Outcomes with volume-based dose specification in CT-planned high-dose-rate brachytherapy for stage I-II cervical carcinoma: A 10-year institutional experience

Cho, Linda P.; Manuel, Matthias M.; Catalano, Paul J.; Lee, Larissa; Damato, Antonio L.; Cormack, Robert A.; Buzurović, Ivan; Bhagwat, Mandar S.; O’Farrell, Desmond A.; Devlin, Phillip M.; Viswanathan, Akila N.

doi:10.1016/j.ygyno.2016.09.017

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…Several groups have published results with image guidance showing a 17% increase in local control of large tumors from 81% to 98% and an 11% decrease in rectal bleeding from 13% to 2%. 2,3 However, even with these advanced planning techniques, target coverage may be compromised when using intracavitary BT (IC-BT) for large or irregularly shaped tumors due to the vicinity of organs at risk (OAR) and radially isotropic dose distribution from conventional HDR BT radiation sources. RetroEMBRACE demonstrated that hybrid intracavitary/interstitial BT (IC/IS-BT) significantly increased local control by 10% without increasing morbidity for larger tumors, compared to the intracavitary BT (IC-BT) group.…”

Section: Introductionmentioning

confidence: 99%

“…The introduction of image‐guided high dose rate (HDR) BT has significantly improved patient outcomes. Several groups have published results with image guidance showing a 17% increase in local control of large tumors from 81% to 98% and an 11% decrease in rectal bleeding from 13% to 2% 2,3 . However, even with these advanced planning techniques, target coverage may be compromised when using intracavitary BT (IC‐BT) for large or irregularly shaped tumors due to the vicinity of organs at risk (OAR) and radially isotropic dose distribution from conventional HDR BT radiation sources.…”

Section: Introductionmentioning

confidence: 99%

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A novel minimally invasive dynamic‐shield, intensity‐modulated brachytherapy system for the treatment of cervical cancer

et al. 2020

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Purpose To present a novel, MRI‐compatible dynamicshield intensity modulated brachytherapy (IMBT) applicator and delivery system using 192Ir, 75Se, and 169Yb radioisotopes for the treatment of locally advanced cervical cancer. Needle‐free IMBT is a promising technique for improving target coverage and organs at risk (OAR) sparing. Methods and materials The IMBT delivery system dynamically controls the rotation of a novel tungsten shield placed inside an MRI‐compatible, 6‐mm wide intrauterine tandem. Using 36 cervical cancer cases, conventional intracavitary brachytherapy (IC‐BT) and intracavitary/interstitial brachytherapy (IC/IS‐BT) (10Ci 192Ir) plans were compared to IMBT (10Ci 192Ir; 11.5Ci 75Se; 44Ci 169Yb). All plans were generated using the Geant4‐based Monte Carlo dose calculation engine, RapidBrachyMC. Treatment plans were optimized then normalized to the same high‐risk clinical target volume (HR‐CTV) D90 and the D2cc for bladder, rectum, and sigmoid in the research brachytherapy planning system, RapidBrachyMCTPS. Plans were renormalized until either of the three OAR reached dose limits to calculate the maximum achievable HR‐CTV D90 and D98. Results Compared to IC‐BT, IMBT with either of the three radionuclides significantly improves the HR‐CTV D90 and D98 by up to 5.2% ± 0.3% (P < 0.001) and 6.7% ± 0.5% (P < 0.001), respectively, with the largest dosimetric enhancement when using 169Yb followed by 75Se and then 192Ir. Similarly, D2cc for all OAR improved with IMBT by up to 7.7% ± 0.6% (P < 0.001). For IC/IS‐BT cases, needle‐free IMBT achieved clinically acceptable plans with 169Yb‐based IMBT further improving HR‐CTV D98 by 1.5% ± 0.2% (P = 0.034) and decreasing sigmoid D2cc by 1.9% ± 0.4% (P = 0.048). Delivery times for IMBT are increased by a factor of 1.7, 3.3, and 2.3 for 192Ir, 75Se, and 169Yb, respectively, relative to conventional 192Ir BT. Conclusions Dynamic shield IMBT provides a promising alternative to conventional IC‐ and IC/IS‐BT techniques with significant dosimetric enhancements and even greater improvements with intermediate energy radionuclides. The ability to deliver a highly conformal, OAR‐sparing dose without IS needles provides a simplified method for improving the therapeutic ratio less invasively and in a less resource intensive manner.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel minimally invasive dynamic‐shield, intensity‐modulated brachytherapy system for the treatment of cervical cancer

