A Comparative Analysis of Two Different Dose Fractionation Regimens of High Dose Rate Intracavitary Brachytherapy in Treatment of Carcinoma of Uterine Cervix: A Prospective Randomized Study

Bs, Rao; Das, Priyanka; Subramanian, BV; Jena, Amitabh; Rashmi, Priyanka; Vla, Konakalla; Jayasree, K

doi:10.7860/jcdr/2017/22489.9607

Cited by 11 publications

(12 citation statements)

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“…The aim of our present study was to compare two treatment schedules of HDR ICBT in cancer cervix in terms of late toxicities, local control, disease-free survival, and overall survival rates. In the past, many studies have compared higher dose per fraction with ABS recommended schedule, and the presented results are rewarding [7,8,9,15].…”

Section: Discussionmentioning

confidence: 99%

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer – regional cancer center experience

Thakur

Dogra

Gupta

et al. 2019

jcb

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Purpose: The study is to evaluate the difference between outcomes of two high-dose-rate fractionation schedules in the treatment of intracavitary brachytherapy (ICBT) of cervical cancer. Material and methods: A retrospective analysis of 163 cervical cancer patients was completed. All patients received external beam radiotherapy (EBRT) to whole pelvis with concurrent weekly chemotherapy, followed by ICBT with either 7 Gy per fraction in three fractions (arm A) or 9 Gy per fraction in two fractions (arm B). Median follow-up was 19 months. The outcomes were compared in terms of 2-year actuarial local control, disease-free survival, overall survival, and late toxicity in the two treatment arms. Results: The 2-year actuarial local control rates in arm A and arm B were 88.5% and 91.5%, respectively. The actuarial 2-year disease-free survival rates in arm A and arm B were 85.9% and 82.6%, respectively. The actuarial 2-year overall survival in arm A and arm B were 95.7% and 100%, respectively (p = 0.06). There were 12.7% and 15.2% local failures in arm A and arm B, respectively. Distant metastases were seen in 8.5% and 7.6% in arm A and arm B, respectively. The 2-year actuarial risk of developing late rectal toxicity in arm A and arm B were 5.6% and 5.4%, respectively. The 2-year actuarial risk of developing late bladder toxicity in arm A and arm B were 2.8% and 2.2%, respectively. Conclusions: ICBT treatment with 9 Gy in two fractions offers equivocal local control rates and survival rates in cancer cervix cases with many advantages of short overall treatment time, improved patient compliance, cost effectiveness, and reduced exposure to aesthetic agents. The toxicities observed were few, low grade, and easily manageable.

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Section: Discussionmentioning

confidence: 99%

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer – regional cancer center experience

Thakur

Dogra

Gupta

et al. 2019

jcb

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“…The prescription and fractionation is ∼24 Gy in 3 fractions (as per Rao et al .) ( 5 ) with CT-based planning using parameters from the EMBRACE II protocol. Treatment is then delivered, and the implant removed.…”

Section: Methodsmentioning

confidence: 99%

Paracervical blocks facilitate timely brachytherapy amidst COVID-19

et al. 2021

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Purpose The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer, the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of locally advanced cervical cancer in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based intracavitary brachytherapy (ICBT). Methods and Materials This technical report will highlight our experience with the use of paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment. Results 18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCBs and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D 2cc for rectum and bladder were 64.8 (58.6–70.2) Gy and 84.1 (70.9–89.4) Gy, respectively. Median (IQR) CTV high-risk D 90 was 88.0 (85.6–89.8) Gy. Conclusions In a multidisciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.

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“…If this was unavailable, 2D point-based planning was strongly recommended [25,[33][34][35][36][37]. ASTRO also strongly recommended total EQD2 of brachytherapy and EBRT to >80 Gy [13,25,30,38]. A D90 ≥8500 cGy was conditionally recommended for tumors that poorly responded to EBRT or tumors >4 cm, with careful consideration to normal tissue constraints [18,[39][40][41].…”

Section: Metricmentioning

confidence: 99%

MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States

Ahmed¹,

Vijayakumar²,

Duggar³

et al. 2021

Cureus

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Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting. The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.

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A Comparative Analysis of Two Different Dose Fractionation Regimens of High Dose Rate Intracavitary Brachytherapy in Treatment of Carcinoma of Uterine Cervix: A Prospective Randomized Study

Cited by 11 publications

References 20 publications

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer – regional cancer center experience

Comparison of iso-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer – regional cancer center experience

Paracervical blocks facilitate timely brachytherapy amidst COVID-19

MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States

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