Intracavitary Preoperative Brachytherapy Followed By Whertheim-Type Hysterectomy in Localized Cervical Cancer: Clinical Data and Toxicity Results from a Single Institution Experience

Abstract

Materials/Methods: 84 plans in total for 17 patients inserted with the ring and tandem (R&T) applicator only were evaluated. All the plans were computed tomography (CT) based and each patient received 6Gy per fraction with the exception of three patient who had 6.5Gy per fraction for four fractions. Each patient had both CT and magnetic resonance Imaging (MRI) during the second fraction for an improved delineation of clinical target volume (CTV) and organs at risk (OAR) (i.e., bladder, rectum, sigmoid and bowel). In scenario A, FSP was used i.e., dwell positions and times were re-optimized for each fraction. In scenario B, SP was used i.e., the same dwell positions and times were used for all fractions. A comparison of the CTV coverage, international commission on radiological units and measurement (ICRU) points, D 2cc (dose to 2cc volume) and D 1cc (dose to 1cc volume) of OAR was carried out to evaluate the two scenarios. Results: The CTV coverage for FSP ranged from 92.5% to 99.5% while that of SP ranged from 88.3 to 99.9%. Only one patient's CTV coverage using SP was below the 90% minimum coverage limit. The OAR D2cc were marginally higher for SP but most were within the dose constraints. The mean of the ratios of D 2cc FSP/D 2cc SP for the bladder, rectum, sigmoid and bowel are 0.97, 0.97, 0.99 and 0.98 respectively. A similar trend was obtained for the D 1cc FSP/D 1cc SP. Conclusion: This study has shown that there is virtually no difference between SP and FSP when using the R&T applicator. The doses to OAR are comparable and most are within the dose limit and also the minimum dose coverage of the CTV was achieved.

Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results

“…One study using pLDR-BT (Cs-137) showed a pCR of 71.3%, with FIGO IIA patients achieving pCR less frequently [21]. Bataille et al observed that 76% of patients achieved pCR after pPDR-BT, but their study is only available as an abstract [14]. In another study with pPDR-BT, pCR was achieved in 70.1% of cases [9], and in a prospective trial comparing two-dimensional with three-dimensional pPDR-BT, pCR was observed in 55.0% and 63.0% of patients, respectively [13].…”

“…Lymph node status is a major prognostic factor and important issue in selection of appropriate therapy and treatment planning [ 8 , 14 , 18 ]. In IB stage patients, pelvic lymph node metastases are found in up to 17.0%, and in IIA patients in 12-30.0% of cases [ 21 , 29 ].…”

“…It is also associated with high local control and acceptable toxicity [7][8][9][10][11][12][13]. In cases of operable disease, BT is usually administered post-operatively [6,7,13], but in selected patients, it may be performed before surgery [3][4][5][6][7][14][15][16].…”

“…In the pre-operative setting, BT has been reported as an effective method for sterilizing tumor cells in the cervix [ 7 , 14 , 15 , 17 ]. Moreover, it is considered an approach that may decrease the extent of surgery and need for adjuvant pelvic EBRT [ 5 , 11 , 16 , 17 ].…”

Efetividade e custo-efetividade da braquiterapia guiada por imagem 3D versus braquiterapia convencional (2D) em pacientes com câncer do colo uterino

“…Dois estudos incluíram apenas mulheres com doença em estágio inicial. [64][65][66]93 Dois estudos excluíram pacientes com tipo histológico diferente de carcinoma espinocelular. [78][79][80][81] Em sete estudos, a TC e a RM foram usadas para planejar diferentes frações de BT 3D ou para planejar todas as frações para diferentes pacientes no grupo de pacientes tratadas com BT 3D.…”