Adjuvant Radiation for Gynecologic Cancers

2019 ◽  
Author(s):  
Joanne Jang
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Vulvar Cancer ◽  
Vaginal Cancer ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Postoperative Setting

Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery. This review contains 5 figures, and 4 tables, and 40 references.  Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer

Analysis of adjuvant chemotherapy and radiotherapy for stage II endometroid type endometrial cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17118-e17118
Author(s):  
Raanan Alter ◽  
William Adams ◽  
Alec Block ◽  
William Small ◽  
Matthew M. Harkenrider
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Tumor Size ◽  
Tumor Grade ◽  
Figo Stage ◽  
Stage Ii ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Beam Radiation ◽  
Time To Death

e17118 Background: Endometrial cancer (EC) is the most common gynecologic malignancy. Stage II EC - involving the cervix - is ideally treated with primary surgical staging; however, adjuvant treatment is not well defined. Methods: The population included 8,506 patients with 2009 FIGO Stage II endometrioid-type EC treated surgically within the National Cancer Database. Patients were categorized into six treatment groups: 1. hysterectomy (HYS) alone; 2. HYS with external beam radiation therapy (EBRT); 3. HYS with chemotherapy (CT); 4. HYS with CT and EBRT; 5. HYS with vaginal brachytherapy (VBT); and 6. HYS with CT and VBT. Univariable frailty survival analysis (UVA) that allowed for clustering of patients was used to determine the effect of sociodemographic factors and comorbidities on time to death; a generalized linear mixed effects allowing random intercepts for each treatment facility type was also used to estimate the odds of receiving any treatment beyond HYS. Results: 3,571 (42%) underwent HYS alone, while 4,312 (51%) received HYS with adjuvant radiation therapy (ART), 251 (3%) received HYS with CT, and 372 (4%) received all three modalities. Of those that received ART, 2,951 (68%) had EBRT while 1,361 (32%) had VBT. On UVA, black race, years of education, government insurance or uninsured status, higher tumor grade, greater Charlson-Deyo comorbidity count (CDCC), increased age, tumor grade, and tumor size all predicted poor survival. On MVA, patients receiving ART were only 0.747 (95% CI: 0.641 – 0.871) times as likely to die at any given time when compared with HYS alone ( p = .0002). There was no difference in survival between radiation modalities. Further, compared to patients who only received HYS, those who received HYS+CT had comparable survival estimates ( p = .20) as did patients who received HYS+ART+CT ( p = .24). When controlling for all other factors, higher tumor grade, increased CDCC, age, or tumor size, and Medicaid insurance were hazardous predictors of time to death ( p< .05). Conclusions: In stage II EC patients, adjuvant EBRT and VBT improved survival. Adjuvant CT did not improve survival though this should be further studied given the infrequency it was delivered in this population.

Impact of vaginal brachytherapy on survival in stage I endometrioid endometrial carcinoma

2020 ◽  
Vol 30 (6) ◽  
pp. 789-796 ◽  
Author(s):  
Mariam AlHilli ◽  
Sudha Amarnath ◽  
Paul Elson ◽  
Lisa Rybicki ◽  
Sean Dowdy
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
External Beam Radiation Therapy ◽  
Stage I ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Stage Ib ◽  
Stage Ia

ObjectiveTo evaluate trends in use of radiation therapy and its impact on overall survival in low- and high-grade stage I endometrioid endometrial carcinoma.MethodsPatients with stage I endometrial cancer who underwent hysterectomy from 2004 to 2013 were identified through the National Cancer Database and classified as: stage IA G1/2, stage IA G3, stage IB G1/2, and stage IB G3. Trends in use of vaginal brachytherapy and external beam radiation therapy were assessed. Overall survival was measured from surgery and estimated using the Kaplan-Meier method. The effect of radiation therapy on overall survival was assessed within each stage/grade group using Cox proportional hazards analysis in propensity-matched treatment groups.ResultsA total of 132 393 patients met inclusion criteria, and 81% of patients had stage IA and 19% had stage IB endometrial cancer. Adjuvant therapy was administered in 18% of patients: 52% received vaginal brachytherapy, 30% external beam radiation therapy, and 18% chemotherapy ±radiation therapy. External beam radiation therapy use decreased from 9% in 2004 to 4% in 2012, while vaginal brachytherapy use increased from 8% to 14%. Stage IA G1/2 patients did not benefit from either external beam radiation therapy or vaginal brachytherapy, while administration of vaginal brachytherapy improved overall survival in stage IB G1/2 compared with no treatment (p<0.0001). In stage IB G1/2 and stage IA G3, vaginal brachytherapy was superior to external beam radiation therapy (p=0.0004 and p=0.004, respectively). Stage IB G3 patients had improved overall survival with either vaginal brachytherapy or external beam radiation therapy versus no treatment but no difference in overall survival was seen between vaginal brachytherapy and external beam radiation therapy (p=0.94).ConclusionsThe delivery of adjuvant radiation therapy in patients with stage IA G1/2 endometrial carcinoma is not associated with improvement in overall survival. Patients with stage IB G1/2 and G3 as well as stage IA G3 are shown to benefit from improved overall survival when adjuvant radiation therapy is administered. These findings demonstrate potential opportunities to reduce both overtreatment and undertreatment in stage I endometrial cancer patients.

