Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Chino, Junzo; Annunziata, Christina M.; Beriwal, Sushil; Bradfield, Lisa; Erickson, Beth; Fields, Emma C.; Fitch, Kathryn Jane; Harkenrider, Matthew M.; Holschneider, Christine H.; Kamrava, Mitchell; Leung, Eric; Lin, Lilie L.; Mayadev, Jyoti; Morcos, Marc; Nwachukwu, Chika; Petereit, Daniel G.; Viswanathan, Akila N.

doi:10.1016/j.prro.2020.04.002

Cited by 157 publications

(85 citation statements)

References 83 publications

(75 reference statements)

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“…La radioquimioterapia concomitante seguida de braquiterapia adaptativa guiada por imágenes de resonancia magnética es el tratamiento estándar del CCLA (4,5,12). La resonancia magnética se ha convertido en una técnica de imagen crucial para definir el volumen tumoral en pacientes con CCLA ya que proporciona una correcta visualización del tumor cervical en múltiples planos, lo que permite una definición volumétrica confiable de los volúmenes objetivos para la planificación del tratamiento con braquiterapia (8,13).…”

Section: Discussionunclassified

Braquiterapia adaptativa guiada por resonancia magnética para el cáncer cervical localmente avanzado: Experiencia del Hospital Carlos Van Buren

Solís

Olivares

Tudela

et al. 2020

Rev. chil. obstet. ginecol.

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Introducción y objetivos: El tratamiento estándar para pacientes con cáncer cervical localmente avanzado (CCLA) se basa en radioterapia externa y quimioterapia concomitante seguida de braquiterapia adaptativa guiada por imágenes (BTAGI). El objetivo de este estudio fue describir los resultados del protocolo de BTAGI de resonancia magnética del Servicio de Oncología del Hospital Carlos Van Buren. Métodos: En pacientes con CCLA tratadas con Radioquimioterapia concomitante seguida de BTAGI de resonancia magnética se evaluó la reducción tumoral, parámetros dosimétricos y la toxicidad aguda. Resultados: Se evaluó la reducción tumoral entre el diagnóstico y el momento de la braquiterapia en 34 pacientes. Todas las pacientes completaron el tratamiento de radioterapia externa. Veinticuatro pacientes recibieron 3 sesiones de braquiterapia. Dosis equivalentes totales > 80 Gy se logro en todos los pacientes. Doce pacientes presentaron reducción del volumen tumoral mayor al 70%. La mediana de las dosis equivalentes totales prescritas al D2cc de vejiga fue 73.9 Gy, al recto 65.6 Gy y al intestino fue de 69.1 Gy. Una paciente presento toxicidad gastrointestinal grado ⩾ 3. No hubo diferencias estadísticamente significativas al comparar pacientes que recibieron dosis equivalentes totales desde los 85 Gy con las que recibieron menor dosis respecto a toxicidad gastrointestinal (p=0.33) y genitourinaria (p=0.97). Conclusión: La braquiterapia adaptativa guiada por resonancia magnética se puede realizar en el sistema público de salud y cumplir con las recomendaciones internacionales requeridas para el tratamiento estándar del CCLA.

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Section: Discussionunclassified

Braquiterapia adaptativa guiada por resonancia magnética para el cáncer cervical localmente avanzado: Experiencia del Hospital Carlos Van Buren

Solís

Olivares

Tudela

et al. 2020

Rev. chil. obstet. ginecol.

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“…The study was closed early due to high toxicity ratesincluding death due to complications of therapy. ASTRO cervical cancer clinical practice guidelines state that either SABR or IMRT are only suitable replacements for brachytherapy when considered for patients refusing or ineligible for brachytherapy (21).…”

Section: Gynecologic Brachytherapymentioning

confidence: 99%

The Case for Brachytherapy: Why It Deserves a Renaissance

Williams¹,

Kahn²,

Thaker³

et al. 2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…IMRT significantly reduced ≥grade 3 acute gastrointestinal toxicities (odds ratio, OR, 0.55, 95% CI 0.32–0.95, p = 0.03), ≥grade 3 acute genitourinary toxicities (OR 0.31, 95% CI 0.14–0.67, p = 0.003), and ≥grade 3 chronic genitourinary toxicities (OR 0.09, 95% CI 0.01–0.67, p = 0.02). In the ASTRO clinical practice guideline of 2020, IMRT is conditionally recommended to decrease acute and chronic toxicity in definitive radiotherapy for cervical cancer ( 52 ). It should be noted that most patients in these studies are treated with pelvic radiotherapy.…”

Section: The Toxicities Of Efimentioning

confidence: 99%

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.

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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Cited by 157 publications

References 83 publications

Braquiterapia adaptativa guiada por resonancia magnética para el cáncer cervical localmente avanzado: Experiencia del Hospital Carlos Van Buren

Braquiterapia adaptativa guiada por resonancia magnética para el cáncer cervical localmente avanzado: Experiencia del Hospital Carlos Van Buren

The Case for Brachytherapy: Why It Deserves a Renaissance

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

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