Low-Dose Adjuvant Cylinder Brachytherapy for Endometrioid Endometrial Cancer

Alban, Gabriela; Buscariollo, Daniela L.; Cheng, Teresa; Pretz, Jennifer; Krechmer, Betty; Buzurović, Ivan; Singer, Lisa; King, Martin T.; Lee, Larissa

doi:10.1016/j.prro.2019.11.004

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…Briefly, study populations were predominantly white, over 60 years of age, diagnosed with Type I endometrial cancer and had FIGO stage I. Most of studies were conducted in Europe ( n = 20) 12,13,15,18,21,22,27,43–55 and North America ( n = 18) 19,20,23–26,56–67 . The remaining studies were conducted in Asia ( n = 4), 14,68–70 Oceania ( n = 2), 17,71 and South America ( n = 1) 72 .…”

Section: Resultsmentioning

confidence: 99%

“… Note : For studies that did not report endometrial cancer type, Type I was based on grade information (Alban et al 57 and Long et al 61 ) or histology (Celik et al, 50 Güzel et al, 52 Kakkos et al, 53 Martra et al, 16 Matsuo et al, 63 Mauland et al, 21 Munsted et al, 22 and Von Gruenigen et al 26 ). Arem et al 56 and Lindemann et al 18 did not directly report FIGO stage; “local” was considered FIGO Stage I/II, “regional” was considered FIGO Stage III, and “distant” was considered FIGO Stage IV.…”

Section: Resultsmentioning

confidence: 99%

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Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

et al. 2021

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Summary Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta‐analysis was to assess the association between excess body fat with recurrence, cancer‐specific, and all‐cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty‐six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2) was associated with increased all‐cause mortality (HR = 1.34, 95%CI = 1.12–1.59) and recurrence (HR = 1.28, 95%CI = 1.06–1.56). In sub‐group analysis, associations between higher BMI and all‐cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all‐cause mortality among endometrial cancer survivors but not endometrial cancer‐specific mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

et al. 2021

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“…The novel DMBT-VC applicator was modeled in GEANT4 using Boolean operations, to be a 30 mm diameter with 3 mm of TT, a single lumen, polyphenylsulfone (PPSU) plastic solid cylinder, with a density of 1.31 g/cm 3 . The inner central part of the applicator, which includes the lumen of 1.5 mm diameter at the center, was a detachable 8 mm diameter rod made of polyether ether ketone (PEEK) plastic, with a density of 1.30 g/cm 3 .…”

Section: Design Of the Dmbt-vc Applicatormentioning

confidence: 99%

“…However, there are known risk factors that increase the risk of tumor recurrence. Of these recurrences, the primary site is the vaginal cuff 1‐3 …”

Section: Introductionmentioning

confidence: 99%

“…Of these recurrences, the primary site is the vaginal cuff. [1][2][3] In women who meet the Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) or the Gynecological Oncology Group (GOG) trials' highintermediate risk criteria, vaginal brachytherapy has been shown to decrease the risk of recurrence with considerably less radiation toxicity in comparison to pelvic external beam radiotherapy. 2,4,5 Although rates of recurrence after vaginal brachytherapy are very low, there are some limiting factors in the application of vaginal cylinder brachytherapy that can result in underdosage of the target.…”

Section: Introductionmentioning

confidence: 99%

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The design of a novel direction modulated brachytherapy vaginal cylinder applicator for optimizing coverage of the apex

et al. 2022

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High-dose-rate (HDR) vaginal cuff brachytherapy is an effective adjuvant therapy for women with stage I endometrial cancer. Although infrequent, failures do occur, most frequently at the vaginal vault. A potential cause of failure is insufficient dosimetric coverage at the vaginal apex due to cold spots from the anisotropic dose distribution of the source. Here, we propose a novel direction modulated brachytherapy (DMBT)-concept vaginal cylinder (VC) applicator that resolves this dosimetric issue. Methods and materials:The novel DMBT-VC applicator was designed and simulated with the GEANT4 Monte Carlo code. The outer cylinder material chosen was polyphenylsulfone (PPSU) plastic, and the central part was a detachable rod, housing a single lumen made of either polyether ether ketone (PEEK) plastic or an MR-compatible tungsten alloy. The PPSU-based outer cylinder, together with the inner PEEK rod provides the dose distribution of a conventional VC applicator. The PEEK rod is then replaced with an MR-compatible tungsten alloy rod of the same dimensions to generate directional "pencil-like" beams to compensate for the anisotropic cold spots. Two widely used 192 Ir HDR sources, VS2000 and GammaMedPlus, were also simulated. Results:The novel DMBT-VC applicator was able to remove the underdosage at the apex due to the anisotropy effect regardless of the HDR sources without unnecessarily increasing the dose to the periphery of the applicator.Also,further directional modulation to reach deeper in the apex by up to 14 mm beyond the VC surface was achievable, again without increasing the peripheral doses. Total treatment dwell times increased only by 7-13%. Conclusions: The novel DMBT-VC applicator provides improved dose coverage at the vaginal apex by overcoming the classical anisotropy issue ubiquitous to all HDR brachytherapy sources. The next step in development of the device is manufacturing a prototype for clinical testing.

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