Brachytherapy in the treatment of cervical cancer: a review

Banerjee, Robyn; Kamrava, Mitchell

doi:10.2147/ijwh.s46247

Cited by 82 publications

(65 citation statements)

References 75 publications

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“…As organs of interest are hollow, the filling status of the spective organ should be clearly stated, especially for the brachytherapy component. The most constant filling status possible is advised for valid and reliable data collection, especially for the bladder, as this may change within short time periods [9,16,17]. Among our patients, dosimetric parameters as D0.1cc, D2cc and ICRU (rectum and bladder) did not indicate dependence on the tumor volume.…”

Section: Discussionmentioning

confidence: 70%

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

Pobijakova¹,

Šćepanović²,

Paluga³

et al. 2018

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Cervical cancer is the third most common cancer in women worldwide. Standard of care for patients with node positive or locally advanced tumors >4 cm is definitive radiotherapy and concurrent chemotherapy. Brachytherapy is an integral part of definitive radiotherapy for cervical cancer. The aim of the study was to show a dynamics of High Risk Clinical Target Volume (HR-CTV) reduction during Brachytherapy (BT) as a part of definitive treatment (External Beam Radiotherapy /EBRT/ +/- Chemotherapy /ChT/) depending on the initial Gross Tumor Volume (GTV) and its impact on HR-CTV coverage in patients with inoperable cervical cancer. We analyzed the dosimetric data for BT of 54 patients who have had Three Dimensional Planning of BT (3D BT). The Gross Tumor Volume, HR-CTV and organs at risk (OARs) were contoured on the magnetic resonance imaging (MRI), subsequently on the co-registered MRI images with computed tomography (CT). Point A and ICRU 38 rectal and bladder points were defined on reconstructed CT images. Patients were categorized on the basis of whether the 100% isodose line of the point-A prescription dose encompassed the HR-CTV (1st group) or not (2nd group). The 30cc volume has been determined as a cut-off value, which represented the most acceptable value of intermediate size of volumes. The initial mean value of GTV was 42cc. After completion of EBRT/ChT, the mean GTV was 3.24cc what was 91% reduction rate in relation to the initial value. We followed the dynamics of HR-CTV reduction during BT and have noted its minimal reduction from 24.3cc (mean value) at the time of the first fraction to the 24.1cc before fourth fraction. The mean V100 was 98% and increased with decreasing of the volume size (p=0.0063, Fisher's exact test). D90 (mean value was 96.3 Gy10) has been correlated with V100 and also, it increased with decreasing of the volume size (p=0.0003). The mean D0.1cc and D2cc of rectum doses were 80 Gy3 and 65.6 Gy3, respectively. The mean ICRU rectal dose for all patients was 67.2 Gy3. The mean D0.1cc (99.5 Gy3), D2cc (79.5 Gy3) and ICRU (75.2 Gy3) of bladder doses were acceptable. Dynamics of HR-CTV reduction during BT was minimal, although, significant reduction of the GTV was achieved after EBRT/ChT. This study revealed that the dose prescription of 7 Gy × 4 fractions to point A was not sufficient indicator for dose coverage of the HR-CTV. However, dosimetric parameters as V100 and D90 were strong indicators for coverage of HR-CTV which was inversely related to the volume of the target and the extension of tumor. However, dosimetric parameters for rectum and bladder (D0.1cc, D2cc and ICRU) did not show dependence on the target volumes.

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Section: Discussionmentioning

confidence: 70%

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

Pobijakova¹,

Šćepanović²,

Paluga³

et al. 2018

neo

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“…Given the tendency of cervical carcinoma to extend into local contiguous tissue, risk assessment of targeted therapy should utilize imaging to determine the degree of cancer spread and possibility of collateral damage to healthy tissue [1] . There are many techniques available to guide the placement of interstitial brachytherapy needles under fluoroscopic, ultrasound, MRI, CT, and laparoscopic guidance to minimize the risk of damage to surrounding structures [1] . One study also used 3D MRI preplanning to reduce the risk of complications by virtually planning needle positions before the procedure was performed [12] .…”

Section: Discussionmentioning

confidence: 99%

“…Cervical cancer is the third most common cancer among women worldwide, but improvements in screening methods and the development of the human papilloma virus vaccine have decreased its incidence by 70% over 50 years [1] . Early stage cervical cancer, defined as stage IA and IB1 based on the International Federation for Gynecology and Obstetrics staging classification, is primarily treated with modified radical hysterectomy rather than primary radiation therapy (RT) [2] , [3] .…”

Section: Introductionmentioning

confidence: 99%

Bleeding after interstitial brachytherapy for cervical cancer requiring embolization

Aggarwal

Chuprin

Aggarwal

et al. 2018

Radiology Case Reports

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Cervical cancer is the third most common cancer among women worldwide and is usually managed with chemoradiation in advanced disease. This case presents a 41-year-old female with locally advanced cervical cancer who underwent combination intracavitary/interstitial brachytherapy after chemoradiation for local disease control. At her fifth brachytherapy session, one of the interstitial needles was malpositioned and lead to vascular injury with significant blood loss. She subsequently underwent emergent embolization of a branch of the right obturator artery with immediate clinical improvement and no complications. This is the first reported case of vascular injury from an interstitial brachytherapy needle that required arterial embolization for hemostasis.

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“…These are real dollars that may be a challenge for smaller centers only treating a small number of patients. For the approximately 15% of radiation therapy centers in the United States that do not have access to HDR equipment, 8 the startup cost for such a program may be prohibitive. This will be even more of a challenge for developing countries with considerably lower healthcare budgets than developed countries.…”

Section: Opening Statementmentioning

confidence: 99%

Low dose‐rate brachytherapy for the treatment of cervix cancer is outdated and should be discontinued

Meadows¹,

Bichay²,

Orton³

2016

Medical Physics

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Brachytherapy in the treatment of cervical cancer: a review

Cited by 82 publications

References 75 publications

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

Bleeding after interstitial brachytherapy for cervical cancer requiring embolization

Low dose‐rate brachytherapy for the treatment of cervix cancer is outdated and should be discontinued

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