scholarly journals A Review of Practice and Outcomes of External Beam Radiotherapy Treatment with Concurrent Chemotherapy Followed by MRI-Assisted Intracavitary Brachytherapy for Locally Advanced Cervix Cancer

Brachytherapy ◽  
2016 ◽  
Vol 15 ◽  
pp. S93
Author(s):  
Vivien Tse ◽  
Anna-Maria Shiarli ◽  
Sarah Aldridge ◽  
Caroline Nahab ◽  
Emma-Louise Jones ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Cervix Cancer ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Radiotherapy Treatment

A PROSPECTIVE RANDOMIZED STUDY TO COMPARE THE CONCURRENT CHEMO-RADIATION VERSUS HYPO-FRACTIONATED CHEMO-RADIATION IN LOCALLY ADVANCED CERVICAL CANCER.

2021 ◽  
pp. 40-42
Author(s):  
Arpan Jana ◽  
Pabitra Das ◽  
Poulami Gupta ◽  
Phalguni Gupta
Keyword(s):  
Cervical Cancer ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Advanced Carcinoma

Background: Concurrent chemo-radiation is the standard treatment worldwide for locally advanced squamous Cell carcinoma cervix. However, conventional chemo-radiotherapy is also associated with unacceptable local and systemic failure rates for locally advanced disease. Biologically squamous cell carcinoma of head- neck cancer and cervical cancer behaves quite similarly in response to radiotherapy. So, it can be expected that, altered fractionation can increase the local control in case of squamous cell carcinoma cervix than conventional radiotherapy. There is no randomised control trial for carcinoma cervix till date, which compares conventional chemo-radiation with hypo-fractionated chemo-radiation. Aims And Objectives: The present study was planned to compare local disease control and acute toxicity of conventional chemo-radiation with hypo-fractionated chemo-radiation in locally advanced carcinoma cervix. Materials And Methods: In Conventional Chemo-radiation Arm A patients (n=30) received external beam radiotherapy 50 Gy in 25 fractions in 5 weeks accompanied by weekly intravenous Cisplatin 40mg/m2 followed by intracavitary brachytherapy 7 Gy per fraction once in a week for 3 weeks. The second group of hypo-fractionated Arm B received external beam radiotherapy 45 Gy in 20 fractions in 4 weeks accompanied by weekly intravenous Cisplatin 40mg/m2 followed by intracavitary brachytherapy 9 Gy per fraction once in a week for 2 weeks. Results: Grade II diarrhea were seen more in Arm B 17 (56.66%) compare to Arm A 12(40%) and grade III diarrhea was seen 4 (3.33%) in Arm B and 2(6.66%) in Arm A. At 2 months and 6 months after completion of treatment Complete response were 25 (83.4%) in Arm A compare to 22 (73.3%) in Arm B and 20 (74.1%) in Arm A and 18 (72%) in Arm B respectively. Conclusion: Hypo-fractioned radiotherapy may be used as an alternate protocol for treatment of locally advanced carcinoma cervix with acceptable toxicities.

Magnetic resonance imaging after external beam radiotherapy and concurrent chemotherapy for locally advanced cervical cancer helps to identify patients at risk of recurrence

2019 ◽  
Vol 29 (3) ◽  
pp. 480-486 ◽  
Author(s):  
Martina Aida Angeles ◽  
Pauline Baissas ◽  
Eric Leblanc ◽  
Amélie Lusque ◽  
Gwénaël Ferron ◽  
...  
Keyword(s):  
Tumor Size ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Reduction Rate ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Size Reduction ◽  
External Beam ◽  
Free Survival

