The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

Abstract

Radical concurrent chemoradiotherapy with combined external beam radiotherapy (EBRT) and brachytherapy is used to treat locally advanced cervical cancer. Our institution has transitioned to high-dose-rate (HDR) intracavitary brachytherapy (ICBT) from lowdose-rate (LDR) brachytherapy in 2008, and a review was conducted on the effect of this change on patient outcomes. Methods and Materials: A single-arm retrospective chart review was performed on locally advanced (Fédération Internationale de Gynécologie et d'Obstétrique stage IB-IVA) patients with cervical cancer treated with combined external beam radiation therapy and HDR-ICBT with curative intent between 2008 and 2014. Clinical outcomes were evaluated, and multivariate analysis was performed to identify prognostic factors. Results: Of the 76 patients selected, median age was 47.9 years and median follow-up was 5.2 years. Thirteen patients (17.1%) developed locoregional recurrence and 23 patients (30.3%) patients developed distant recurrence. Five-year progression-free survival and overall survival were 63.7% and 69.3%, respectively. A significant survival difference was found between stages (P < .001). Multivariate analysis found nodal involvement was strongly associated with poorer survival (P Z .007). Conclusions: Our experience with the transition to HDR-ICBT as part of concurrent chemoradiotherapy in treatment of locally advanced cervical cancer resulted in acceptable long-term outcomes and toxicity to that of LDR brachytherapy. Potential further improvement of treatment outcomes for patients may be possible with image guided brachytherapy and the addition of effective systemic therapy.

GammaTile: Comprehensive Review of a Novel Radioactive Intraoperative Seed-Loading Device for the Treatment of Brain Tumors

“…Figure 1 shows the various median OS periods for GammaTile and other treatment studies. The study by Song et al (2020) [ 13 ] has the highest median OS, asserting that it will take 60 months for half of the patients diagnosed with the cervical cancer group to die. Bhuiyan et al (2014) [ 20 ] established that it takes 14 months for half of the patients diagnosed with locally advanced carcinoma of the uterine cervix to die.…”

“…In the clinical trial, measuring the progression-free survival will be instrumental in helping to see how the GammaTile surgically targeted radiation therapy and other treatment work. Song et al [ 13 ] found that it will take cervical cancer patients 45.2 months during and after the treatment to live with the disease without getting worse. On the other hand, Bhuiyan et al [ 20 ] found that it will take patients diagnosed with locally advanced carcinoma of the uterine cervix 12.5 months during and after the treatment to live with the diseases without getting worse.…”

“…Figure 1 shows the various median OS periods for GammaTile and other treatment studies. The study by Song et al (2020) [13] has the highest median OS, asserting that it will take 60 months for half of the patients diagnosed with the cervical cancer group to die. Bhuiyan et al…”

“…The fundamental benefits of GammaTile surgically targeted radiation therapy include instant commencement of radiation treatment after tumor resection when the disease burden is minimal as opposed to waiting for the surgical wound to heal, which typically takes 3-4 weeks [ 12 ]. Moreover, this treatment approach optimizes radiation dosimetry, allowing the maximum dose in the tumor region and the lesser dose in the normal adjacent tissue [ 13 ]. Furthermore, it is used immediately after resection when there is visible surgical bed tissue to enable effective tile placement, enabling precise targeting of radiation therapy [ 2 ].…”

Dose to pelvic lymph nodes in locally advanced cervical cancer during high-dose-rate brachytherapy with tandem-ring applicators

“…External beam radiation therapy (EBRT) in combination with high-dose-rate (HDR) brachytherapy (BT) is now considered as the definitive treatment strategy of locally advanced cervical cancer. The gold standard in adaptive brachytherapy is image-guided adaptive brachytherapy (IGABT), which enables individualized treatment planning and delivery [ 1 ].…”