Radiation Therapy for Residual or Recurrent Atypical Meningioma

Neurosurgery ◽  
2015 ◽  
Vol 79 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Sam Q. Sun ◽  
Chunyu Cai ◽  
Rory K.J. Murphy ◽  
Todd DeWees ◽  
Ralph G. Dacey ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Tumor Progression ◽  
Cox Regression ◽  
Atypical Meningioma ◽  
Locoregional Control ◽  
External Beam Radiation ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Beam Radiation ◽  
Brain Invasion

Abstract BACKGROUND Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear. OBJECTIVE: To analyze features associated with progression after radiation therapy. METHODS: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses. RESULTS: Thirty-two patients (64%) received adjuvant radiation after subtotal resection, 12 patients (24%) received salvage radiation after progression following subtotal resection, and 6 patients (12%) received salvage radiation after recurrence following gross total resection. Twenty-one patients (42%) received SRS (median 18 Gy), and 7 (33%) had tumor progression. Twenty-nine patients (58%) received EBRT (median 54 Gy), and 13 (45%) had tumor progression. Whereas tumor volume (P = .53), SRS vs EBRT (P = .45), and adjuvant vs salvage (P = .34) were not associated with progression after radiation therapy, spontaneous necrosis (hazard ratio [HR] = 82.3, P &lt; .001), embolization necrosis (HR = 15.6, P = .03), and brain invasion (HR = 3.8, P = .008) predicted progression in univariate and multivariate analyses. Tumors treated with SRS/EBRT had 2- and 5-year actuarial locoregional control rates of 91%/88% and 71%/69%, respectively. Tumors with spontaneous necrosis, embolization necrosis, and no necrosis had 2- and 5-year locoregional control rates of 76%, 92%, and 100% and 36%, 73%, and 100%, respectively (P &lt; .001). CONCLUSION: This study suggests that necrosis may be a negative predictor of radiation response regardless of radiation timing or modality.

External beam radiation and brachytherapy boost at different facilities is associated with increased treatment delays in cervical cancer

2020 ◽  
Vol 30 (10) ◽  
pp. 1505-1512
Author(s):  
Richard Li ◽  
Elizabeth Germino ◽  
Zachary D Horne ◽  
John A Vargo ◽  
Yi-Jen Chen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Treatment Delays ◽  
Exact Test ◽  
Cancer Management ◽  
Brachytherapy Boost

IntroductionDue to variation in facility expertise and capabilities, patients commonly complete external beam radiation therapy at one facility and brachytherapy boost at another. We evaluated the association of external beam radiation therapy and brachytherapy at the same facility versus different facilities with treatment delays and survival.MethodsPatients receiving definitive external beam radiation therapy and brachytherapy for non-metastatic cervical cancer from 2004 to 2015 were identified in the National Cancer Database. Treatment delays were classified based on published thresholds: a course of >56 days was considered delayed, >65 days moderately delayed, and >77 days severely delayed. Fisher’s exact test and logistic regression were used to evaluate the association of same facility versus different facilities with treatment delays and predictors of same facility versus different facility treatment.ResultsWe identified 23 911 patients meeting the inclusion criteria at a median follow-up of 39.7 months (IQR 21.0–72.6 months), with 17 391 patients (72.7%) receiving same facility treatment and 6520 patients (27.3%) receiving different facility treatment. Any treatment delay was found in 49.3% of same facility treatments versus 51.9% of different facility treatments (p<0.001); moderate or worse delays in 24.8% of same facility versus 29.4% of different facility treatments (p<0.001); severe treatment delays in 11.3% of same facility versus 15.5% of different facility treatments (p<0.001). Receipt of same facility versus different facility treatment was independently associated with treatment delays (OR 1.28, 95% CI 1.20 to 1.37; p<0.001). Both treatment delays, particularly moderate delays (HR 1.20, 95% CI 1.13 to 1.28; p<0.001) and severe delays (HR 1.32, 95% CI 1.24 to 1.41; p<0.001), and different facility treatments (HR 1.11, 95% CI 1.06 to 1.16; p<0.001) were associated with worse survival.ConclusionsDelivery of external beam radiation therapy and brachytherapy at different facilities was associated with treatment delays and worse survival. Our findings underscore the importance of care coordination in cervical cancer management.

Radiation therapy for elderly patients with uterine cervical cancer: feasibility of curative treatment

2019 ◽  
Vol 29 (3) ◽  
pp. 622-629 ◽  
Author(s):  
Masaharu Hata
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Elderly Patients ◽  
Adult Population ◽  
Locally Advanced ◽  
Uterine Cervical Cancer ◽  
External Beam Radiation ◽  
Curative Treatment ◽  
Carbon Ions ◽  
Beam Radiation

As the average lifespan lengthens worldwide, and the older adult population increases, the number of elderly patients with uterine cervical cancer is increasing. Because intensive and invasive treatments, including surgery, are frequently unacceptable in elderly patients, cancer treatments for these patients must be carefully considered. Elderly patients have undergone radiation therapy as less-invasive curative treatment, and it has been shown to be safe and effective for local control of cervical cancer in this population, even among patients aged ≥80 years treated with curative radiation doses. Although concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer, it is unclear whether the addition of chemotherapy to radiation therapy prolongs survival in elderly patients. Elderly patients treated with curative radiation therapy for cervical cancer might develop more therapy-related gastrointestinal and hematological toxicities and insufficiency fractures compared with younger patients. However, advanced techniques of radiation therapy (eg, intensity-modulated radiation therapy and volumetric modulated arc therapy with photons, charged-particle radiation therapy with protons and carbon ions in external-beam radiation therapy, and image-guided adaptive brachytherapy) can minimize radiation-induced toxicities and thus make curative treatment safer and more effective for elderly patients with uterine cervical cancer.

Disparities in the Use of Adjuvant External Beam Radiation Therapy in Node-positive Cervical Cancer Patients Following Hysterectomy

2020 ◽  
Vol 43 (1) ◽  
pp. 43-46
Author(s):  
Dimitrios Nasioudis ◽  
Kelsey Musselman ◽  
Sushmita Gordhandas ◽  
Eloise Chapman-Davis ◽  
Melissa K. Frey ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Node Positive
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