Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: A randomized study of two dose-per-fraction levels

Sorbe, Bengt; Straumits, A; Karlsson, Leif

doi:10.1016/j.ijrobp.2004.12.079

Cited by 91 publications

(73 citation statements)

References 18 publications

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“…Other trials showed that brachytherapy did not improve overall survival or recurrence in comparison with observation alone and was associated with significantly more toxicities, including vaginal, urogenital, and gastrointestinal adverse effects (15,16). Based on these results, observation following surgery was recommended for the majority of patients with low-risk endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

İnan¹,

Ersoy²,

Yıldırım³

et al. 2015

J Turkish German Gynecol Assoc

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Conclusion:In the presented study, adjuvant radiotherapy failed to improve the overall survival of the patients in the low-risk group (stage 1a grade 2). With the addition of the significant risk of radiation toxicity, it is highly probable that these patients will not benefit from postoperative radiotherapy. Close observation should be performed following the primary surgery in this patient group. Nevertheless, it should also be considered that adjuvant radiotherapy is a very effective treatment modality for the recovery of patients with vaginal relapse. (J Turk Ger Gynecol Assoc 2015; 16: 153-

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Section: Discussionmentioning

confidence: 99%

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

İnan¹,

Ersoy²,

Yıldırım³

et al. 2015

J Turkish German Gynecol Assoc

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“…8.8 Gy at surface beam spatially fractionated grid radiotherapy, 25 although on the other hand it may also risk possible vaginal side effects 3,23 such as vaginal stenosis, since the applicator tip can receive a high dose.…”

Section: Gy At 5 MM Depthmentioning

confidence: 99%

Therapeutic analysis of high-dose-rate ¹⁹² Ir vaginal cuff brachytherapy for endometrial cancer using a cylindrical target volume model and varied cancer cell distributions

et al. 2015

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Purpose: To evaluate high-dose-rate (HDR) vaginal cuff brachytherapy (VCBT) in the treatment of endometrial cancer in a cylindrical target volume with either a varied or a constant cancer cell distributions using the linear quadratic (LQ) model. Methods: A Monte Carlo (MC) technique was used to calculate the 3D dose distribution of HDR VCBT over a variety of cylinder diameters and treatment lengths. A treatment planning system (TPS) was used to make plans for the various cylinder diameters, treatment lengths, and prescriptions using the clinical protocol. The dwell times obtained from the TPS were fed into MC. The LQ model was used to evaluate the therapeutic outcome of two brachytherapy regimens prescribed either at 0.5 cm depth (5.5 Gy × 4 fractions) or at the vaginal mucosal surface (8.8 Gy × 4 fractions) for the treatment of endometrial cancer. An experimentally determined endometrial cancer cell distribution, which showed a varied and resembled a half-Gaussian distribution, was used in radiobiology modeling. The equivalent uniform dose (EUD) to cancer cells was calculated for each treatment scenario. The therapeutic ratio (TR) was defined by comparing VCBT with a uniform dose radiotherapy plan in term of normal cell survival at the same level of cancer cell killing. Calculations of clinical impact were run twice assuming two different types of cancer cell density distributions in the cylindrical target volume: (1) a half-Gaussian or (2) a uniform distribution. Results: EUDs were weakly dependent on cylinder size, treatment length, and the prescription depth, but strongly dependent on the cancer cell distribution. TRs were strongly dependent on the cylinder size, treatment length, types of the cancer cell distributions, and the sensitivity of normal tissue. With a half-Gaussian distribution of cancer cells which populated at the vaginal mucosa the most, the EUDs were between 6.9 Gy × 4 and 7.8 Gy × 4, the TRs were in the range from (5.0) 4 to (13.4) 4 for the radiosensitive normal tissue depending on the cylinder size, treatment lengths, prescription depth, and dose as well. However, for a uniform cancer cell distribution, the EUDs were between 6.3 Gy × 4 and 7.1 Gy × 4, and the TRs were found to be between (1.4) 4 and (1.7) 4 . For the uniformly interspersed cancer and radio-resistant normal cells, the TRs were less than 1. The two VCBT prescription regimens were found to be equivalent in terms of EUDs and TRs. Conclusions: HDR VCBT strongly favors cylindrical target volume with the cancer cell distribution following its dosimetric trend. Assuming a half-Gaussian distribution of cancer cells, the HDR VCBT provides a considerable radiobiological advantage over the external beam radiotherapy (EBRT) in terms of sparing more normal tissues while maintaining the same level of cancer cell killing. But for the uniform cancer cell distribution and radio-resistant normal tissue, the radiobiology outcome of the HDR VCBT does not show an advantage over the EBRT. This study strongly suggests that radiation therapy desi...

