The promise of image-guided brachytherapy of better clinical outcomes in treatment of cervical cancer: Does it deliver? An Indian scenario

Tiwari, Richa; Narayanan, Geeta S; Jayakumar, Vijetha; Narayanan, Sowmya; Vishwanathan, Bhaskar; Mandal, Sharmistha; Babu, Suresh; Ramya, VC; George, Daicy

doi:10.1016/j.ygyno.2018.07.012

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…With the advent of 3D imaging and its integration in the radiotherapeutic planning process, the scope and quality of the transperineal interstitial approach have improved considerably. In an MRI-based ICBT series from our institution, the authors had reported LC of 84.4% in tumors with HRCTV BT volume larger than 35 cc and 77.1% in stage IIIB disease (11). In our present study, with the use of imageguided interstitial implants, we delivered LC of 86.7% and 84.1% in a much larger HRCTV volume up to 50 cc and those larger than 50 cc, respectively.…”

Section: Discussionsupporting

confidence: 49%

Long-term effectiveness and safety of image-based, transperineal combined intracavitary and interstitial brachytherapy in treatment of locally advanced cervical cancer

Tiwari

Narayanan

et al. 2020

Brachytherapy

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The aim of the study was to evaluate the impact of image-based combined intracavitary-interstitial brachytherapy (IC-ISBT) using a transperineal template in locally advanced cervical cancer treatment. METHODS AND MATERIALS: A total of 94 patients of cervical cancer stage IIB-IVA underwent image-based transperineal interstitial brachytherapy without tandem (ISBT) or with tandem (IC-ISBT) between June 2008 and June 2018 at our institution. After pelvic chemoradiation, 42 patients underwent ISBT and 52 IC-ISBT. Dosimetric data, clinical response, and toxicity records of these patients were reviewed. RESULTS: Clinical stage distribution was as follows: IIB: 22.4% (21), IIIA: 10.6% (10), IIIB: 56.4% (53), and IVA: 10.6% (10). Mean high-risk clinical target volume was 75.72 cc, and mean cumulative equivalent of 2 Gy per fraction for high-risk clinical target volume was 81 Gy. The median followup was 35.5 months. Overall 3-and 5-year local control, disease-free survival (DFS), and overall survival (OS) were 84% and 84%, 69.1% and 62.9%, and 80.9% and 71.5%, respectively. Local control (90.4% vs. 76.2%; p 5 0.048) and DFS (78.8% vs. 57.1%; p 5 0.04) were significantly better in the patients of IC-ISBT arm. IC-ISBT (hazard ratio: 0.763; 95% confidence interval 0.217, 1.38; p 5 0.046) and D90 dose O85 Gy (hazard ratio: 0.957; 95% confidence interval 0.927, 1.07; p 5 0.037) were predictors of better DFS on univariate analysis. Overall survival was not affected significantly by any of the factors. Grade 3 and 4 late complications were recorded in 3.2% (3) of patients and were similar in both arms (p 5 0.86). However, the mean rectum 2 cc dose was significantly lower in the IC-ISBT arm (p 5 0.038). CONCLUSIONS: Combined IC-ISBT is a safe and effective approach to treat ICBT unsuitable cases. It integrates the benefits of ICBT to the adaptability of ISBT around various targets and should be practiced whenever feasible to provide superior outcomes in locally advanced cervical cancer.

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Section: Discussionsupporting

confidence: 49%

Long-term effectiveness and safety of image-based, transperineal combined intracavitary and interstitial brachytherapy in treatment of locally advanced cervical cancer

Tiwari

Narayanan

et al. 2020

Brachytherapy

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“…Therefore, it should be interpreted favourably that the incidence of morbidity in the volume-based group is not significantly higher than the point-A group. A decrease in morbidity after IGBT introduction was reported in several mono-institutional cohorts [4,6,8,35,43] and may be likely when targets are not large. This is expected since average doses to OARs and irradiated volumes [4,33,49] significantly decrease for most patients who responded well to chemoradiation.…”