et al. 2020

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“…Concurrent chemoradiotherapy (CCRT) is considered the primary treatment of choice for Stage IB2‐IVA uterine cervical squamous cell carcinoma based on randomized clinical trials and meta‐analyses . Recent studies have shown that CCRT and image‐guided brachytherapy improve the clinical outcome of patients with cervical carcinoma, especially squamous cell carcinoma . Conversely, few studies have investigated treatment options for adenocarcinomas; these are typically treated in a similar manner to squamous cell carcinomas .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of carbon ion radiotherapy with concurrent chemotherapy for locally advanced uterine cervical adenocarcinoma in a phase 1/2 clinical trial (Protocol 1001)

et al. 2018

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We conducted a phase 1/2 study to evaluate the efficacy and safety of carbon ion radiotherapy (C‐ion RT) with concurrent chemotherapy for locally advanced uterine cervical adenocarcinoma. Thirty‐three patients were enrolled between April 2010 and March 2014. Treatment consisted of C‐ion RT with concurrent weekly cisplatin at a dose of 40 mg/m2. In the phase 1 component, the total dose was escalated from 68.0 Gy (relative biological effectiveness [RBE]) to 74.4 Gy (RBE) to determine the maximum tolerated dose of C‐ion RT. In the phase 2 component, the efficacy and safety of C‐ion RT with concurrent chemotherapy were evaluated using the dose determined in the phase 1 component. The median follow‐up duration was 30 months. Two patients did not receive chemotherapy because of anemia or leukocytopenia immediately prior to commencing treatment; 31 patients were analyzed. None of the patients developed dose‐limiting toxicities. The recommended dose (RD) was determined to be 74.4 Gy (RBE). In the phase 2 component, two patients developed Grade 3–4 toxicities in the gastrointestinal tract, due to repeated laser coagulation or peritonitis caused by appendicitis. In the patients treated with the RD, the 2‐year local control, progression‐free survival, and overall survival rates were 71%, 56%, and 88%, respectively. C‐ion RT with concurrent weekly cisplatin was well tolerated in patients with locally advanced uterine cervical adenocarcinoma. Our findings support further investigations into the efficacy of this strategy.

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“…A great number of studies have published clinical results of CT-based BT (Table 1). Cho et al [47] retrospectively analyzed 128 patients with FIGO stage I-II disease treated with IC. The overall LC, progression-free survival (PFS), and OS were 96%, 88%, and 88% at 2 years, respectively, and no isolated pelvic local recurrence was observed.…”

Section: Clinical Outcomesmentioning

confidence: 99%

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

Wang,

Jiang

2023

Current Oncology

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Background: Brachytherapy (BT) is a critical component of radiotherapy for locally advanced cervical cancer (LACC), and it has rapidly developed in recent decades. Since the advent of three-dimensional image-guided adaptive brachytherapy (3D-IGABT), magnetic resonance imaging (MRI) has emerged as the primary modality for image guidance. Meanwhile, other imaging modalities, such as computed tomography, 18F-fluorodeoxyglucose positron emission tomography, ultrasound, and their combinations have also been widely studied. Materials and methods: We reviewed studies on different imaging modalities utilized for target delineation and planning. Emerging techniques in IGABT like real-time image guidance and 3D printing were also included. We summarized research on their feasibility and concentrated on their clinical outcomes. Results: MRI-guided BT was the gold standard, and CT-guided BT was the most widely applied. Other modalities have shown feasibility and promising efficacy in dosimetry studies and preliminary outcomes. The longer-term clinical outcomes associated with these approaches require further elucidation. Conclusions: As 3D-IGABT was validated by promising clinical outcomes, the future of BT for LACC is expected to progress toward the refinement of more effective image-guided procedures. Moreover, achieving operational consensus and driving technological advancements to mitigate the inherent limitations associated with different imaging modes remain essential.

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Outcomes with volume-based dose specification in CT-planned high-dose-rate brachytherapy for stage I-II cervical carcinoma: A 10-year institutional experience

Cited by 12 publications

References 29 publications

A novel minimally invasive dynamic‐shield, intensity‐modulated brachytherapy system for the treatment of cervical cancer

A novel minimally invasive dynamic‐shield, intensity‐modulated brachytherapy system for the treatment of cervical cancer

Clinical outcomes of carbon ion radiotherapy with concurrent chemotherapy for locally advanced uterine cervical adenocarcinoma in a phase 1/2 clinical trial (Protocol 1001)

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

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