Phase 1 Trial of Concurrent Gemcitabine and Cisplatin with Image Guided Intensity Modulated Radiation Therapy for Locoregionally Advanced Cervical Carcinoma

Mell, Loren K.; Xu, Ronghui; Yashar, Catheryn M.; McHale, Michael; Einck, John; Mayadev, Jyoti; Lee, Euyhyun; Binder, Pratibha; Rash, Dominique; Eskander, Ramez N.; Heide, Elena S.; Plaxe, Steven C.; Mundt, Arno J.; Saenz, Cheryl C.

doi:10.1016/j.ijrobp.2020.04.019

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…Bone marrow sparing (BMS) radiotherapy reduces G2 + HT by approximately 70%, particularly leukopenia and neutropenia [2]. BMS-IMRT could reduce the volume of bone marrow receiving high-dose irradiation while maintaining the target coverage, resulting in fewer HT and potentially limiting the suppressive effect on immune responses [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Functional MRI radiomics-based assessment of pelvic bone marrow changes after concurrent chemoradiotherapy for cervical cancer

et al. 2022

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Objectives To quantify the dose-response relationship of changes in pelvic bone marrow (PBM) functional MR radiomic features (RF) during concurrent chemoradiotherapy (CCRT) for patients with cervical cancer and establish the correlation with hematologic toxicity to provide a basis for PBM sparing. Methods A total of 54 cervical cancer patients who received CCRT were studied retrospectively. Patients underwent MRI IDEAL IQ and T2 fat suppression (T2fs) scanning pre- and post-CCRT. The PBM RFs were extracted from each region of interest at dose gradients of 5–10 Gy, 10–15 Gy, 15–20 Gy, 20–30 Gy, 30–40 Gy, 40–50 Gy, and > 50 Gy, and changes in peripheral blood cell (PBC) counts during radiotherapy were assessed. The dose-response relationship of RF changes and their correlation with PBC changes were investigated. Results White blood cell, neutrophils (ANC) and lymphocyte counts during treatment were decreased by 49.4%, 41.4%, and 76.3%, respectively. Most firstorder features exhibited a significant dose-response relationship, particularly FatFrac IDEAL IQ, which had a maximum dose-response curve slope of 10.09, and WATER IDEAL IQ had a slope of − 7.93. The firstorder-Range in FAT IDEAL IQ and firstorder-10Percentile in T2fs, showed a significant correlation between the changes in ANC counts under the low dose gradient of 5–10 Gy (r = 0.744, -0.654, respectively, p < 0.05). Conclusion Functional MR radiomics can detect microscopic changes in PBM at various dose gradients and provide an objective reference for bone marrow sparing and dose limitation in cervical cancer CCRT.

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Section: Discussionmentioning

confidence: 99%

Functional MRI radiomics-based assessment of pelvic bone marrow changes after concurrent chemoradiotherapy for cervical cancer

et al. 2022

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“…[49][50][51][52] A phase I study using image-guided, intensity-modulated radiation therapy with the goal of allowing for intensification of systemic therapy by reducing the radiation dose to bowel and bone marrow did support the concept of allowing for a higher dose of concurrent gemcitabine in addition to cisplatin and pelvic radiation, but acute toxicity remains a substantial factor. 53…”

Section: Gemcitabinementioning

confidence: 99%

Novel Therapies in Gynecologic Cancer

Bejar

Oaknin

Williamson

et al. 2022

American Society of Clinical Oncology Educational Book

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During the past decade, considerable strides have been made in the understanding and treatment of gynecologic cancers. The advent of PARP inhibitors, antiangiogenic therapies, immunotherapy combinations, and targeted agents have altered the standard of care in ovarian, endometrial, and cervical cancers. However, continued advancement in the treatment of gynecologic cancers is critical. Fortunately, exciting work defining new therapeutic targets and novel treatment strategies is on the horizon. Here, we discuss emerging treatments for gynecologic cancers, including endometrial, cervical, ovarian, and rare gynecologic cancers. We highlight research that has deepened our understanding of the unique biology and molecular underpinnings of these cancers and is being translated into powerful new treatment approaches. We particularly highlight the advent of immunotherapy in endometrial cancer; radiosensitizers in cervical, vaginal, and vulvar cancers; targeted therapies in ovarian cancer; and molecularly driven approaches to treat rare gynecologic cancers. Continued basic, translational, and clinical research holds the promise to change the landscape of gynecologic cancer and improve the lives of all women impacted by these diseases.

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“…Weekly or daily cone beam CT prior to treatment delivery can identify changes in rectum or bladder filling status as well as an overlay of the treatment volumes on the scan of the day. Use of IG-IMRT has been associated with reduced haematological and gastrointestinal toxicity compared with using IMRT alone [51] and can enable additional systemic therapy [52].…”

Section: Cw Williamson Et Al / Clinical Oncology XXX (Xxxx) Xxxmentioning

confidence: 99%

Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer

et al. 2021

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The standard of care for the definitive treatment of locoregionally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost. Historically, EBRT was delivered via a two-dimensional technique based primarily on bony landmarks. This gave way to three-dimensional conformal radiation therapy, which allows for dose calculation and adjustment based on individual tumour and patient anatomy. Further technological advances have established intensity-modulated radiation therapy (IMRT) as a standard treatment modality, given the ability to maintain tumoricidal doses to target volumes while reducing unwanted radiation dose to nearby critical structures, thereby reducing toxicity. Routine image guidance allows for increased confidence in patient alignment prior to treatment, and the ability to visualise the daily position of the targets and organs at risk has been instrumental in allowing safe reductions in treated volumes. Additional EBRT technologies, including proton therapy and stereotactic body radiation therapy, may further improve the therapeutic index. In the realm of brachytherapy, a shift from point-based dose planning to image-guided brachytherapy has been associated with improved local control and reduced toxicity, with additional refinement ongoing. Here we will discuss these advances, the supporting data and future directions.

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Phase 1 Trial of Concurrent Gemcitabine and Cisplatin with Image Guided Intensity Modulated Radiation Therapy for Locoregionally Advanced Cervical Carcinoma

Cited by 11 publications

References 27 publications

Functional MRI radiomics-based assessment of pelvic bone marrow changes after concurrent chemoradiotherapy for cervical cancer

Functional MRI radiomics-based assessment of pelvic bone marrow changes after concurrent chemoradiotherapy for cervical cancer

Novel Therapies in Gynecologic Cancer

Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer

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