Image-guided adaptive brachytherapy in primary vaginal cancers: A monocentric experience

Huertas, Alice; Dumas, Isabelle; Escande, Alexandre; Campo, Eleonor Rivin del; Felefly, Tony; Canova, C.-H.; Tailleur, Aurélie; Gouy, Sébastien; Bentivegna, Enrica; Morice, Philippe; Haie-Méder, Christine; Chargari, Cyrus; Mazeron, R.

doi:10.1016/j.brachy.2018.01.005

Cited by 18 publications

(11 citation statements)

References 37 publications

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“…The most common treatment options for primary vaginal carcinoma are surgical resection, radiotherapy (including brachytherapy), and chemotherapy (5)(6)(7)(8)(9)(10)(11). However, the rarity of vaginal carcinoma makes it challenging to assess the efficacy of different treatment options applied to primary vaginal carcinoma patients.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

Zhou

Yue

2020

Front. Oncol.

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BackgroundThe efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort.MethodsWe performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan–Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied.ResultsOf the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62–0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63–0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69–0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69–0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT.ConclusionRTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.

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Section: Introductionmentioning

confidence: 99%

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

Zhou

Yue

2020

Front. Oncol.

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“…Furthermore, it is also unclear whether improved DVH parameters by selected brachytherapy according to vaginal tumor thickness make better tumor control or not. 9 – 11 In the ABS consensus guideline, IBT is recommended for bulky vaginal cancers thicker than 5 mm. 4 The present study evaluated the clinical outcomes for cervical cancer patients who required irradiation of the entire vagina.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Evaluation of American Brachytherapy Society Consensus Guideline for Bulky Vaginal Mass in Gynecological Cancer

Murofushi

Kitamura

Yoshioka

et al. 2018

Int J Gynecol Cancer

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ObjectivesAmerican Brachytherapy Society (ABS)-recommended interstitial brachytherapy (IBT) should be considered for bulky vaginal tumor thicker than 5 mm. The aim of this study was to evaluate the ABS consensus guideline for patients with severe vaginal invasion based on our long-term follow-up results.Methods/MaterialsThe study included 7 patients with vaginal cancer and 14 patients with cervical cancer invading to the lower vagina. Based on prebrachytherapy magnetic resonance imaging findings, patients received intracavitary brachytherapy (ICT) for vaginal tumors 5 mm or less or IBT for vaginal tumors less than 5 mm. Nine patients received ICT and the remaining 12 patients received IBT. For dosimetric comparison, an experimental recalculation as the virtual IBT for patients actually treated by ICT, and vice versa, was performed.ResultsThe 5-year local control rate for all tumors was 89.4%. No differences in local control between ICT- and IBT-treated groups were observed (P = 0.21). One patient experienced a grade 3 rectal complication. There were no significant differences in the CTV D90 and rectum D2cc between the 2 groups (P = 0.13 and 0.39, respectively). In the dosimetric study of ICT-treated patients, neither the actual ICT plans nor the experimental IBT plans exceeded the limited dose for organs at risk, which were recommended in the guideline published from the ABS. In the IBT-treated patients, D2cc for bladder and rectum of the experimental ICT plans was significantly higher than for the actual IBT plans (P < 0.001 and <0.001, respectively), and 11 experimental ICT plans (92%) exceeded the limited dose for bladder and/or rectum D2cc.ConclusionsTumor control and toxicity after selected brachytherapy according to vaginal tumor thickness were satisfactory; IBT instead of ICT is recommended for patients with vaginal tumor thickness greater than 5 mm to maintain bladder and/or rectum D2cc.

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“…A study using data from the National Cancer Database showed improved survival with the inclusion of brachytherapy for treatment of vaginal cancer 45. A few small, single institution studies have shown encouraging results for treating primary vaginal cancer with image-guided adaptive brachytherapy by applying cervix-based Groupe Européen de Curiethérapie and European Society for Radiotherapy & Oncology recommendations 46–49 Figure 6. shows example pre-external beam radiation, pre-brachytherapy, and 3 month post-treatment PET and MRI images for a patient with vaginal cancer.…”

Section: Vaginal Cancermentioning

confidence: 99%

Imaging to optimize gynecological radiation oncology

Kidd

2022

Int J Gynecol Cancer

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Gynecological cancers have particularly benefited from the increasing use of imaging to guide radiation treatment planning for both external beam radiation and brachytherapy. While the different gynecological cancers have varying use of imaging, certain trends predominate. CT represents an economical choice for evaluating initial disease extent or potential metastasis at follow-up, particularly for endometrial and ovarian cancers. F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is particularly useful for assessing the initial disease extent and longer term treatment response of squamous predominant cancers, including cervical, vaginal, and vulvar cancers. With its excellent pelvic soft tissue discrimination, MRI provides the greatest assistance in evaluating the local extent of gynecological tumors, including initial evaluation for non-operative endometrial and vulvar cancer, and assessment before, after and during brachytherapy for cervix, locally recurrent endometrial, and primary vaginal cancers. With more limited availability of MRI, ultrasound can also help guide brachytherapy, particularly during procedures. The benefits of using imaging to better spare bone marrow or earlier assessment of treatment response are topics still being explored, in particular for cervical cancer. As imaging along with radiation oncology technologies continue to evolve and develop, such as with MRI-linacs and ultra high dose rate (FLASH) radiation, we may continue to see increasing use of imaging for advancing gynecological radiation oncology.

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Image-guided adaptive brachytherapy in primary vaginal cancers: A monocentric experience

Cited by 18 publications

References 37 publications

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

A Clinical Evaluation of American Brachytherapy Society Consensus Guideline for Bulky Vaginal Mass in Gynecological Cancer

Imaging to optimize gynecological radiation oncology

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