Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients

Ríos, I. García; Rovirosa, Á.; Ascaso, Carlos; Valduvieco, Izaskun; Herreros, Antonio Garcı́a de; Castilla, L.; Sabater, S.; Holub, K; Pahisa, Jaume; Biete, Albert; Arenas, Meritxell

doi:10.1007/s12094-015-1463-z

Cited by 17 publications

(14 citation statements)

References 15 publications

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“…Although the accelerated form of current therapy might have resulted in occurrence of increased long-term complications, no grade 3 or higher toxicities were observed in patients after the median follow up of 14 months. Our results were consistent with the one reported by Martínez-Monge et al, (2007) and Rios et al, (2016). Similar to previous evidences, accelerated schedules were tolerable with acceptable outcomes (Sabater et al, 2017).…”

Section: Resultssupporting

confidence: 93%

Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer

Hashemi

Kiasari

Kalaghchi

et al. 2019

Asian Pac J Cancer Prev

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Background:Brachytherapy in treatment of endometrial cancer patients is growing and therefore, evaluation of more feasible schedule has become of great importance. The purpose of current study was to evaluate the complications of accelerated short course high dose rate intravaginal brachytherapy (HDR IVB), a new brachytherapy approach which is a more feasible treatment option in developing countries.Method:From 2017 to 2018, 54 patients diagnosed with endometrial cancer and FIGO stages IA to IIB who underwent total abdominal hysterectomy with a bilateral salpingo-oophorectomy were enrolled in present study. They were treated with a total dose of 25 Gy in 5 fractions which was prescribed daily. A dose of 5 Gy was prescribed at a depth of 0.5 cm in the upper third and middle third of vagina. Adverse effects related to organs at risk consist of bladder, vagina and rectum were documented based on the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). Results:The accelerated short course HDR IVB was well tolerated and no grade 3 or higher toxicities was reported for patients during the follow up period. There were no chronic rectal toxicities and only one patient showed chronic urinary toxicities. However, the incidence rate of vaginal toxicities at the end of 4-month and 8-month follow up periods was higher than acute toxicities and significantly lower in elderly group compared to younger group. Conclusion:Overall, the accelerated HDR IVB was safe and was well tolerated in endometrial cancer patients and the incidence rate of undue complications were equal, if not less, in elderly patients compared to the younger ones.

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Section: Resultssupporting

confidence: 93%

Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer

Hashemi

Kiasari

Kalaghchi

et al. 2019

Asian Pac J Cancer Prev

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“…Late toxicity in post-operative VBT has been associated with the length of the vagina treated, fractionation schedule, overall brachytherapy treatment time interval, cylinder diameter, overall dose, and dose per fraction. In previous studies, we did not observe any influence of the overall BT treatment time on late complications, and consequently BT was administered daily in our patients [ 18 , 20 , 21 , 22 ]. Our fractionation schedule and dose per fraction did not show an increase of late toxicity in comparison to other schedules, and the cylinder diameter was 3.5 cm in most of the patients.…”

Section: Discussionmentioning

confidence: 50%

Late G2 vagina toxicity in post-operative endometrial carcinoma is associated with a 68 Gy dose equivalent to 2 Gy per fraction (α/β=3Gy) at 2 cm 3 of vagina

