Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer

Abstract

Purpose: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer.Material and methods: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy).Results: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3).Conclusions: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.

High-Dose Rate Salvage Interstitial Brachytherapy: A Case-Based Guide to the Treatment of Therapeutically Challenging Recurrent Vulvar Cancer

“…However, some patients are unable or unwilling to undergo surgery. The blood supply and lymphatic drainage of remaining tissue is compromised following surgery making additional surgical or radiotherapeutic attempts more complex and less successful ( 10 , 12 , 13 ). Patients with central recurrences require more extensive surgery which is associated with high mortality and complication rates as high as 50–75% ( 9 , 14 , 15 ).…”

“…Also, surgical procedures can make radiotherapy attempts more challenging. Patients who previously underwent EBRT are limited with reirradiation due to the proximity of dose-limiting organs such as the bladder or rectum which have likely already accumulated their maximal dose of radiation ( 10 , 12 ). Brachytherapy may play a useful role in these cases where patients require extensive surgery or in cases where surgery is contraindicated or refused.…”

“…Interstitial brachytherapy is an elegant technique delivering high-dose, focal radiotherapy which allows for a maximal radiation dose to be delivered to the tumor with minimal damage to nearby organs at risk. High-dose rate (HDR) interstitial brachytherapy has been used as a salvage treatment, however, only 11 patients have been reported on in the literature ( 10 , 11 ). One study reported on 8 salvage patients with median time to failure of 31 months and progression free survival at 1 and 3 years 100 and 62.5%, respectively.…”

Rationale, indications, techniques and applications of interstitial brachytherapy for carcinoma cervix

“…Locally confined recurrent cases. [6] General Contraindications of Interstitial Brachytherapy 1. Risks for general anesthesia/epidural anesthesia due to medical reasons 2.…”

Patterns of Failures and Clinical Outcome of Patients with Early-Stage, High-Risk, Node-Negative Endometrial Cancer Treated with Surgery Followed by Adjuvant Platinum-Based Chemotherapy and Vaginal Brachytherapy

“…where D is the total dose, d is the dose per fraction, α is the component of linear damage (Gy), β is the component of quadratic damage (Gy) and the α / β ratio is considered 10 for the tumor [31-33]. VBT started within 2–3 weeks from the last cycle of chemotherapy.…”