Perineal Template Interstitial Brachytherapy Salvage for Recurrent Endometrial Adenocarcinoma Metastatic to the Vagina

Nag, Subir; Martı́nez-Monge, Rafael; Vacarello, Luis; Lewandowski, George

doi:10.1006/gyno.1997.4722

Cited by 36 publications

(16 citation statements)

References 7 publications

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“…Nag and co-workers from the Arthur G. James Cancer Hospital in Ohio and Charra and colleagues from the Centre Hospitalier LyonSud in France have reported 5-year survival rates of 68 and 56%, respectively [26,27]. The present series updates this interstitial experience with a 5-year survival rate of 65% (Table 4).…”

Section: Discussionsupporting

confidence: 64%

“…This may result in improved dosimetry compared with intracavitary techniques, particularly for deeply infiltrating tumors and bulky recurrences with complex geometries. Interstitial irradiation techniques were reintroduced by Syed and co-workers in the early 1980s for the management of gynecologic cancer [24,25], but have only rarely been reported in the treatment of vaginal recurrences [26,27].…”

Section: Introductionmentioning

confidence: 99%

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Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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Objective. The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma.Methods. Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death.Results. The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n ‫؍‬ 18), Stage II (n ‫؍‬ 7), and Stage III (n ‫؍‬ 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingooophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n ‫؍‬ 5) or at distant sites (n ‫؍‬ 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n ‫؍‬ 2), fistula (n ‫؍‬ 2), and radiation stricture (n ‫؍‬ 1).Conclusion. Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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“…We use the linear quadratic formulation for dose equivalence. Assuming that the α/β ratio for prostate is about 1.5 Gy [16], the rationale of this study was to use an HDR-BT regimen that provided a BED 2 of at least 50 Gy EQD2 [17]. Table 2 shows the different HDR dose levels with the corresponding BEDs values using a α/β ratio of 1.5 and 3.0.…”

Section: Methodsmentioning

confidence: 99%

Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity

et al. 2014

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PurposeTo evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy.Methods and materialsBetween 1993 and 2007, we retrospectively analyzed 56 consecutively patients (pts) undergoing salvage brachytherapy. After local biopsy-proven recurrence, pts received 145 Gy LDR-BT (37 pts, 66%) or HDR-BT (19 pts, 34%) in different dose levels according to biological equivalent doses (BED2 Gy). By the time of salvage BT, only 15 pts (27%) received ADT. Univariate and multivariate analyses were performed to identify predictors of biochemical control and toxicities. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded using Common Terminology Criteria for Adverse Events (CTCv3.0).ResultsMedian follow-up after salvage BT was 48 months. The 5-year FFbF was 77%. HDR and LDR late grade 3 GU toxicities were observed in 21% and 24%. Late grade 3 GI toxicities were observed in 2% (HDR) and 2.7% (LDR). On univariate analysis, pre-salvage prostate-specific antigen (PSA) > 10 ng/ml (p = 0.004), interval to relapse after initial treatment < 24 months (p = 0.004) and salvage HDR-BT doses BED2 Gy level < 227 Gy (p = 0.012) were significant in predicting biochemical failure. On Cox multivariate analysis, pre-salvage PSA, and time to relapse were significant in predicting biochemical failure.HDR-BT BED2 Gy (α/β 1.5 Gy) levels ≥ 227 (p = 0.013), and ADT (p = 0.049) were significant in predicting grade ≥ 2 urinary toxicity.ConclusionsProstate BT is an effective salvage modality in some selected prostate local recurrence patients after radiation therapy. Even, we provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended.

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“…In practice, only a minority of patients with small, centrally located vaginal relapses have substantial salvage rates if treated with either surgery or brachytherapy, alone or combined with external beam radiation therapy (EBRT) (3,4). Patients with lateral recurrences are not usually considered candidates for exenterative surgery, because tumor-free surgical margins cannot be achieved.…”

Section: Introductionmentioning

confidence: 99%