Two fractions of high-dose-rate brachytherapy in the management of cervix cancer: clinical experience with and without chemotherapy

Sood, Brij; Gorla, Giridhar R.; Gupta, Sajel; Garg, Madhur; Deore, S M; Runowicz, Carolyn D.; Fields, Abbie L.; Goldberg, Gary L.; Anderson, Patrick; Bhatia, Vikram

doi:10.1016/s0360-3016(02)02745-1

Cited by 45 publications

(35 citation statements)

References 11 publications

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“…Dosing schedules of HDR-ICBT (i.e., total dose and fractions in combination with EBRT) differ substantially among various countries, both in clinical practice (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and in published guidelines (21,22). Table 1 lists various schedules for definitive RT with HDR-ICBT along with pelvic control rates for stage I and II cervical cancer (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Immediately evident is the lack of a clear dose-response relationship between biologically effective dose (BED) at point A and pelvic control, which has been previously noted (23).…”

Section: Introductionmentioning

confidence: 99%

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Toita

Kato²,

Niibe

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Section: Introductionmentioning

confidence: 99%

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Toita

Kato²,

Niibe

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…Earlier studies on HDR ICBT with 9 Gy per fraction in two fractions [3,[6][7][8] have failed to find any significantly increased toxicity with the regime. Similarly, in the current study, there was no significantly increased toxicity with HDR ICBT using 9 Gy per fraction in two fractions.…”

Section: Discussionmentioning

confidence: 86%

“…Patel et al [6][7][8], Sood et al [3] and Souhami et al [14] have described their experiences with [7.5 Gy per fraction HDR ICBT dose and reported their fractionation schedules to be safe and effective in the treatment of cervical cancer. In the current study, it was found that 9 Gy per fraction in two fractions had better efficacy (though not statistically significant) than that of 7 Gy per fraction in three fractions in terms of local tumour control.…”

Section: Discussionmentioning

confidence: 99%

“…Even though there are more than four decades of published literature on the optimum dose fractionation schedules in HDR ICBT for the treatment of cervical cancer, there is still no uniform consensus on it [3,4]. The American Brachytherapy Society (ABS) has recommended an individual fraction size of \7.5 Gy in four to eight fractions, depending on the dose per fraction.…”

Section: Introductionmentioning

confidence: 99%

“…There have been few studies where the authors have demonstrated that HDR ICBT is also quite safe and equally effective if the dose per fraction is higher than 7.5 Gy, as opposed to the ABS [3,6,7]. Even before the ABS recommendations, in 1994, Patel et al [8] demonstrated the efficacy of HDR ICBT with 9 Gy per fraction for two fractions when compared to the then standard of continuous low-dose-rate (LDR) ICBT with 35 Gy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible??

Ghosh

Rao

2015

J Obstet Gynecol India

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Extended‐field radiotherapy and high–dose‐rate brachytherapy in carcinoma of the uterine cervix

Sood

Gorla

Garg

et al. 2003

Cancer

Self Cite

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BACKGROUNDIt has long been recognized that many patients with locally advanced carcinoma of the cervix harbor occult paraaortic metastases. A randomized study demonstrated that elective paraaortic irradiation improved survival and reduced distant metastases. More recently, concomitant chemotherapy with pelvic irradiation has improved survival among patients with locally advanced carcinoma of the cervix. This has led to a reexamination of the role of extended‐field irradiation. An important issue is the toxicity of concomitant chemotherapy and extended‐field radiotherapy. The authors report a retrospective analysis of their experience with extended‐field radiotherapy and high–dose‐rate brachytherapy with or without concomitant chemotherapy.METHODSThe authors treated 54 women with biopsy‐confirmed carcinoma of the cervix using extended‐field radiotherapy and high–dose‐rate brachytherapy with or without concomitant chemotherapy. The histology was squamous cell carcinoma in 49 patients (91%) and nonsquamous cell carcinoma in 5 patients (9%). The median size of the primary tumor was 7 cm (range, 3–10 cm). Each patient received 45 grays (Gy) of external beam radiotherapy to the pelvis and the paraaortic region, followed by a parametrial boost (9 Gy) in the patients with disease extension to the parametrium or the pelvic side wall(s). Each patient also underwent two applications of high–dose‐rate brachytherapy, 1 week apart. The median dose delivered to Point A from each application was 9 Gy. Forty‐four of the 54 patients (81%) received concomitant chemotherapy (cisplatin, 20 mg/m2/day for 5 days) during the first and the fourth weeks of external beam radiotherapy, and once after the second high‐dose rate application. Chemotherapy was not assigned randomly.RESULTSOne of the 10 patients (10%) treated without chemotherapy experienced acute toxicity, whereas 41 of 44 patients (93%) who received chemotherapy suffered from acute toxicity, including hematologic toxicity, gastrointestinal toxicity, and deep venous thrombosis. During a median follow‐up period of 28 months (range, 12–70 months), 6 of the 54 patients have died (11%). The actuarial rate of local control at 3 years is 100% among the patients treated without chemotherapy, compared with 85% among those receiving chemotherapy. No one failed in the paraaortic region. The actuarial rates of freedom from distant metastases are 90% and 95% among the patients treated without and with chemotherapy, respectively. The actuarial incidence of late toxicity is 10% among the patients treated without chemotherapy and 6% among those receiving chemotherapy.CONCLUSIONSThe regimen of extended‐field radiotherapy with concomitant cisplatin and high–dose‐rate brachytherapy produced substantial acute toxicity, but its long‐term toxicity is low and the preliminary tumor control excellent, albeit with limited follow‐up. Only prospective, randomized trials can evaluate whether these results are truly better than those of pelvic radiotherapy with concomitant chemotherapy, or those of other regimens of extended‐field radiotherapy with concomitant chemotherapy. Cancer 2003;97:1781–8. © 2003 American Cancer Society.DOI 10.1002/cncr.11248

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Two fractions of high-dose-rate brachytherapy in the management of cervix cancer: clinical experience with and without chemotherapy

Cited by 45 publications

References 11 publications

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible??

Extended‐field radiotherapy and high–dose‐rate brachytherapy in carcinoma of the uterine cervix

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