Treatment of cervical cancer with electronic brachytherapy

Abstract

Purpose We report the first cervical cancer cases treated with interstitial electronic brachytherapy (eBT) at our hospital and compare them with plans made with high‐dose‐rate interstitial brachytherapy based on Ir192 (HDR‐BT). Materials and methods Eight patients with cervical cancer were treated with the Axxent eBT device (Xoft, Inc.). Planning was with magnetic resonance imaging and computed tomography following the recommendations of the EMBRACE protocol. The dosimetry parameters of organs at risk (OAR) were evaluated for the bladder, rectum, and sigmoid colon (D2cc, D1cc, and D0.1cc). In addition, the V150 and V200 of irradiated tissue were compared for both eBT and HDR‐BT. All patients received intensity‐modulated external beam radiation therapy with a regimen of 23 sessions of 2 Gy followed by four sessions of 7 Gy of eBT performed over 2 weeks (two sessions followed by another two sessions a week later) following the EMBRACE recommendations. Each of the eight patients was followed to assess acute toxicity associated with treatment. Results The doses reaching OAR for eBT plans were lower than for HDR‐BT plans. As for acute toxicity associated with eBT, very few cases of mucositis were detected. No cases of rectal toxicity and one case with grade 1 urinary toxicity were detected. The results at 1 month are equally good, and no relapses have occurred to date. Conclusions The first results of treatment with the Axxent eBT device are promising, as no recurrences have been observed and toxicity is very low. eBT is a good alternative for treating cervical cancer in centers without access to conventional HDR.

Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma

“…The Xoft System [ Figure 1 ] is FDA-approved, CE marked and is licensed in a growing number of countries for the treatment of cancer. [ 26 , 28 , 38 ]…”

Needle‐free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the 169Yb Isotope

“…Although the clinical implications of the hot spots remain unknown, they represented a cause for concern in the extent and viability of clinical trials needed to evaluate the approach. In a previous study in which cervical cancer patients were treated with intracavitary applicators using the Xoft Axxent electronic brachytherapy source it was found that hot spots to normal tissue increased slightly relative to what would have been delivered with 192 Ir for 8 patients (V 150% was 132% vs 124% on average and V 200% was 67% vs 63% on average), and no increase in acute mucositis was observed 36 …”

“…In a previous study in which cervical cancer patients were treated with intracavitary applicators using the Xoft Axxent electronic brachytherapy source it was found that hot spots to normal tissue increased slightly relative to what would have been delivered with 192 Ir for 8 patients (V 150% was 132% vs 124% on average and V 200% was 67% vs 63% on average), and no increase in acute mucositis was observed. 36 Another approach for improving cervical cancer brachytherapy, direction-modulated brachytherapy (DMBT), is a technically viable and well-investigated. 15,17,18 In a 45-patient treatment planning study it was found that the DMBT applicator with a ring compared to a conventional tandem and ring applicator resulted in a mean (range) organ-at-risk sparing of À4.07% AE 9.90% (À45.3%, 10.4%) for bladder, 3.17% AE 4.57% (À26.5%, 6.1%) for rectum, and À3.63% AE 4.49% (À18.3%, 3.9%) for the sigmoid colon when 192 Ir was used as the radiation source.…”

Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors

“…Additionally, EBT devices are mobile and may be used in any room that fulfils basic requirements for operating kV-energy emitting X-ray devices (e.g., classical X-ray imaging, C-arm fluoroscopy, or computed tomography – CT) [ 7 , 8 , 9 ]. Current applications of EBT mostly involve intracavitary (intraoperative) radiotherapy of breast, brain, and spine tumors, but also intravaginal or intrauterine EBT and superficial EBT of skin tumors [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”