Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra

Villafranca, E.; Navarrete, Paola; Sola, A.; Muruzábal, Juan Carlos; Aguirre, Sara; Ostiz, S.; Sánchez, Carlos Morales; Guarch, Rosa; Laínez, Núria; Barrado, M.

doi:10.1016/j.rpor.2018.09.006

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…BT is an important form of definitive RT used for treating CC; the modality has evolved from a two-dimensional (2D) planning to a three-dimensional (3D) image-guided BT (IGBT) technique (7). IGBT can be administered using an intracavitary (IC), interstitial (IS), or combined IC/IS approach (8). At our institution, 3D computed tomography (CT) image-based IC/IS for the definitive treatment of CC after EBRT has been used since 2013.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

et al. 2019

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Purpose: To evaluate treatment outcomes and toxicity in patients with cervical cancer (CC) treated with volumetric modulated arc therapy (VMAT), followed by three-dimensional high-dose-rate intracavity combined with interstitial brachytherapy (IC/IS BT) compared with intensity-modulated radiation therapy (IMRT) treatment. Materials and Methods: A total of 398 patients with stage IA–IVB CC treated with definitive radiotherapy with or without chemotherapy were retrospectively analyzed (331 VMAT and 67 IMRT). A total prescription dose of 45–50 Gy was delivered to pelvic field with VMAT/IMRT in 25/28 fractions, with five fractions per week. Every patient further received IC/IS BT for four to six 6.0-Gy fractions. Local control (LC), disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) rates were calculated. Acute hematotoxicity and late toxicity were recorded. Results: The median follow-up period was 25.47 (range, 0.93–58.93) months for the VMAT and 35.07 (4.8–90.37) months for IMRT. The 3-year OS, DFS, LC, and DMFS rate were 80.5, 65.4, 88.7, and 78.1% in VMAT group, and 76.2, 76.4, 83.1, and 86.1% in the IMRT group, respectively. No significant differences were found between VMAT and IMRT groups for OS, DFS, LC, and DMFS rate. However, patients in the VMAT group had lower incidence of chronic enterocolitis complication (26.6 vs. 38.8%, p = 0.004). In addition, a total of 3 (0.9%) patients developed grade 3 chronic cystitis, and 7 (2.1%) patients developed grade 3 or greater chronic enterocolitis in VMAT group. Conclusion: VMAT combined with IC/IS BT can result in satisfactory curative outcomes and low incidences of late radiation enterocolitis and cystitis in CC treatment.

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Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

et al. 2019

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“…Ректовагинальная контрольная точка расположена на уровне пересечения между тандемной и исходной позициями в овоидах или кольце и на 5 мм дорсальнее задней стенки влагалища на оси, перпендикулярной оси тела. Было показано, что доза в ректовагинальной точке коррелирует с вероятностью развития вагинального стеноза [24]. Также индивидуальное планирование помогает снизить риск возникновения ранних лучевых реакций, которые наиболее часто выявляются при проведении БТ: эпителииты слизистой влагалища, циститы, ректиты, энтероколиты [25].…”

Section: оконтуривание органов рискаunclassified

Brachytherapy of Malignant Neoplasms of the Cervix Uteri: Current Status of the Problem (Literature Review)

