Change in Patterns of Failure After Image-Guided Brachytherapy for Cervical Cancer: Analysis From the RetroEMBRACE Study

Tan, Li Tee; Pötter, Richard; Sturdza, Alina; Fokdal, Lars; Haie-Méder, Christine; Schmid, Maximilian; Gregory, D.; Petrič, Primož; Jürgenliemk-Schulz, Ina M.; Gillham, Charles; Limbergen, E. Van; Hoskin, Peter; Tharavichitkul, Ekkasit; Villafranca, E.; Mahantshetty, Umesh; Kirisits, Christian; Lindegaard, J.C.; Kirchheiner, Kathrin; Tanderup, Kari

doi:10.1016/j.ijrobp.2019.03.038

Cited by 74 publications

(64 citation statements)

References 22 publications

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“…40 In their updated analysis, Tan et al describe the change in predominant relapse patterns from locoregional failure with conventional brachytherapy, to systemic failure after image guided brachytherapy, thus highlighting the excellent locoregional disease control with image guided brachytherapy and the transition of focus to more effective systemic therapy in the current era. 41 This observation of distant recurrences predominating over locoregional relapses was also seen in our study. Another area of interest is the addition of PET-CT as part of initial staging investigation, where dose escalation in FDG-avid nodal areas could potentially result in greater regional disease control.…”

Section: Discussionsupporting

confidence: 89%

The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

Song

Alyamani

Bhattacharya

et al. 2020

Advances in Radiation Oncology

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Radical concurrent chemoradiotherapy with combined external beam radiotherapy (EBRT) and brachytherapy is used to treat locally advanced cervical cancer. Our institution has transitioned to high-dose-rate (HDR) intracavitary brachytherapy (ICBT) from lowdose-rate (LDR) brachytherapy in 2008, and a review was conducted on the effect of this change on patient outcomes. Methods and Materials: A single-arm retrospective chart review was performed on locally advanced (Fédération Internationale de Gynécologie et d'Obstétrique stage IB-IVA) patients with cervical cancer treated with combined external beam radiation therapy and HDR-ICBT with curative intent between 2008 and 2014. Clinical outcomes were evaluated, and multivariate analysis was performed to identify prognostic factors. Results: Of the 76 patients selected, median age was 47.9 years and median follow-up was 5.2 years. Thirteen patients (17.1%) developed locoregional recurrence and 23 patients (30.3%) patients developed distant recurrence. Five-year progression-free survival and overall survival were 63.7% and 69.3%, respectively. A significant survival difference was found between stages (P < .001). Multivariate analysis found nodal involvement was strongly associated with poorer survival (P Z .007). Conclusions: Our experience with the transition to HDR-ICBT as part of concurrent chemoradiotherapy in treatment of locally advanced cervical cancer resulted in acceptable long-term outcomes and toxicity to that of LDR brachytherapy. Potential further improvement of treatment outcomes for patients may be possible with image guided brachytherapy and the addition of effective systemic therapy.

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Section: Discussionsupporting

confidence: 89%

The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

Song

Alyamani

Bhattacharya

et al. 2020

Advances in Radiation Oncology

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“…The possible explanation of our findings might be cancer-associated muscle loss after CCRT [26][27][28]. The circulating tumor cells (CTCs) in LACC may not be completely eradicated by CCRT [3][4][5][6]29]. Elevated CTCs levels are also associated with poor disease-free survival in LACC [29], implying that residual CTCs after CCRT might contribute to progressive muscle loss before resulting in gross detectable distant failures [30,31].…”

Section: Discussionmentioning

confidence: 91%

“…Multivariable Cox proportional hazards regression analysis was used to develop multivariable models, including a "clinical model" (which included clinical prognostic parameters), a "weight-loss model" (adding weight change to the "clinical model"), and a "muscle-loss model" (adding SMI and SMD change to the "clinical model"). Clinical parameters considered for their potential prognostic ability in the LACC included the FIGO stage (IB-II vs. III-IVA), PLN involvement (negative vs. positive), pathology (SCC vs. adenocarcinoma), and SCC-Ag (continuous variable) [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…However, the main type of treatment failure after CCRT is distant failure [2][3][4][5][6]. Adjuvant chemotherapy after CCRT might improve survival outcomes [7], but its role remains controversial [8][9][10], and this may be attributed to the insufficiency of current classical risk stratification for high-risk patients [6]. The classical prognostic factors, such as International Federation of Gynaecology and Obstetrics (FIGO) stage, lymph nodes, histology, and Figure 1.…”

Section: Introductionmentioning

confidence: 99%

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Muscle Loss after Chemoradiotherapy as a Biomarker of Distant Failures in Locally Advanced Cervical Cancer

Lee

Lin

et al. 2020

Cancers

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This study aimed to evaluate whether computed tomography (CT)-based muscle measurement predicts distant failure in patients with locally advanced cervical cancer (LACC). Data from 278 patients with LACC who underwent chemoradiation therapy (CCRT) between 2004 and 2017 were analysed. Changes in the skeletal muscle index (SMI), skeletal muscle density, and total adipose tissue index during CCRT were calculated from CT images taken at the baseline and after CCRT. The predictive capability of CT-based muscle measurement for distant failure was evaluated using Cox proportional hazards regression, Harrell’s concordance index (C-index), and time-dependent receiver operating characteristic curves. SMI loss ≥ 5% was independently associated with worse distant recurrence-free survival (DRFS) (HR: 6.31, 95% CI: 3.18–12.53; p < 0.001). The addition of muscle change to clinical models, including International Federation of Gynaecology and Obstetrics (FIGO) stage, lymph nodes, pathology, and squamous cell carcinoma-antigen, achieved higher C-indices (0.824 vs. 0.756; p < 0.001). Models including muscle change had superior C-indices than those including weight change (0.824 vs. 0.758; p < 0.001). The area under the curve for predicting 3-year DRFS was the highest for the muscle-loss model (0.802, muscle-loss model; 0.635, clinical model; and 0.646, weight-loss model). Our study demonstrated that muscle loss after CCRT was independently associated with worse DRFS and that integrating muscle loss into models including classical prognostic factors improved the prediction of distant failure.

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“…We have made major advancements with image guided brachytherapy in changing the patterns of recurrence from predominantly local to distant, but at least 20% of women need needles to accomplish this. 6 New hybrid applicators provide easier and safer ways to add needles compared with full interstitial template-based implants. The fact that the addition of needles was viewed as enough of an impediment, even at a large academic institution, to include it as an exclusion criterion raises a major problem that must be addressed.…”

mentioning

confidence: 99%

SAbR as an Alternative Boost Modality for Cervical Cancer: A Cautionary Exercise

Kamrava

Chino

Beriwal

2020

International Journal of Radiation Oncology*Biology*Physics

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Change in Patterns of Failure After Image-Guided Brachytherapy for Cervical Cancer: Analysis From the RetroEMBRACE Study

Cited by 74 publications

References 22 publications

The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer

Muscle Loss after Chemoradiotherapy as a Biomarker of Distant Failures in Locally Advanced Cervical Cancer

SAbR as an Alternative Boost Modality for Cervical Cancer: A Cautionary Exercise

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