Combined intracavitary and interstitial brachytherapy of cervical cancer using the novel hybrid applicator Venezia: Clinical feasibility and initial results

Walter, Franziska; Maihöfer, Cornelius; Schüttrumpf, Lars; Well, Justus; Burges, Alexander; Ertl‐Wagner, Birgit; Mahner, Sven; Belka, Claus; Gallwas, Julia; Corradini, Stefanie

doi:10.1016/j.brachy.2018.05.009

Cited by 60 publications

(52 citation statements)

References 10 publications

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“…Treatment outcomes were comparable with our results (local control, recurrences, and survival data) when analyzed in FIGO stages IIB-IVB, but with a substantial higher rate of serious late side effects (20% of grade 3-4 toxicity, including 4 fistulas) and acute treatment-related complications (active bleeding in 27% of cases). In a smaller series of 10 patients, with a total of 40 fractions, another new hybrid applicator (Venezia) was tested and was found to be feasible, enabling improved dose coverage and sparing organs at risk [24].…”

Section: Discussionmentioning

confidence: 99%

Combined external pelvic chemoradiotherapy and image-guided adaptive brachytherapy in treatment of advanced cervical carcinoma: experience from a single institution

Möller

Mordhorst

Hermansson

et al. 2020

jcb

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Purpose: External pelvic chemoradiotherapy and image-guided adaptive brachytherapy (IGABT) were studied in advanced cervical carcinomas. Treatment modalities were defined and related to outcomes and side effects. Material and methods: From a single cancer center, 138 patients with advanced cervical cancer were recruited. All patients were treated with external radiotherapy and IGABT. A dosimetric study was performed and related to treatment outcome and side effects. Toxicity of the organs at risk was evaluated by the CTCAE-grading system. Results: The median follow-up was 44 months. More than 60% of the tumors were FIGO stage IIB-IIIB and 82% were squamous cell carcinomas. Largest tumor size (width) was in mean 41 mm and 27% had lymph node spread. The mean total external dose was 51 Gy, and the mean total dose to the high-risk clinical target volume (HRCTV) was 88 Gy. In 130 patients (94%), weekly cisplatin was given in 4-6 cycles. The median number of brachytherapy fractions was four, and in 86 patients, interstitial needles were applied. The primary local control was 97% and 94% after four local recurrences. The overall pelvic control was 89%. The overall recurrence rate was 25% and distant metastases rate was 22%. The overall 5-year survival rate was 65% and cancer-specific survival rate was 69%. Prognostic factors were FIGO stage and total brachytherapy dose (D 90) to HRCTV. Late serious toxicity of the bladder and intestine were rare, occurring in only 3% of patients. Conclusions: The local and pelvic control rates were excellent in this series. The IGABT was an important part of the treatment schedule and could probably not be replaced by increasing the external pelvic dose. Adenocarcinomas seemed to benefit from the addition of interstitial needles. Late serious toxicity was rare.

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Section: Discussionmentioning

confidence: 99%

Combined external pelvic chemoradiotherapy and image-guided adaptive brachytherapy in treatment of advanced cervical carcinoma: experience from a single institution

Möller

Mordhorst

Hermansson

et al. 2020

jcb

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“…[ 24 25 ] Combined intracavitary-interstitial (IC/IS) applicators have been developed for targeting tumors that are not well covered by IC applicators. [ 26 27 28 29 ] IC/IS applicators allow for improved dose conformality, and target dose escalation and/or dose de-escalation in organs at risk can be carried out. [ 27 30 ] The use of IC/IS-BT in large tumors significantly increased local control without increasing morbidity.…”

Section: Discussionmentioning

confidence: 99%

Bibliometric analysis of the 100 most cited articles on cervical cancer radiotherapy

