A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy

Bloemers, M.; Portelance, Lorraine; Ruo, R.; Parker, William; Souhami, Luís

doi:10.1016/j.meddos.2011.11.005

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…A similar comparison of these treatment schemes in vulvar carcinoma patients yielded comparable sparing of nearby structures, with differences in favor of SIB IMRT for the small bowel (17) . Our results are consistent with these previous findings, but show greater sparing of organs‐at‐risk, including those partially embedded within the target volumes.…”

Section: Discussionmentioning

confidence: 88%

“…Previous studies have illustrated the improved conformity and homogeneity during delivery of radiation therapy using SIB IMRT over sequential IMRT in a variety of anatomic sites (16,17) . While some authors have investigated the use of SIB for replacing the brachytherapy boost of gross disease, (23) there is no thorough dosimetric analysis of these parameters for boosting nodal targets in locally advanced cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that SIB IMRT may deliver smaller doses to nontarget tissues, thus reducing toxicity to organs at risk during pelvic irradiation. A previous dosimetric comparison of sequential versus SIB IMRT plans in locally advanced vulvar carcinoma patients indicate that higher doses may be delivered to target volumes using SIB IMRT plans with no significant increase in radiation to surrounding organs (17) . Thus, we performed a paired dosimetric comparison of sIMRT and SIB IMRT to treat the pelvic targets while either sequentially or simultaneously boosting PET avid lymph nodes in locally advanced cervical cancer (11,18) .…”

Section: Introductionmentioning

confidence: 99%

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Simultaneously integrated boost (SIB) spares OAR and reduces treatment time in locally advanced cervical cancer

Feng

Hasan

Kopeć

et al. 2016

J Applied Clin Med Phys

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We performed a dosimetric comparison of sequential IMRT (sIMRT) and simultaneously integrated boost (SIB) IMRT to boost PET‐avid lymph nodes while concurrently treating pelvic targets to determine the potential of SIB IMRT to reduce overall treatment duration in locally advanced cervical cancer. Ten patients receiving definitive radiation therapy were identified retrospectively. RTOG consensus guidelines were followed to delineate the clinical target volume and organs at risk (OAR), which were then expanded per IMRT consortium guidelines to yield the planning target volume (PTV). Dosimetric parameters for PTVs and OAR including conformity (CI95%) were collected and compared using Wilcoxon signed‐rank tests with Bonferroni correction. The median PTV volume was 1843 cc (1088–2225 cc) and the median boost volume was 43 cc (15–129 cc). Comparable target volume coverage was achieved with sIMRT and SIB plans, while hot spots were significantly reduced using SIB. SIB plans improved sparing for all OAR, though only rectum and small bowel doses were statistically significant. Comparing sIMRT and SIB plans averaged over all patients, rectal doses were V45: 70.8% vs. 64.5%false(p=0.002false) and 0.1 cc: 50.7 Gy vs. 48.7 Gy false(p=0.006false). For small bowel, sIMRT and SIB IMRT plans yielded V45: 13.4% vs. 11.4%false(p=0.006false) and 1 cc: 54.4 Gy vs. 52.6 Gy false(p=0.006false), respectively. Doses to femoral heads and bladder trended towards significance in favor of SIB plans. The mean treatment time was 25 versus 29 days for SIB and sIMRT plans, respectively. When compared to sIMRT, SIB for treatment of nodal targets provides a significant, but small, dose reduction (3.8%–4.4%) to OAR, which leads to comparable biological dose despite higher fractional doses. Furthermore, SIB IMRT reduces overall treatment time and simplifies the planning process, and should be considered for targeting PET‐positive nodal disease in patients with locally advanced cervical cancer.PACS number(s): 87.19.xj cancer

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simultaneously integrated boost (SIB) spares OAR and reduces treatment time in locally advanced cervical cancer

Feng

Hasan

Kopeć

et al. 2016

J Applied Clin Med Phys

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“…Radiation has traditionally been administered in the supine, frog-legged position using opposed anteroposterior-posteroanterior field setup in addition to supplemental dose to the vulva or inguinal nodes as needed. Beriwal et al 3 and Bloemers et al 4 have shown in dosimetric studies that intensity modulated RT (IMRT) may be advantageous in the treatment of vulvar cancer because it may reduce dose to small bowel, rectum, bladder, and femurs.…”

Section: Introductionmentioning

confidence: 99%

Intensity modulated radiation therapy for squamous cell carcinoma of the vulva: Treatment technique and outcomes

Rao

Chundury

Schwarz

et al. 2017

Advances in Radiation Oncology

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ObjectiveThe objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer.Methods and materialsThis retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients.ResultsThe median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89% and 67%, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42% and 49%, respectively. In patients receiving definitive or neoadjuvant IMRT, 69% had complete clinical response and 44% had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7%. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities.ConclusionsIMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.

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“…54 The Radiation Therapy Oncology Group is creating an IMRT contouring atlas for vulvar cancer. Fourteen patients underwent surgery, 9 patients had a pathologic complete response, and 5 patients had partial responses.…”

Section: Intensity-modulated Radiation Therapy (Imrt)mentioning

confidence: 99%

ACR Appropriateness Criteria® Management of Locoregionally Advanced Squamous Cell Carcinoma of the Vulva

Kidd¹,

Moore

Varia

et al. 2013

American Journal of Clinical Oncology

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A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy

Cited by 16 publications

References 19 publications

Simultaneously integrated boost (SIB) spares OAR and reduces treatment time in locally advanced cervical cancer

Simultaneously integrated boost (SIB) spares OAR and reduces treatment time in locally advanced cervical cancer

Intensity modulated radiation therapy for squamous cell carcinoma of the vulva: Treatment technique and outcomes

ACR Appropriateness Criteria® Management of Locoregionally Advanced Squamous Cell Carcinoma of the Vulva

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