ObjectiveTumor volume and regression after external beam radiotherapy have been shown to be accurate parameters to assess treatment response via magnetic resonance imaging (MRI). The aim of the study was to evaluate the prognostic value of tumor size reduction rate after external beam radiotherapy and chemotherapy prior to brachytherapy.MethodsPatients with locally advanced cervical cancer treated at two French comprehensive cancer centers between 1998 and 2010 were included. Treatment was pelvic external beam radiotherapy with platinum based chemotherapy followed by brachytherapy. Records were reviewed for demographic, clinical, imaging, treatment, and follow-up data. Anonymized linked data were used to ascertain the association between pre-external and post-external beam radiotherapy MRI results, and survival data.Results185 patients were included in the study. Median age at diagnosis was 45 years (range 26–72). 77 patients (41.6%) were International Federation of Gynecology and Obstetrics stage IB2-IIA disease and 108 patients (58.4%) were stage IIB-IVA. Median tumor size after external beam radiotherapy and chemotherapy was 2.0 cm (range 0.0–8.0) and median tumor size reduction rate was 62.4% (range 0.0–100.0%). Tumor size and tumor reduction rate at 45 Gy external beam radiotherapy MRI were significantly associated with local recurrence free survival (P<0.001), disease free survival, and overall survival (P<0.05). Tumor reduction rate ≥60% was significantly associated with a decreased risk of relapse and death (HR (95% CI) 0.21 (0.09 to 0.50), P=0.001 for local recurrence free survival; 0.48 (0.30 to 0.77) P=0.002 for disease free survival; and 0.51 (0.29 to 0.88), P=0.014 for overall survival).ConclusionsTumor size reduction rate >60% between pre-therapeutic and post-therapeutic 45 Gy external beam radiotherapy with concurrent chemotherapy was associated with improved survival. Future studies may help to identify patients who may ultimately benefit from completion surgery, adjuvant chemotherapy, and closer follow-up.

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.

Quality of life in patients of carcinoma cervix treated with chemoradiotherapy: A prospective study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16545-e16545
Author(s):  
Pavankumar Lachi ◽  
Monica Malik ◽  
Kesava Ramgopal Adavikolanu ◽  
Syedakram Kothwal ◽  
Deepajoseph M ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Dose ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Carcinoma Cervix ◽  
Duration Of Treatment

e16545 Background: The standard of care in locally advanced carcinoma cervix is concurrent chemoradiotherapy. The aim of the study is to prospectively assess quality of life (QoL) in patients of carcinoma cervix treated with chemoradiotherapy. Methods: Between June 2011 and June 2012, 20 patients of carcinoma cervix were included in the study. All patients received conformal external beam radiotherapy (EBRT) on Linear accelerator to a total dose of 50Gy, 2 Gy per fraction, 25 fractions to the pelvis and intracavitary brachytherapy by High dose rate brachytherapy, 7 Gy per fraction, 3 fractions to a total dose of 21 Gy. Patients received concurrent chemotherapy with Cisplatin 40 mg/m2 weekly for five weeks. QoL was assessed using EORTC QLQ-C30 and QLQ-C24 questionnaires at baseline and at six months following completion of treatment. The collected data was analyzed using standard statistical software package (SPSS version 20.0). Results: Median age of the patients in the study was 52years ( range 34 – 69 years), 13 (65%) patients were stage II and seven (35%) were stage III. Mean duration of treatment is 37 days (range 34- 70 days). Local control rate at six months was 95%. Compliance with completion of QoL scores was high. A statistically significant improvement (p = 0.001) was seen at six months post treatment in Global health score and in function scales like physical function, role function, emotional function, social function and cognitive function. There was a significant improvement in symptom scales of urologic and vaginal symptoms. The difference in sexual function at six months showed a trend towards significance (p = 0.052). Conclusions: Patients of carcinoma cervix have a significant improvement in quality of life following treatment with radiotherapy and chemotherapy.