Section: Discussionmentioning

confidence: 85%

“…From these, 343 full-text studies were selected for review, and 319 were excluded (Supplementary Table A3). Thus, 24 studies [3,5,6,[8][9][10][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were included. Samples from three studies [30,31,45] were analysed as separate groups according to prescription types (point-A cohort and volume-based cohort), leading to 27 studies with 5488 patients (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Since emergence of evidence on concurrent chemo-radiation, further improvement in local control (LC) and disease-free survival (DFS) for cervical cancer has hinged on radiation dose escalation through advances in BT, specifically through development of Image-Guided Brachytherapy (IGBT) [4]. The IGBT paradigm is based on integration of Magnetic Resonance Imaging (MRI) for accurate target identification and dose prescription to high-risk clinical target volume; and advanced intracavitary (IC) and interstitial (IS) techniques to facilitate dose escalation for bulky tumours or for poor response to chemo-radiation [5,6]. Using these approaches, three-year LC of >85% was reported in monoinstitutional series [7][8][9].…”

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confidence: 99%

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Point-A vs. volume-based brachytherapy for the treatment of cervix cancer: A meta-analysis

Hande

Chopra

Kalra

et al. 2022

Radiotherapy and Oncology

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“…The clinical results in terms of response, survival and toxicity of this study can be found elsewhere. 20…”

Section: Resultsmentioning

confidence: 99%

A prospective comparative dosimetric study between diffusion weighted MRI (DWI) & T2-weighted MRI (T2W) for target delineation and planning in cervical cancer brachytherapy

Kumar

Narayanan

Vishwanthan

et al. 2020

Reports of Practical Oncology & Radiotherapy

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Aim: To evaluate the difference between GTVBT (Gross Tumor Volume at Brachytherapy) and HR CTV (High Risk Clinical Tumor Volume) delineated with DWI and T2W MRI. To evaluate doses to organs at risk and targets from plans generated using T2W and DWI. Background: Functional imaging with DWI can improve cervical tumor distinction as it is more sensitive than T2W MRI even in detecting parametrial invasion. This study does a dosimetric comparison between a T2W and DWI based plan. Methods: Fifty carcinoma cervix patients were subjected to MRI based brachytherapy. T2W and a diffusion weighted sequence were acquired. Target delineation and brachytherapy planning was done on both T2W and DWI. Standard DVH parameters were recorded and the treatment was given using the plan generated from T2W images. Results: GTVBT and HRCTV contours on DWI were different when compared with T2W. Mean GTVBT volume on T2W and DWI was 5.25 and 5.23, respectively (p value 0.8). Mean HRCTV on T2W and DWI was 28.3 and 27 cc, respectively (p value 0.003). Planning on the above volumes resulted in a superior coverage in terms of HRCTV D90 and D100 for DWI based plan, HRCTV D90 -735.1 and 741 cGy for T2W and DWI, respectively (p value 0.006), HRCTV D100 -441.05 and 444.5 for T2W and DWI plans, respectively (p value = 0.006). Doses to the OAR were not significantly increased. Conclusion: GEC ESTRO based contouring guidelines cover all the functionally abnormal areas on DWI. DWI should only be used as a supplement to T2W for contouring target volumes.

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The promise of image-guided brachytherapy of better clinical outcomes in treatment of cervical cancer: Does it deliver? An Indian scenario

Cited by 6 publications

References 29 publications

Long-term effectiveness and safety of image-based, transperineal combined intracavitary and interstitial brachytherapy in treatment of locally advanced cervical cancer

Long-term effectiveness and safety of image-based, transperineal combined intracavitary and interstitial brachytherapy in treatment of locally advanced cervical cancer

Point-A vs. volume-based brachytherapy for the treatment of cervix cancer: A meta-analysis

A prospective comparative dosimetric study between diffusion weighted MRI (DWI) & T2-weighted MRI (T2W) for target delineation and planning in cervical cancer brachytherapy

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