Aguilera¹,

Rovirosa²,

Ascaso³

et al. 2018

jcb

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PurposeTo evaluate if the dose equivalent to 2 Gy per fraction (EQD2)(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of vagina in vaginal-cuff-brachytherapy (VBT) (high-dose-rate [HDR] 192Ir-source) ± external-beam-irradiation (EBRT) is associated with toxicity in post-operative endometrial carcinoma (P-EC).Material and methodsFrom June 2014 till November 2015, 67 consecutive P-EC patients underwent VBT ± EBRT; 44 patients received EBRT (median, 45 Gy; range, 44-50.4) + VBT (7 Gy), and 23 exclusive-VBT (6 Gy x 3 fractions). The upper 2.5 cm of vagina was delineated on computed tomography (CT). The active-length source was 2.5 cm, and the brachytherapy dose was prescribed at 5 mm from the applicator. D90, V100, and EQD2(α/β=3Gy) at 0.1 cm3, 1 cm3, and 2 cm3 of the most exposed part of the vagina were calculated. Vaginal toxicity assessment was completed with a LENT-SOMA-objective-criteria. Statistics were done with the use of χ2 and Student’s-t test.ResultsThe mean follow-up was 23.2 months (7.6-46.8). Median D90 was 7.8 Gy(α/β=3Gy). Late toxicity: 8 G1 and 9 G2. Median EQD2(α/β=3Gy) in vagina was 88.6 Gy (62.8-177.6) for 0.1 cm3, 72.4 Gy (57.1-130.4) for 1 cm3, and 69 Gy (53-113.4) for 2 cm3. Exclusive VBT vs. EBRT+VBT showed no differences in vaginal toxicity. There was no relationship between EQD2(α/β=3Gy) at 0.1 cm3 and 1 cm3 of vagina with G1-G2 toxicity (p = 0.62 and p = 0.58, respectively). G2 toxicity was related to EQD2(α/β=3Gy) at 2 cm3 (p = 0.03). EQD2(α/β=3Gy) > 68 Gy caused G2 late toxicity in 20.5% patients. All patients presenting G2 toxicity received > 68 Gy EQD2(α/β=3Gy).ConclusionsMore than 68 Gy EQD2(α/β=3Gy) at 2 cm3 was related to G2 toxicity in P-EC-VBT. Further studies including larger number of patients are needed to confirm these results. Patients receiving these doses should be informed of the risk of toxicity, with individualized treatment planning and follow-up to reduce G2 toxicity.

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“…For these reasons, using BT technique, a high-dose can be given for fractions sparing normal tissue with acceptable acute and late toxicities, as reported through different data in the literature [34,35,36,37,38,39,40,41,42].…”

Section: Resultsmentioning

confidence: 99%

Vaginal toxicity after high-dose-rate endovaginal brachytherapy: 20 years of results

Delishaj¹,

Barcellini²,

D’Amico³

et al. 2018

jcb

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PurposeTo evaluate vaginal toxicity (primary endpoint) and local control (secondary endpoint) in patients with endometrial cancer who underwent primary surgery and adjuvant high-dose-rate (HDR) endovaginal brachytherapy (BT).Material and methodsIn September 2017, the authors conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus, and Cochrane library. In this systematic review, the authors included randomized trials, non-randomized trials, prospective studies, retrospective studies, and cases. The time period of the research included articles published from September 1997 to September 2017.ResultsAcute endovaginal toxicity occurred in less than 20.6% and all acute toxicities were G1-G2. The most common early side effects due to HDR-BT treatment were vaginal inflammation, vaginal irritation, dryness, discharge, soreness, swelling, and fungal infection. G1-G2 late toxicity occurred in less than 27.7%. Finally, G3-G4 late vaginal occurred in less than 2%. The most common late side effects consisted of vaginal discharge, dryness, itching, bleeding, fibrosis, telangiectasias, stenosis, short or narrow vagina, and dyspareunia.ConclusionsThe data suggest that HDR endovaginal brachytherapy, with or without chemotherapy, is very well tolerated with low rates of acute and late vaginal toxicities. Further prospective studies with higher numbers of patients and longer follow-up are necessary to evaluate acute and late toxicities after HDR endovaginal brachytherapy.

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Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients

Abstract: The present HDR-BT schedule of 2 fractions of 5 Gy after EBI and 4 fractions of 5 Gy administered daily showed excellent results in terms of VCC and toxicity.

Cited by 17 publications

References 15 publications

Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer

Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer

Late G2 vagina toxicity in post-operative endometrial carcinoma is associated with a 68 Gy dose equivalent to 2 Gy per fraction (α/β=3Gy) at 2 cm 3 of vagina

Vaginal toxicity after high-dose-rate endovaginal brachytherapy: 20 years of results

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