2cc EQD2 for the bladder, rectum, sigmoid, and bowel were 74.8 Gy (58.6-89.7), 57.9 Gy (49.6-72.4), 60.0 Gy (47.2-75.0), and 52.4 Gy (44.1-72.1), respectively.…”

Section: Discussionmentioning

confidence: 99%

Interstitial needles versus intracavitary applicators only for locally advanced cervical cancer: results from real-life dosimetric comparisons

Cordoba,

Gesta,

Escande

et al. 2024

Front. Oncol.

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Background and purposeImage-guided adapted brachytherapy (IGABT) is superior to other radiotherapy techniques in the treatment of locally advanced cervical cancer (LACC). We aimed to investigate the benefit of interstitial needles (IN) for a combined intracavitary/interstitial (IC/IS) approach using IGABT over the intracavitary approach (IC) alone in patients with LACC after concomitant external beam radiotherapy (EBRT) and chemotherapy.Materials and methodsWe included consecutive patients with LACC who were treated with IC/IS IGABT after radiochemotherapy (RCT) in our retrospective, observational study. Dosimetric gain and sparing of organs at risk (OAR) were investigated by comparing the IC/IS IGABT plan with a simulated plan without needle use (IC IGABT plan) and the impact of other clinical factors on the benefit of IC/IS IGABT.ResultsNinety-nine patients were analyzed, with a mean EBRT dose of 45.5 ± 1.7 Gy; 97 patients received concurrent chemotherapy. A significant increase in median D90% High Risk Clinical target volume (HR-CTV) was found for IC/IS (82.8 Gy) vs IC (76.2 Gy) (p < 10-4). A significant decrease of the delivered dose for all OAR was found for IC/IS vs IC for median D2cc to the bladder (77.2 Gy), rectum (68 Gy), sigmoid (53.2 Gy), and small bowel (47 Gy) (all p < 10-4).ConclusionHR-CTV coverage was higher with IC/IS IGABT than with IC IGABT, with lower doses to the OAR in patients managed for LACC after RCT. Interstitial brachytherapy in the management of LACC after radiotherapy provides better coverage of the target volumes, this could contribute to better local control and improved survival of patients.

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“…Several studies have reported favorable clinical outcomes using hybrid brachytherapy, suggesting its potential as a therapeutic modality for locally advanced cervical cancer [ 7 , 8 ]. Novel hybrid applicators for combined intracavitary and interstitial brachytherapy have also become available and their usefulness confirmed, suggesting that hybrid brachytherapy will become increasingly popular [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Are prophylactic antibiotics required for combined intracavitary and interstitial brachytherapy of gynecologic cancers?

Kumazawa,

Ohkubo,

Mochida

et al. 2024

Journal of Radiation Research

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The purpose of this study is to evaluate the need for prophylactic antibiotic treatment prior to combined intracavitary and interstitial (hybrid) brachytherapy for gynecologic cancer. A total of 105 gynecologic cancer patients received 405 brachytherapy sessions, including 302 sessions of intracavitary brachytherapy and 103 sessions of hybrid brachytherapy. Prophylactic antibiotics were administered before 35% of the hybrid brachytherapy sessions. The incidence of postbrachytherapy fever and the frequency of subsequent antibiotic use for infection were compared between treatment groups. Among patients treated with hybrid brachytherapy, fever ≥37.5°C occurred in 16.4% of those not receiving prophylactic antibiotics and 16.7% of those receiving prophylactic antibiotics (P > 0.05). Similarly, fever ≥38.0°C occurred in 4.9% of patients not receiving prophylactic antibiotics and 2.4% of those receiving prophylactic antibiotics (P > 0.05). Additional antibiotics were used to treat postbrachytherapy infections in 4.8% of the group receiving prophylactic antibiotics and 0% of those not receiving prophylactic antibiotics, again without statistically significant difference. There were also no significant differences in posttreatment fever incidence and antibiotics use for infection between intracavitary brachytherapy and hybrid brachytherapy sessions. In conclusion, the incidences of infection and fever are low following hybrid brachytherapy, so prophylactic antibiotics are generally unnecessary.

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Clinical outcome of combined intracavitary / interstitial brachytherapy using a hybrid applicator in locally advanced cervical cancer

Cited by 9 publications

References 28 publications

Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

Interstitial needles versus intracavitary applicators only for locally advanced cervical cancer: results from real-life dosimetric comparisons

Are prophylactic antibiotics required for combined intracavitary and interstitial brachytherapy of gynecologic cancers?

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