Bowel Morbidity in Locally Advanced Cervical Cancer Patients Treated with Combined External Beam Radiotherapy, Image-Guided Adaptive Brachytherapy (IGABT) and Concomitant Chemotherapy; a Descriptive Analysis from the Embrace Study

Brachytherapy ◽  
2016 ◽  
Vol 15 ◽  
pp. S54-S55 ◽  
Author(s):  
N. B.K. Jensen ◽  
L.U. Fokdal ◽  
K. Kirchheiner ◽  
C. Haie-Meder ◽  
U. Mahantshetty ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
External Beam Radiotherapy ◽  
Descriptive Analysis ◽  
Locally Advanced ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Concomitant Chemotherapy ◽  
Locally Advanced Cervical Cancer ◽  
Image Guided

Brachytherapy or external beam radiotherapy as a boost in locally advanced cervical cancer: a Gynaecology Study Group in the Italian Association of Radiation and Clinical Oncology (AIRO) review

2021 ◽  
pp. ijgc-2020-002310
Author(s):  
Maura Campitelli ◽  
Roberta Lazzari ◽  
Federica Piccolo ◽  
Patrizia Ferrazza ◽  
Anna Rita Marsella ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Tech ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Image Guided

This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.

scholarly journals Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

2017 ◽  
Vol 27 (4) ◽  
pp. 768-775 ◽  
Author(s):  
Zhong-Shan Liu ◽  
Jie Guo ◽  
Yang-Zhi Zhao ◽  
Xia Lin ◽  
Bing-Ya Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Dose ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
3 Dimensional ◽  
Locally Advanced Cervical Cancer ◽  
The Mean

ObjectiveWe present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.Materials/MethodsInterstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT.ResultsThe mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications.ConclusionsThe IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.

Individually customised parametrial boost for locally advanced cervical cancer: is 2D planned external beam radiotherapy useful?

2019 ◽  
Vol 19 (3) ◽  
pp. 248-253
Author(s):  
Aparna Gangopadhyay ◽  
Subrata Saha
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Pelvic Wall ◽  
Significant Difference ◽  
Median Period

AbstractAim:Pelvic wall control and toxicity was retrospectively assessed in patients who received individually customised parametrial boost (PMB) for locally advanced cervical cancer with 2D planned external beam radiotherapy. Outcomes of a dose-escalated combined boost were also evaluated.Materials and methods:Toxicity and pelvic wall recurrence was evaluated over a median period of 24 months between two groups who received different pelvic wall doses. One group was randomised to receive either intracavitary brachytherapy (ICRT) with an external beam PMB using a customised midline shield, or a dose-escalated combined boost with interstitial brachytherapy (ISBT) and PMB. The comparator group received no PMB.Results:At 24 months, pelvic wall recurrence occurred in 2/112 and 40/130 with and without PMB, respectively (p < 0·000001). No significant difference in toxicity was noted between boost versus no-boost groups (p = 0·56). Combined ISBT/PMB dose escalation showed no significant difference in pelvic wall recurrence compared with PMB alone (p = 0·49).Findings:Individually customised 2D PMBs with 3D image-based ICRT was safe and improved pelvic wall control in locally advanced cervix cancer. Dose-escalated combined boosts offered no significant benefit over standard boost doses.

scholarly journals Image guided interstitial brachytherapy for locally advanced disease after external beam radiotherapy in a case of carcinoma cervix – our institutional experience

2016 ◽  
Author(s):  
S. Tandon ◽  
S. Mitra ◽  
M. K. Sharma ◽  
U. Saxena ◽  
P. Ahlawat ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
External Beam Radiotherapy ◽  
Descriptive Analysis ◽  
Locally Advanced ◽  
Early Response ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Image Guided ◽  
The Mean

Purpose/Objective: Cervical cancer is the third most common cancer in women worldwide. Definitive chemoradiation is the accepted standard of care for patients especially for locally advanced cervical cancers. Intracavitary brachytherapy (ICBT) is an important part of definitive radiotherapy shown to improve overall survival. Interstitial brachytherapy (ISBT) is generally reserved for patients either with extensive pelvic and/or vaginal residual disease after external beam radiotherapy (EBRT) or with anatomy not allowing ICBT with standard applicators in an attempt to improve local control. We have conducted an observational study for patients who underwent image guided HDR-ISBT at our institute. Materials and Methods: Seven patients; diagnosed as a case of carcinoma cervix; were selected from the period of 2012 to 2015 who received EBRT by IMRT and for whom ICBT couldn’t be done for various reasons. These patients were then taken up for Martinez Universal Perineal Interstitial Template (MUPIT) image based ISBT. A descriptive analysis was done for doses received by HRCTV, bladder, rectum and sigmoid colon. At the end of treatment, early response at 3 months along with overall survival (OS) and disease free survival (DFS) was also calculated. Results: All the patients recruited were locally advanced with 3 patients in IIB, 1 patient in IIIA and 3 patients belonging to IIIB. The mean dose received by 95% high risk CTV (HRCTV) by IMRT was 49.75 Gy. Out of 7 patients, 3 were taken up for ISBT due to anatomical restriction whereas remaining 4 patients were included because of lack of dose coverage by ICBT. The mean doses received by 90% of HRCTV, 2 cc bladder, 2 cc rectum and 2 cc sigmoid colon were 20.58 Gy, 2.73 Gy, 3.19 Gy and 2.82 Gy respectively. The early response at 3 months was 57.14%. The DFS at one year and OS at 3 year were 53.6% and 53.3% respectively. Conclusions: Our descriptive analysis of seven patients being treated by image based ISBT have revealed that locally advanced cervical cancer patients for whom ICBT is unsuitable can achieve equitable LRC and OS with a combination of EBRT by IMRT and image based HDR-ISBT.

scholarly journals Сombined radiotherapy for cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine - immediate trial results of Azerbaijan national center of oncology

2017 ◽  
Vol 98 (6) ◽  
pp. 884-889
Author(s):  
J A Aliyev ◽  
I H Isayev ◽  
K S Akbarov ◽  
E H Guliyev ◽  
N R Aliyeva ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Group 2

Aim. Study of immediate results of chemoradiotherapy of locally advanced cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine. Methods. The article analyzes diagnostic and treatment results of 128 patients with IIA-IIIB stage cervical cancer. The age of patients varied between 31 and 76 years. External beam radiotherapy was performed with 1.8 Gy fraction up to a total dose of 45 Gy, high dose rate brachytherapy consisted of four 7.0 Gy fractions. Patients from group 1 received weekly infusions of cisplatin (40 mg/m2) and from group 2 - polyradiosensitization with cisplatin (40 mg/m2) and gemcitabine (75 mg/m2). Results. Chemoradiotherapy with the use of polyradiosensitization compared to standard chemoradiotherapy allowed significant improving of immediate results of treatment of patients with locally advanced cervical cancer, which was particularly prominent in such unfavorable cases as cervical adenocarcinoma and IIIB stage of the disease. Early toxicity of the treatment was higher in group 2 but effectively resolved with symptomatic supportive treatment and did not lead to interruptions in radiotherapy. Conclusion. Combination of conformal external beam radiotherapy, high dose rate intracavitary brachytherapy and concurrent polychemotherapy with cisplatin and gemcitabine is feasible and reasonably safe; chemoradiotherapy with the use of polyradiosensitization improves immediate results of the treatment of cervical cancer with acceptable level of toxicity.

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