Magnetic Resonance Image Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer: An Experience From a Tertiary Cancer Center in a Low and Middle Income Countries Setting

Liu

et al. 2020

Preprint

Abstract Purpose The purpose of the present study was to evaluate the role of the pre-treatment metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in patients with locally advanced cervical cancer (LACC) treated with definitive concurrent chemoradiotherapy (CCRT) or radiotherapy. Methods Patients with LACC who underwent pre-treatment 18F-FDG PET/CT examination and definitive CCRT or radiotherapy between February 2010 and December 2015 in our institute were enrolled. For each patient, the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) of the primary tumour were measured. The survival outcomes were calculated with the Kaplan-Meier method. Cox proportional hazards models were used for univariate and multivariate analyses. Results A total of 125 patients were finally included in this study. The median follow-up duration was 62 months (range, 4-114 months). The 5-year overall survival (OS), disease-free survival (DFS), local control (LC) and distant metastasis-free survival (DMFS) rates were 83.6%, 75.1%, 92.3% and 79.9%, respectively. Univariate analysis indicated that MTV ≥ 18.3 cm3 showed worse OS and DMFS; however, no significant differences were identified for OS and DMFS in multivariate analyses. TLG ≥ 113.4 implied worse DFS and DMFS. In multivariate analysis, TLG ≥ 113.4 was an independent predictive factor for OS, DFS and DMFS. SUVmax and SUVmean had no significant influence on OS, DFS, LC or DMFS in either univariate or multivariate analysis. Conclusion Pre-treatment TLG ≥ 113.4 was associated with a high incidence of disease recurrence and poor OS in patients with LACC.

Section: Discussionsupporting

confidence: 69%

The role of the metabolic parameters of pre-treatment 18F-FDG PET/CT in patients with locally advanced cervical cancer

Liu

et al. 2020

Preprint

Clinical and Translational Radiation Oncology

“…The excellent outcome of IGABT has been demonstrated in several mono-institutional reports as well as in the RetroEMBRACE study [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . The 3-year local and pelvic control rates reached 98–100% and 96%, respectively, for FIGO stage IB1 and IB2 disease, and 93–96% and 89–91%, respectively, for stage IIB disease [12] , [22] .…”

Section: Current Evidence From the Embrace Studies And Image Guided Amentioning

confidence: 79%

The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies

Pötter

Tanderup

Kirisits

et al. 2018

Self Cite

458

436

“…Although a recently reported phase III International Atomic Energy Association trial demonstrated superiority of 7 Gy × 4 fractions over 9 Gy × 2 fractions for cervical cancer BT, there is a need to abbreviate BT schedules to equieffective lesser fractions (eg, 8 Gy × 3 fractions) to improve compliance with overall treatment time. 11 …”

Section: Discussionmentioning

confidence: 99%

Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

Mittal

Chopra

Pant

et al. 2018

JGO

Self Cite

PurposeRecent guidelines recommend magnetic resonance imaging–based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with chemoradiation and point A–based brachytherapy (BT) using x-ray– or computed tomography–based planning.MethodsPatients treated between January 2014 and December 2015 were included. Patients underwent x-ray– or computed tomography–based BT planning with an aim to deliver equivalent doses in 2 Gy (EQD2) > 84 Gy10 to point A while minimizing maximum dose received by rectum or bladder to a point or 2 cc volume to < 75 Gy EQD2 and < 90 Gy EQD2, respectively. The impact of known prognostic factors was evaluated.ResultsA total of 339 patients were evaluated. Median age was 52 (32 to 81) years; 52% of patients had stage IB2 to IIB and 48% had stage III to IVA disease. There was 85% compliance with chemoradiation, and 87% of patients received four or more cycles. Median point A dose was 84 (64.8 to 89.7) Gy. The median rectal and bladder doses were 73.5 (69.6 to 78.4) Gy3 and 83 (73.2 to 90.0) Gy3, respectively. At a median follow-up of 28 (4 to 45) months, the 3-year local, disease-free, and overall survival for stage IB to IIB disease was 94.1%, 83.3%, and 82.7%, respectively. The corresponding rates for stage III to IVA were 85.1%, 60.7%, and 69.6%. Grade III to IV proctitis and cystitis were observed in 4.7% and 0% of patients, respectively.ConclusionThis audit demonstrates good 3-year outcomes that are comparable to published MRBT series. Conventional BT with selective use of interstitial needles and MRBT should continue as standard procedures until level-I evidence for MRBT becomes available.