3D HDR intracavitary brachytherapy combined with complementary applicator-guided external beam radiotherapy for 338 patients with stage IIB-IIIB uterine cervical cancer: A single-center phase II prospective study with long-term follow-up.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5530-5530 ◽  
Author(s):  
Jin Yi Lang ◽  
Zixuan Fan ◽  
Peng Xu ◽  
Mei Feng ◽  
Weidong Wang
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Uterine Cervical Cancer ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Gynecology And Obstetrics

5530 Background: For uterine cervical cancer (UCC) patients with asymmetric parametric lesions, 3D HDR-intracavitary brachytherapy (HDR-ICBT) could not cover all the lesions, resulting in residual lesion and treatment failure. To settle this problem, a novel treatment modal of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy (EBRT) was used for UCC patients with stage IIB-IIIB in present study. Methods: Between June 2010 and June 2015, 338 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IIB-IIIB) were treated with concurrent chemoradiotherapy. Imaged guided IMRT was used for external beam radiotherapy, 45Gy/25f. The chemotherapy was weekly cisplatin (40mg/m2). Four fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were used. The prescribed dose for HR-CTV and IR-CTV was 7Gy (D90) and 5Gy (D90). Dose constraints for organs at risk were D2cc <70 Gy for rectum, and D2cc<90 Gy for bladder in terms of equivalent total dose in 2 Gy fractions as GEC-ESTRO recommendations. Results: Median follow-up was 64 months (11–71 months). The D90 of GTV, HR-CTV, and IR-CTV in all cases were 93.4 (85.1-107.8) Gy, 86.4 (79.9-91.3) Gy and 72.3 (70.8-75.2) Gy, respectively. The D2CC of bladder, rectum and sigmoid were 74.3Gy、65.5Gy and 64.1Gy, respectively. 5-year LRC, DFS, and OS was 90.8%, 84.1% and 80.8%, respectively. Treatment was well tolerated. The grade ≥3 genitourinary and gastrointestinal acute and late toxicities were 2.1% and 5.2%, respectively. Conclusions: The combination of HDR-ICBT with an applicator-guided IMRT is feasible for uterine cervical cancer patients with asymmetric parametric lesions. Further study is needed to determine whether this treatment modal could be used to replace the invasive interstitial brachytherapy (ISBT) in the cases of locally advanced cervical cancer where HR-CTV coverage cannot be obtained with ICBT.

scholarly journals Radical External-Beam Radiotherapy in Combination With Intracavitary Brachytherapy for Localized Carcinoma of the Cervix in Sri Lanka: Is Treatment Delayed Treatment Denied?

2020 ◽  
pp. 1574-1581
Author(s):  
Nuradh Joseph ◽  
Hasanthi Jayalath ◽  
Jayantha Balawardena ◽  
Thurairajah Skandarajah ◽  
Kanthi Perera ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Sri Lanka ◽  
External Beam Radiotherapy ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Univariable Analysis

PURPOSE Radical external-beam radiotherapy (EBRT) followed by intracavitary brachytherapy is standard of care for patients with localized carcinoma of the cervix unsuitable for radical surgery. However, outcome data are scarce in resource-limited settings. We conducted a retrospective analysis of survival in a cohort of patients treated with this strategy in Sri Lanka. PATIENTS AND METHODS All patients with localized cervical cancer treated with primary EBRT and intracavitary brachytherapy from 2014 to 2015 were included in the study. Primary end point was disease-free survival (DFS), defined as time to local or systemic recurrence or death. Univariable analysis was performed to determine the prognostic significance of the following variables: age, stage, use of concurrent chemotherapy, EBRT dose, brachytherapy dose, and time to completion of treatment (dichotomized at 60 days). Factors significant on univariable analysis were included in a multivariable model. RESULTS A total of 113 patients with available data were included in the analysis. Mean age was 58 years (range, 35-85 years), and most patients (n = 103 of 113) presented with stage ≥ IIB disease. Median time to delivery of brachytherapy from commencement of EBRT was 110 days (range, 34-215 days), with only 12 (11%) of 113 patients completing treatment within 60 days. Median follow-up was 28 months (range, 5-60 months), and 2-year DFS was 63.7% (95% CI, 55.4% to 73.2%). Treatment delay was the only significant factor associated with inferior DFS on univariable analysis (log-rank P = .03), and therefore, multivariable analysis was not performed. CONCLUSION There are significant delays in receiving intracavitary brachytherapy after completing EBRT for cervical cancer in Sri Lanka, which is associated with inferior DFS. Increasing brachytherapy resources is an urgent priority to improve outcomes of patients with cervical cancer.

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