Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Lin, Yanzhu; Ouyang, Yan‐Qiong; Chen, Kai; Lu, Zhiyuan; Liu, Yonghong; Cao, Xuejun

doi:10.3389/fonc.2019.00760

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…By applying KBP, the dosimetric indices of the rectum and the bladder, such as D mean , V 40Gy and V 30Gy , were all significantly reduced ( p < 0.001) under the condition of approximately similar target dose distributions. This may contribute to the fact that the incidence of late toxicities at our institution appeared to be lower than those reported in previous studies [ 3 ]. Moreover, the KBP method was found to help standardize the patient treatment, making treatment results less operator- and experience-dependent.…”

Section: Discussioncontrasting

confidence: 52%

Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer

Wang

et al. 2021

Radiat Oncol

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Background and purpose To explore whether a highly refined dose volume histograms (DVH) prediction model can improve the accuracy and reliability of knowledge-based volumetric modulated arc therapy (VMAT) planning for cervical cancer. Methods and materials The proposed model underwent repeated refining through progressive training until the training samples increased from initial 25 prior plans up to 100 cases. The estimated DVHs derived from the prediction models of different runs of training were compared in 35 new cervical cancer patients to analyze the effect of such an interactive plan and model evolution method. The reliability and efficiency of knowledge-based planning (KBP) using this highly refined model in improving the consistency and quality of the VMAT plans were also evaluated. Results The prediction ability was reinforced with the increased number of refinements in terms of normal tissue sparing. With enhanced prediction accuracy, more than 60% of automatic plan-6 (AP-6) plans (22/35) can be directly approved for clinical treatment without any manual revision. The plan quality scores for clinically approved plans (CPs) and manual plans (MPs) were on average 89.02 ± 4.83 and 86.48 ± 3.92 (p < 0.001). Knowledge-based planning significantly reduced the Dmean and V18 Gy for kidney (L/R), the Dmean, V30 Gy, and V40 Gy for bladder, rectum, and femoral head (L/R). Conclusion The proposed model evolution method provides a practical way for the KBP to enhance its prediction ability with minimal human intervene. This highly refined prediction model can better guide KBP in improving the consistency and quality of the VMAT plans.

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Section: Discussioncontrasting

confidence: 52%

Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer

Wang

et al. 2021

Radiat Oncol

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“…Due to the rareness of the disease, only a limited number of patients are treated per facility [ 30 ]. These aspects might explain that to date, only a few, mostly small studies have reported clinical results with VMAT [ 15 – 18 ]. A systematic comparison of VMAT with other EBRT techniques has only been occasionally reported [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…These aspects might explain that to date, only a few, mostly small studies have reported clinical results with VMAT [ 15 – 18 ]. A systematic comparison of VMAT with other EBRT techniques has only been occasionally reported [ 18 ]. We herein compared clinical results with VMAT to clinical results with conventional 3DCRT.…”

Section: Discussionmentioning

confidence: 99%

“…On a clinical level, a few studies have reported favorable toxicity profiles or promising outcomes with VMAT, whereby these studies focused on adjuvant treatment [ 15 ], neoadjuvant treatment [ 16 ], or treatment in elderly patients [ 17 ]. However, comparisons of VMAT with other external beam radiotherapy (EBRT) techniques are still rare [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters

et al. 2021

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Purpose Intensity-modulated radiotherapy (IMRT) for cervical cancer yields favorable results in terms of oncological outcomes, acute toxicity, and late toxicity. Limited data are available on clinical results with volumetric modulated arc therapy (VMAT). This study’s purpose is to compare outcome and toxicity with VMAT to conventional 3D conformal radiotherapy (3DCRT), giving special consideration to the influence of patient- and treatment-related parameters on side effects. Materials and methods Patients with cervical cancer stage I–IVA underwent radiotherapy alone or chemoradiotherapy using 3DCRT (n = 75) or VMAT (n = 30). Survival endpoints were overall survival, progression-free survival, and locoregional control. The National Cancer Institute Common Terminology Criteria for Adverse Events and the Late Effects of Normal Tissues criteria were used for toxicity assessment. Toxicity and patient- and treatment-related parameters were included in a multivariable model. Results There were no differences in survival rates between treatment groups. VMAT significantly reduced late small bowel toxicity (OR = 0.10, p = 0.03). Additionally, VMAT was associated with an increased risk of acute urinary toxicity (OR = 2.94, p = 0.01). A low body mass index (BMI; OR = 2.46, p = 0.03) and overall acute toxicity ≥grade 2 (OR = 4.17, p < 0.01) were associated with increased overall late toxicity. Conclusion We demonstrated significant reduction of late small bowel toxicity with VMAT treatment, an improvement in long-term morbidity is conceivable. VMAT-treated patients experienced acute urinary toxicity more frequently. Further analysis of patient- and treatment-related parameters indicates that the close monitoring of patients with low BMI and of patients who experienced relevant acute toxicity during follow-up care could improve late toxicity profiles.

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“…Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy has been widely used for post-operative patients with uterine cervical cancer [ 1 ]. VMAT can achieve excellent treatment outcomes for cervical cancer while effectively reducing gastrointestinal and urinary toxicity in comparison with three-dimensional conformal radiotherapy [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Knowledge-based planning using pseudo-structures for volumetric modulated arc therapy (VMAT) of postoperative uterine cervical cancer: a multi-institutional study

Kamima

Ueda

Fukunaga

et al. 2021

Rep Pract Oncol Radiother.

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Background The aim of this study was to investigate the performance of the RapidPlan (RP ) using models registered pseudostructures, and to determine how many structures are required for automatic optimization of volumetric modulated arc therapy (VMAT) for postoperative uterine cervical cancer. Materials and methods Pseudo-structures around the PTV were retrospectively contoured for patients who had completed treatment at five institutions. For 22 common patients, plans were generated with a single optimization for models with two (RP_2), four (RP_4), and five (RP_5) registered structures, and the dosimetric parameters of these models were compared with a clinical plan with several optimizations. Results Most dosimetric parameters showed no major differences between each RP model. In particular, the rectum D max , V 50Gy , and V 40Gy with RP_2, RP_4, and RP_5 were not significantly different, and were lower than those of the clinical plan. The average proportions of plans achieving acceptable criteria for dosimetric parameters were close to 100% for all models. Using RP_2, the average time for the VMAT planning was reduced by 88 minutes compared with the clinical plan. Conclusion The RapidPlan model with two registered pseudo-structures could generate clinically acceptable plans while saving time.

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Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Cited by 12 publications

References 28 publications

Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer

Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer

Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters

Knowledge-based planning using pseudo-structures for volumetric modulated arc therapy (VMAT) of postoperative uterine cervical cancer: a multi-institutional study

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