Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

Abstract

The Vienna and Venezia (Elekta) are hybrid intracavitary/interstitial brachytherapy (BT) applicators for cervical cancers unsuitable for intracavitary BT alone to improve target coverage or reduce critical organ dose. There is limited outcome data with the use of these applicators outside published experience of the EMBRACE group. We report feasibility and early outcomes with the use of these hybrid applicators at our institution. METHODS AND MATERIALS: Hybrid applicators were used to treat 61 patients with cervical cancer from November 2011 to December 2019. Indications for hybrid applicator use were involvement of the vagina in 10 patients (16%), residual central or parametrial disease in 46 patients (75%), and a narrow introitus in 5 patients (9%). Toxicities were graded using the CTCAE v4.0. Outcomes were assessed with the KaplaneMeier method. RESULTS: Median follow-up was 16 months (IQR 9e32 mos). Median HRCTV volume was 31.6 cm 3 (IQR 25e48 cm 3 ). Median HRCTV D90 was 86.1 Gy (IQR 84.3e88.0 Gy). In 54 patients with follow-up PET/CT at 3 months, complete initial imaging response locally was seen in 46 patients.Estimated 12-month KaplaneMeier overall survival, locoregional control, distant control, and recurrence-free survival estimates were 86.9%, 80.6%, 73.8%, and 65.9%, respectively. The 12month incidence of Grade 3þ GI/GU chronic toxicities was 5.7%, consisting of vesicovaginal fistula, rectovaginal fistula, and ureterovesical fistula. CONCLUSIONS: Our single-institution data support the use of the hybrid applicators, as an alternative to traditional BT applicators when clinically warranted. Use of hybrid applicators is feasible with adequate coverage of disease in the vagina and parametrium.

Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

“…Only 1 patient (1%) showed HR-CTV D 90 lower than 80 Gy, due to the large volume of initial HR-CTV (93.08 cm 3 ). Compared with traditional IC brachytherapy alone, interstitial technique is more feasible with adequate coverage of disease in the vagina and parametrium ( 40 ).…”

Image-guided brachytherapy in cervical cancer including fractionation

“…In parallel to imaging development as a guidance tool for brachytherapy, different types of MRI and CT compatible applicators were developed. These allow insertion of the needles to cover the parametrial infiltration to the pelvic wall and vaginal involvement 32–35. In some cases, free or trans-perineal application of needles could be required (Figure 2).…”

“…These events were classified as arterial in six patients and were seen mainly with a large diameter ring (30 or 34 mm), venous in 12 patients, and arterial bleeding due to myoma rupture occurred in one patient. In a different cohort of 61 patients including all stages of locally advanced cervical cancer who were treated by means of a hybrid applicator (Venezia), significant bleeding also occurred after removal of the applicator, but only in four of 241 applications 35. This low rate may be due to improved ease of insertion/removal of the split ring design of the Venezia applicator compared with the standard ring.…”

Effect of applicator removal from target volume for cervical cancer patients treated with Venezia high-dose-rate brachytherapy applicator

“…The Venezia applicator (Elekta, Sweden) can improve lower vaginal and lateral parametrium dose coverages for patients with locally advanced cervical cancer [ 6 - 12 ]. Walter et al .…”