Image-Based Brachytherapy for the Treatment of Cervical Cancer

Harkenrider, Matthew M.; Alite, Fiori; Silva, Scott R.; Small, William

doi:10.1016/j.ijrobp.2015.03.010

Cited by 77 publications

(56 citation statements)

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“…Three-dimensional imaging modalities currently in use include computed tomography (CT) scan, and magnetic resonance imaging (MRI). MRI has been shown to be superior to CT in delineating gynecologic tumors and normal pelvic structures (19, 26, 30–31). However, no study has compared clinical outcomes and quality of life indices of MR-based to CT-based ISBT for vaginal recurrence of EC.…”

Section: Introductionmentioning

confidence: 99%

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

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Purpose To compare clinical outcomes of MR-based versus CT-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). Methods We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier (K-M) survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS) and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Results Median follow up was 33 months (CT 30 months, MR 35 months). Median cumulative EQD2 was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p=0.58). MR patients were older (p=0.03) and had larger tumor size (>4cm vs ≤4cm) compared to CT patients (p=0.04). For MR- vs. CT-based ISBT, 3-year KM rate for LC was 100% vs. 78% (p = 0.04), DFI was 69% vs. 55% (p= 0.1), and OS was 63% vs. 75% (p= 0.81), respectively. On multivariate analysis, tumor grade 3 was associated with worse OS (HR 3.57, 95%CI 1.25,11.36) in a model with MR-ISBT (HR=0.56, 95%CI 0.16,1.89). Toxicities were not significantly different between the two modalities. Conclusion Despite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.

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Section: Introductionmentioning

confidence: 99%

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

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“…The American Brachytherapy Society Consensus Guidelines for interstitial brachytherapy for vaginal cancer recommend the use of image-guided BT to optimize dose delivery to the target tissue and minimize dose to the organs at risk [4, 9]. However, there have been no comparative studies to date of clinical outcomes of image-based interstitial brachytherapy (IBBT) for vaginal cancer that assess the advantages of the addition of imaging.…”

Section: Introductionmentioning

confidence: 99%

Outcomes with image-based interstitial brachytherapy for vaginal cancer

Manuel

Cho

Catalano

et al. 2016

Radiotherapy and Oncology

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PURPOSE To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IBBT) for vaginal cancer METHODS AND MATERIALS Of 72 patients with vaginal cancer treated with brachytherapy (BT), 47 had image guidance (CT=31, MRI=16) and 25 did not. Kaplan-Meier (KM) estimates were generated for any recurrence, local control (LC), disease-free interval (DFI), and overall survival (OS) and Cox models were used to assess prognostic factors. RESULTS Median age was 66 and median follow-up time was 24 months. Median cumulative EQD2 dose was 80.8 Gy in the non-IBBT group and 77 Gy in the IBBT group. For non-IBBT versus IBBT, the 2-year KM LC was 71% vs. 93% (p=0.03); DFI was 54% vs. 86% (p=0.04); and OS 52% vs. 82% (p=0.35). On multivariate analysis, IBBT was associated with better DFI (HR 0.24, 95% CI 0.07–0.73). Having any 2 or more of chemotherapy, high-dose-rate (HDR) BT or IBBT (temporally correlated variables) significantly reduced risk of relapse (HR=0.33, 95% CI= 0.13–0.83), compared to having none of these factors. CONCLUSION Over time, the use of chemotherapy, HDR and IBBT has increased in vaginal cancer. The combination of these factors resulted in the highest rates of disease control. Image-guided brachytherapy for vaginal cancer patients maximizes disease control.

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“…4,14 Interstitial BT with the insertion of needles resulted in an optimized dose for large tumors, parametrial extension, or unfavorable topography; therefore, it is a more efficient technique. 18 The 2 classic perineal template IS applicators are the Syed-Neblett butterfly template and Martinez Universal Perineal Template. 14,19 Although perineal templates can ensure a high dose to lateral parametrial extension, the dose to the fundus and cervical central tumors, which is achieved mainly by intrauterine tandem, may be insufficient.…”

Section: Discussionmentioning

confidence: 99%

“…25 However, our results were significantly higher than those of the other 2 studies, in which a mean number of 2.7 (range, 1Y6) and 3.5 (range, 1Y8) needles were used for IC/IS applicators, respectively. 18,30 It is especially important to determine the number and position of free needles. Generally, according to our clinical experience, 5 to 9 needles are suitable, and most needles in this study were distributed in the lateral 2-to 5-and 7-to 10-o'clock uterine canal positions, usually in the region of the cervix and parametrial extension.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

Guo

Zhao

Xia

et al. 2017

Int J Gynecol Cancer

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ObjectiveWe present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.Materials/MethodsInterstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT.ResultsThe mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications.ConclusionsThe IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.

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Image-Based Brachytherapy for the Treatment of Cervical Cancer

Cited by 77 publications

References 78 publications

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

Outcomes with image-based interstitial brachytherapy for vaginal cancer

Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

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