Zhao

Tang

et al. 2020

Medicine

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Purpose: To identify the 100 most cited research articles on cervical cancer radiotherapy. Methods: The Web of Science and Scopus databases were searched to identify the 100 most cited articles on cervical cancer radiotherapy as of September 29, 2019. Articles were ranked based on the total citations received from 2 databases. One hundred articles about radiotherapy for cervical cancer were identified. The following important information was extracted: author, journal, year and month of publication, country or region, and radiotherapy technologies. Results: The 100 most cited articles on cervical cancer radiotherapy were published between 1964 and 2016, and the total citations from 2 databases ranged from 3478 to 211, including a total of 49,262 citations as of September 29, 2019. The index of citations per year ranged from 170.4 to 13.1. These articles were from 16 countries or regions, with most publications being from the United States (n = 38), followed by Austria (n = 15), Canada (n = 8), France (n = 8) and the United Kingdom (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 42), followed by Radiotherapy and Oncology (n = 13), Cancer (n = 8) and Journal of Clinical Oncology (n = 7). These articles were categorized as original studies (n = 86), recommendations (n = 5), guidelines (n = 5) and reviews (n = 4). Of the 100 most cited articles, intracavitary brachytherapy (n = 50) and 3-dimensional conformal radiotherapy (n = 34) were the most commonly used treatment techniques. Conclusion: To the best of our knowledge, this is the first report and analysis of the most cited articles on cervical cancer radiotherapy. This bibliographic study presents the history of technological development in external radiation therapy and brachytherapy. Brachytherapy is an indispensable part of radiotherapy for cervical cancer. The International Journal of Radiation Oncology Biology Physics is the journal with the most publications related to cervical cancer radiotherapy.

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“…For cervical cancer treatments, combined intracavitary and interstitial brachytherapy can be performed using a tandem and ring (TR) applicator [1,2]. The path of a high-dose-rate (HDR) brachytherapy source has been found to deviate from centerline in a curved ring channel when pushed toward an outer wall by a drive cable [3,4,5].…”

Section: Purposementioning

confidence: 99%

“…In addition to full-ring applicators, different split-ring designs have been introduced for gynecological treatments including the Mick ® split-ring applicator (Eckert & Ziegler BEBIG, Germany) and the Venezia TM advanced gynecological applicator (Elekta, Sweden) [2,12]. The present study focuses on the Venezia TM applicator first used clinically in 2017 [2]. The Venezia TM applicator (Figure 1) incorporates three available lunar ovoid sizes with an effective diameter between split-ring channels of 22, 26, or 30 mm [13].…”

Section: Purposementioning

confidence: 99%

Comparison of catheter reconstruction techniques for the lunar ovoid channels of the VeneziaTM applicator

Hansen¹,

Dunkerley²,

Bradley³

et al. 2020

jcb

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Purpose: The aim of this study was to compare catheter reconstruction methods for lunar ovoid channels of the Venezia TM advanced gynecological applicator (Elekta, Sweden). Material and methods: Three available lunar ovoid sizes (22, 26, and 30 mm effective diameter) were evaluated. Computed tomography (CT) scans were performed with a dummy wire inserted and with the Flexitron ® source position simulator (SPS) at step sizes of 5 mm from the most distal dwell position. Treatment plans were generated in Oncentra ® (version 4.5.3) with different catheter reconstruction techniques: centerline reconstruction, tracing a CT dummy wire, using a source path model provided by Elekta, and using the SPS at each planning dwell position. Source position agreement was assessed in registered CT images, and dose differences were calculated with the SPS-based treatment plan as a reference. Finally, dose-volume histogram (DVH) parameters were evaluated for clinical plans with the Venezia TM applicator. Results: For the most distal dwell position, the manufacturer's model had the closest agreement with the SPS at 0.6 ±0.3 mm across applicator sizes. Relative to the SPS, maximal dose differences outside of the applicator were between 16-39% for a 0.1 cm 3 volume and 3.6-9.1% for a 2.0 cm 3 volume. For two clinical plans, volume-based DVH parameters agreed ≤ 3.9%, while deviations ≤ 5.3% were seen for point metrics. Conclusions: Relative to the SPS-based plan, large local dose discrepancies were reduced, but not eliminated, using the manufacturer's source path model. The choice of reconstruction technique was found to have relatively limited impact on DVH parameters for regions outside of the vaginal mucosa.

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Combined intracavitary and interstitial brachytherapy of cervical cancer using the novel hybrid applicator Venezia: Clinical feasibility and initial results

Cited by 60 publications

References 10 publications

Combined external pelvic chemoradiotherapy and image-guided adaptive brachytherapy in treatment of advanced cervical carcinoma: experience from a single institution

Combined external pelvic chemoradiotherapy and image-guided adaptive brachytherapy in treatment of advanced cervical carcinoma: experience from a single institution

Bibliometric analysis of the 100 most cited articles on cervical cancer radiotherapy

Comparison of catheter reconstruction techniques for the lunar ovoid channels of the VeneziaTM applicator

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