Zavyalov,

Solodova,

Tyryshkin

et al. 2023

MEDICAL RADIOLOGY AND RADIATION SAFETY

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Purpose: To conduct a search and generalization of literature data to assess the relevance and prospects for the development of brachytherapy in the treatment of cervical cancer. Material and methods: Scientific sources were searched in PubMed / Medline for the following key words: «cervical cancer», «radiotherapy», «brachytherapy». The time horizon covered 2016–2023. Using a time filter, the most relevant and innovative research papers on cervical cancer brachytherapy were selected. Results: Modern radiology provides specialists with a wide range of methods, one of which is brachytherapy (BT). Brachytherapy is a promising direction in the treatment of cervical cancer, however, its use is largely limited and continues to gradually progressively decline around the world. The reasons associated with this are different: the complex technical component of this technique, the high requirements for the training of BT specialists, the high cost of treatment, and others. However, it should be noted that most of the current data demonstrate the high efficacy of BT in the complex therapy of cervical cancer. Therefore, research is ongoing to increase the involvement of BT in the treatment strategy for cervical cancer. Thus, many authors emphasize that the rates of primary complete remission and 5-year cancer-specific survival were significantly higher in patients treated with BT than in those who were treated with EBRT instead of BT (92.5 % versus 73.3 % and 68. 5 % versus 35.4 % respectively). Modern technical developments in the field of BT are also interesting, for example, the use of 3D printing methods. New applicators make it possible to increase the conformity of the conducted BT. The presented methodology also provides an opportunity for better training of specialists in the field of BT. An important aspect of the spread of BT and radiological treatment in general, and along with it the dynamics of the main indicators of survival, is still the socioeconomic factor. Thus, there are direct correlations between the total income of a country and the degree of prevalence of BT in it. Some countries are almost completely deprived of the possibility of using BT methods in health care. In general, brachytherapy is actively developing, opening up new horizons in the treatment of malignant neoplasms of cervical cancer.

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“…Modern HDR-IGABT is a complex medical procedure, which requires resources. HDR-BT for LACC consists of 2-5 fractions, with prescription doses of 3.5-9 Gy [6][7][8][9] delivered intracavitarily, and if needed, also with an interstitial component. Treatment protocols with two or more fractions implemented by a single application on consecutive days may save resources.…”

Section: Purposementioning

confidence: 99%

The impact of different treatment protocols on achieved radiation doses of high-dose-rate brachytherapy for locally advanced cervical cancer: a comparison between 2 fractions in 1 application and separate applications for each fraction

Jääskeläinen¹,

Anttila²,

Palmgren³

et al. 2022

jcb

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Purpose: To compare radiation doses achieved by image-guided brachytherapy for locally advanced cervical carcinoma implemented with two different protocols.Material and methods: Medical records of 117 patients with locally advanced cervical carcinoma treated with brachytherapy from 2009 to 2018 at our institution were retrospectively reviewed. All patients had received previous external beam radio/chemotherapy. We performed magnetic resonance image-guided adaptive high-dose-rate brachytherapy delivered by intra-cavitary/interstitial applicators. Dose prescription was 7 Gy for four fractions within two weeks. Original schedule of brachytherapy was two fractions delivered on consecutive days with one applicator insertion; this process was repeated one week later (group 1, 54 patients). From 2015 onwards, another protocol of brachytherapy was mainly used, separately performing applicator insertions for each of the four administered fractions (group 2, 63 patients).Results: The high-risk clinical target volume (HR-CTV) D 90 planning aim (PA) of ≥ 85 Gy (hard constraint) was not achieved in 9 cases out of 54 (17%) in group 1 compared with only 2 out of 63 cases (3%) in group 2 (p = 0.022). A difference between the two groups was also found in the fulfillment of PA 90 Gy (soft constraint) (p = 0.027). We conducted a sub-group analysis of target volume groups and observed that the differences were most pronounced with very large tumors (> 50 cm 3 ). In these patients, PA 85 Gy was only fulfilled in 67% cases when treatment involved two applications, but in all cases with four separate applicator insertions (p = 0.010).Conclusions: In our experience, by performing an applicator insertion for each of the fractions, it is possible to correct the non-optimal position of the applicator immediately, and to deliver better doses for consecutive fractions. As a result, the planning aim is more often achieved, especially for large tumors.

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Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra

Cited by 6 publications

References 15 publications

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Brachytherapy of Malignant Neoplasms of the Cervix Uteri: Current Status of the Problem (Literature Review)

The impact of different treatment protocols on achieved radiation doses of high-dose-rate brachytherapy for locally advanced cervical cancer: a comparison between 2 fractions in 1 application and separate applications for each fraction

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