Combined Interstitial and Intracavitary High-Dose Rate Brachytherapy of Cervical Cancer

Itami, Jun; Murakami, Naoya; Watanabe, Miho; Sekii, Shuhei; Kasamatsu, Takahiro; Kato, Shingo; Hirowatari, Hisako; Ikushima, Hitoshi; Ando, Ken; Ohno, Tatsuya; Okamoto, Hiroyuki; Okuma, Kae; Igaki, Hiroshi

doi:10.3389/fonc.2021.809825

“…The chemotherapy was administered at 3week intervals for 2 cycles, during which symptomatic treatments such as hydration and antiemetic were routinely used. The 3D-afterloading intracavitary radiation therapy with 5.5-6 Gy each time was performed twice and completed within 1 week [16]. Radical hysterectomy and pelvic lymph node dissection was performed 2 weeks after adjuvant therapy.…”

Section: Methodsmentioning

confidence: 99%

A Retrospective Study of Chemotherapy and 3D-Image-Guided Afterloading Intracavitary Radiotherapy in Locally Advanced Cervical Cancer

Li

¹

,

An

²

,

Feng

³

et al. 2022

Journal of Oncology

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Aim. To investigate the value of neoadjuvant chemotherapy combined with 3D-image-guided afterloading intracavitary radiotherapy in locally advanced cervical cancer (LACC). Methods. Patients with cervical cancer admitted to our hospital from January 1, 2020 to January 1, 2021 were retrieved and analyzed. Cases treated with neoadjuvant chemotherapy and 3D-image-guided afterloading intracavitary radiotherapy were assigned into the observation group (OG), while cases with neoadjuvant chemotherapy alone were assigned into the control group (CG). The short-term effects were determined by RECIST 1.1. Total effective rate TR = complete remission CR + partial remission PR . The serum levels of squamous epithelial cell carcinoma antigen (SCC-Ag), glycoantigen 125 (CA125), carcinoembryonic antigen (CEA), and vascular endothelial growth factor (VEGF) were assessed. In view of the difference between tumor markers and diameters before and after treatment, the correlation between them was analyzed by Pearson test. The adverse events were compared, and the amount of operative bleeding and operation time were evaluated. Cox regression analysis was conducted to assess the influencing factors of 1-year disease-free survival time. Results. Sixty-seven patients were retrieved, including 30 cases in the OG and 37 cases in the CG. There were no significant differences in age, pathological type, tumor size, FIGO stage, past medical history, or smoking history between the two groups ( P > 0.05 ). The TR of patients in the OG was higher than that in the CG ( P < 0.05 ). The SCC-Ag, CA125, CEA, and VEGF levels in the OG decreased markedly after treatment ( P < 0.001 ). The difference in SCC-Ag, CA125, CEA, and VEGF was positively correlated with the difference in tumor diameter before and after treatment ( P < 0.05 ). The incidence of adverse events revealed no obvious difference between the OG and CG ( P > 0.05 ). Cox regression analysis showed that FIGO stage and treatment regimens were independent prognostic factors for 1-year disease-free survival ( P < 0.05 ). Conclusion. Neoadjuvant chemotherapy combined with 3D-image-guided afterloading intracavitary radiotherapy can improve the TR rate and 1-year disease-free survival of LACC patients without increasing the incidence of adverse events.

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The current state and future perspectives of radiotherapy for cervical cancer

Yamada,

Kawamura,

Oie

et al. 2024

J of Obstet and Gynaecol

0

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Radiotherapy is an effective treatment method for cervical cancer and is typically administered as external beam radiotherapy followed by intracavitary brachytherapy. In Japan, center shielding is used in external beam radiotherapy to shorten treatment time and reduce the doses delivered to the rectum or bladder. However, it has several challenges, such as uncertainties in calculating the cumulative dose. Recently, external beam radiotherapy has been increasingly performed with intensity‐modulated radiotherapy, which reduces doses to the rectum or bladder without center shielding. In highly conformal radiotherapy, uncertainties in treatment delivery, such as inter‐fractional anatomical structure movements, affect treatment outcomes; therefore, image‐guided radiotherapy is essential for appropriate and safe performance. Regarding intracavitary brachytherapy, the use of magnetic resonance imaging‐based image‐guided adaptive brachytherapy is becoming increasingly widespread because it allows dose escalation to the tumor and accurately evaluates the dose delivered to the surrounding normal organs. According to current evidence, a minimal dose of D90% of the high‐risk clinical target volume is significantly relevant to local control. Further improvements in target coverage have been achieved with combined interstitial and intracavity brachytherapy for massive tumors with extensive parametrical involvement. Introducing artificial intelligence will enable faster and more accurate generation of brachytherapy plans. Charged‐particle therapies have biological and dosimetric advantages, and current evidence has proven their effectiveness and safety in cervical cancer treatment. Recently, radiotherapy‐related technologies have advanced dramatically. This review provides an overview of technological innovations and future perspectives in radiotherapy for cervical cancer.

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Salvage radiotherapy for locally recurrent cervical and endometrial carcinoma: clinical outcomes and toxicities

Cong,

Yang,

Li

et al. 2024

BMC Cancer

0

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Background The management of locally recurrent gynecological carcinoma remains a challenge due to the limited availability of data. This study aims to share our institutional experience in using definitive radiotherapy (RT) for the treatment of locally recurrent cervical and endometrial carcinoma. Methods The study retrospectively reviewed 20 patients in our hospital completing salvage 3D image-based HDR brachytherapy, with or without EBRT, for locally recurrent cervical and endometrial carcinoma after surgery. The Kaplan–Meier method was applied to estimate the disease-free survival (DFS) and overall survival (OS). The toxicities were assessed by CTCAEv5. Results During a median observation period of 21 months, the study reported a tumor objective response rate of 95%. The 3-year DFS and OS rates were 89.4% and 90.9%, respectively. The EBRT combined with brachytherapy achieved a median cumulative dose of 88 Gy to CTV D90. 14 patients received concurrent and/or systemic chemotherapy. Two patients suffered locoregional recurrence after salvage treatment, one of whom only received salvage brachytherapy for prior RT history. The analysis identified significant predictors for DFS, including tumor histology and FIGO stage. 5 patients observed acute grade 1–2 rectal (15%) or genitourinary (10%) toxicities. Late toxicities including grade 1–2 rectal bleeding (10%) and grade 2 pelvic fracture (5%) were seen in 3 patients. Conclusions 3D image-guided brachytherapy combined with EBRT shows effective tumor control and acceptable toxicity profile for women with locally recurrent gynecologic cancer. The success in managing vaginal recurrence is notably influenced by histologic subtype and FIGO staging.

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Combined Interstitial and Intracavitary High-Dose Rate Brachytherapy of Cervical Cancer

Cited by 4 publications

References 23 publications

A Retrospective Study of Chemotherapy and 3D-Image-Guided Afterloading Intracavitary Radiotherapy in Locally Advanced Cervical Cancer

A Retrospective Study of Chemotherapy and 3D-Image-Guided Afterloading Intracavitary Radiotherapy in Locally Advanced Cervical Cancer

The current state and future perspectives of radiotherapy for cervical cancer

Salvage radiotherapy for locally recurrent cervical and endometrial carcinoma: clinical outcomes and toxicities

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