Concomitant Chemoradiotherapy With Image-guided Pulsed Dose Rate Brachytherapy as a Definitive Treatment Modality for Early-stage Cervical Cancer

Abstract

Intracavitary MRI PDR-IGBT boost after CRT is a feasible, tolerable, and effective treatment modality for patients with stages IB2 and II cervical cancer.

A review of the clinical experience in pulsed dose rate brachytherapy

“…Seeger et al 69 included Gy after EBRT in all types of gynaecological tumours. LC of 53% was lower than that of the more recent studies, [10][11][12]65 with GI, GU and gynaecological Grade 3 toxicity approximately 15%.…”

“…In some articles, the treatment was combined with surgery. Although follow-up time was short, most studies showed a local control (LC) of 80-90% and overall survival (OS) ranged from 4-year OS of 55% reported by Rogers et al 17 in 1999 to a 2.5-year OS of 100% with MRI-based brachytherapy as reported by Refaat et al 10 With PDR, $Grade 3 gastrointestinal (GI) and genitourinary (GU) late toxicity was low, and when 3D optimization was performed with dose restriction on the OARs, this incidence became even less.…”

“…[9][10][11][12][13][14][15][16][17][18][19] Articles were published between 1997 and 2013 and mostly 9 reported data only for a subset of patients for whom optimization was performed on CT scan or MRI. In all studies, intracavitary PDR was performed with a tandem and ovoids, but occasionally a mould was used in the STIC-PDR study.…”

Dose Rate Definition in Brachytherapy

“…Recently, the use of PDR BRT has increased in patients with cervical cancer, particularly in Europe. In most studies, PDR BRT was used as a component of definitive therapy in primary cervical cancer [35][36][37][38][39][40][41][42][43]. In these studies, 15-40 Gy (0.4-0.8 Gy/pulse) of PDR BRT was applied after 45-50 Gy of EBRT and concomitant cisplatin, and; local control, and 2-3 years overall survival rates were reported as 80%-90% and 65%-100%, respectively.…”

“…Additionally ≥grade-3 gastrointestinal and genitourinary system toxicity and were reported as 0%-14% and 0%-7%, respectively. [35][36][37][38][39][40][41][42][43][44] PDR BRT has been applied both as a primary treatment and as a salvage therapy in recurrent head and neck tumors. De Pree et al evaluated the efficacy, toxicity, and oncologic outcomes of interstitial PDR BRT in 17 patients with head and neck tumors.…”