American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

Abstract

PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFSdRT: 55%, SD: 10; CRT: 65%, SD: 7; OSdRT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1–6% and for chemoRT 2–20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4–11% and for chemoRT, 1–11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1–2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.

High dose-rate tandem and ovoid brachytherapy in cervical cancer: dosimetric predictors of adverse events

“…There are inherent challenges to comparing toxicity outcomes across different series. The American Brachytherapy Task Group conducted a meta-analysis of retrospective and prospective series from 2000 to 2015 [ 16 ]. In their report, the late GI and GU toxicities ranged from 4 to 11% and 1–6%, respectively, for radiation alone and 1–11% and 2–20%, respectively, for chemo-radiation.…”

Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

“…Perhaps there are subsets of patients that have a high risk of systemic failure, for example those with lymph node burden, where local control with BT would not be as impactful to the overall prognosis or quality of life. At this time, given the available literature, BT remains the standard treatment for all locally advanced cervical cancer patients [2]. In addition, our data was unable to detail specific institutional brachytherapy case load which can influence both quality and practice patterns of brachytherapy [25].Gynecologic brachytherapy requires a coordinated and skilled team, which may limit the number of cancer treatment centers that could offer the care required for brachytherapy services [26].…”

Management for locally advanced cervical cancer: new trends and controversial issues

“…In 2007, Potter et al [56] reported that MRI-assisted adaptive BT was more effective in LC in tumors larger than 5 cm. The American Brachytherapy Task Group [57] reported the pooled analysis of outcomes for high-dose BT for cervical cancer. In their analysis, 57 studies www.e-roj.org https://doi.org/10.3857/roj.2018.00500 used point A prescription, while 10 studies used image-based BT.…”