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“…Applying inverse square law calculations and assuming use of a 3 cm diameter applicator, the vaginal surface would receive 30.2 Gy, translating to an equivalent dose at 2 Gy per fraction (EQD 2 ) of 79.2 Gy. Numerous fractionation regimens have been proposed with some data suggesting a positive correlation with dose per fraction and vaginal toxicity risk [5,[34][35][36][37]. In a randomized trial of two HDR fractionation schemes, compared to 5.0 Gy 9 6 prescribed to 5 mm depth, a lower dose per fraction regimen (2.5 Gy 9 6) led to no difference in vaginal relapse rates and lesser vaginal shortening (mean reduction 0.3 vs. 2.1 cm) [35].…”

Section: Advances In Technique: Vaginal Cuff Brachytherapymentioning

confidence: 99%

Current Concepts in Radiation Therapy for Early-Stage Endometrial Cancer

Gill

Minkoff

Beriwal

2015

Indian J Gynecol Oncolog

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Purpose The present article aims to review current management for early-stage endometrioid carcinomas with a specific focus on adjuvant radiotherapy. Methods A comprehensive literature review was conducted regarding management of early-stage endometrioidtype endometrial cancers. Abstracted information included risk of relapse, treatment approach, and morbidity from treatment. Results A majority of low-risk patients are safely managed with observation, with vaginal cuff brachytherapy (VCBT) reserved for those with multiple other risk factors. Intermediate-risk patients are a heterogeneous group with a variable definition; previous trials have established that VCBT alone is suitable for most patients to avoid morbidity of pelvic external beam radiotherapy (EBRT). Highand high-intermediate risk patients warrant pelvic EBRT ± VCBT with or without sequential chemotherapy. Continued controversy exists regarding the optimal VCBT fractionation regimen, with suggestion that higher dose/ fraction regimens may lead to increased vaginal toxicity. Intensity-modulated radiotherapy is being investigated in an effort to reduce late toxicities. Advanced brachytherapy techniques such as image-guided brachytherapy have improved treatment of salvage and medically inoperable patients.Conclusions Identification of risk groups and toxicity reduction through either appropriate radiotherapy techniques or advanced techniques has enabled optimization of adjuvant management for early-stage endometrial cancer.

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Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: A randomized study of two dose-per-fraction levels

Cited by 91 publications

References 18 publications

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

Therapeutic analysis of high-dose-rate ¹⁹² Ir vaginal cuff brachytherapy for endometrial cancer using a cylindrical target volume model and varied cancer cell distributions

Current Concepts in Radiation Therapy for Early-Stage Endometrial Cancer

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Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: A randomized study of two dose-per-fraction levels

Cited by 91 publications

References 18 publications

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

Is adjuvant radiotherapy necessary for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma?

Therapeutic analysis of high-dose-rate 192 Ir vaginal cuff brachytherapy for endometrial cancer using a cylindrical target volume model and varied cancer cell distributions

Current Concepts in Radiation Therapy for Early-Stage Endometrial Cancer

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Therapeutic analysis of high-dose-rate ¹⁹² Ir vaginal cuff brachytherapy for endometrial cancer using a cylindrical target volume model and varied cancer cell distributions