CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy

Sun, Roger; Mazeron, R.; Chargari, Cyrus; Barillot, I.

doi:10.1016/j.canrad.2016.07.088

Cited by 13 publications

(10 citation statements)

References 48 publications

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“…The current standard of care for locally advanced cervical cancers consists of concurrent cisplatin-containing chemotherapy followed by brachytherapy [ 4 – 7 ]. However, although brachytherapy (BT) is a mainstay of treatment, data are limited on its efficacy in stage IVA disease, with some suggesting that bladder infiltration is a contraindication to brachytherapy [ 6 , 8 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae

et al. 2018

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ObjectiveWe report outcomes of cervical cancer patients with bladder invasion (CCBI) at diagnosis, with focus on the incidence and predictive factors of vesicovaginal fistula (VVF).ResultsSeventy-one patients were identified. Twenty-one (30%) had para-aortic nodal involvement. Eight had VVF at diagnosis. With a mean follow-up time of 34.2 months (range: 1.9 months–14.8 years), among 63 patients without VVF at diagnosis, 15 (24%) developed VVF. A VVF occurred in 19% of patients without local relapses (9/48) and 40% of patients with local relapse (6/15). Two-year overall survival (OS), disease-free survival (DFS) and local control rates were 56.4% (95% CI: 44.1–67.9%), 39.1% (95% CI: 28.1–51.4%) and 63.8% (95% CI: 50.4–75.4%), respectively. Para-aortic nodes were associated with poorer OS (adjusted HR = 3.78, P-value = 0.001). In multivariate analysis, anterior tumor necrosis on baseline MRI was associated with VVF formation (63% vs 0% at 1 year, adjusted-HR = 34.13, 95% CI: 4.07–286, P-value = 0.001), as well as the height of the bladder wall involvement of >26 mm (adjusted-HR = 5.08, 95% CI: 1.38–18.64, P-value = 0.014).ConclusionsA curative intent strategy including brachytherapy is feasible in patients with CCBI, with VVF occurrence in 24% of the patients. MRI patterns help predicting VVF occurrence.MethodsPatients with locally advanced CCBI treated with (chemo)radiation ± brachytherapy in our institute from 1989 to 2015 were analyzed. Reviews of baseline magnetic resonance imaging (MRI) scans were carried out blind to clinical data, retrieving potential parameters correlated to VVF formation (including necrosis and tumor volume).

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Section: Introductionmentioning

confidence: 99%

Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae

et al. 2018

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“…All patients were treated with conformal EBRT or intensity-modulated radiation therapy (IMRT) technique, delivering a total dose of 45 Gy using standard fractionation of 1.8 Gy per daily fraction. Clinical target volumes (CTV) were delineated according to the recommendation and planning target volume (PTV), was generated as previously described [15,25].…”

Section: Methodsmentioning

confidence: 99%

Total Reference Air Kerma is Associated with Late Bowel Morbidity in Locally Advanced Cervical Cancer Patients Treated with Image-Guided Adaptive Brachytherapy

Bockel

Escande

Dumas

et al. 2019

JCM

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No dose volume parameter has been identified to predict late bowel toxicities in locally advanced cervical cancer (LACC) patients treated with image-guided adaptive brachytherapy. We examined the incidence of bowel toxicities according to the total reference air kerma (TRAK) in 260 LACC patients. In both univariate and multivariate analysis, late morbidity positively correlated with a TRAK ≥2 cGy (centigray) at 1 meter, emphasizing the importance of this parameter in term of late bowel morbidity. Objective: There is no validated dose volume parameter to predict late bowel toxicities in cervical cancer patients treated with image-guided adaptive brachytherapy (IGABT). We examined the incidence of bowel toxicities according to the TRAK, which is proportional to the integral dose to the patients. Material/Methods: Clinical data of 260 LACC patients treated with curative intent from 2004 to 2016 were examined. Patients received chemoradiation plus a pulse-dose rate IGABT boost. The relationship between TRAK and morbidity was assessed by Kaplan-Meier method, log-rank tests, and Cox proportional-hazards model on event-free periods. Results: Median follow-up was 5.2 years (SE (Standard Error): 0.21). Probability of survival without late bowel toxicity Grade ≥ 2 rate for patients without recurrence (n = 227) at 5 years was 66.4% (SE 3.7). In univariate analysis, bowel and/or sigmoid dose/volume parameters were not significant. Late morbidity positively correlated with active smoking, CTVHR volume >25 cm3, and a TRAK ≥2 cGy at 1 meter. In multivariate analysis, the following factors were significant: Active smoking (p < 0.001; HR: 2.6; 95%CI: 1.4–5.0), and the TRAK (p = 0.02; HR: 2.4; 95%CI: 1.2–5.0). Conclusion: TRAK was associated with late bowel toxicities probability, suggesting that the integral dose should be considered, even in the era of IGABT.

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“…Despite the development of modern dynamic-volumetric irradiation techniques and the use of advanced Image Guided Radiotherapy (IGRT) solutions, such as Cone Beam Computed Tomography (CBCT), one of the most significant limits of these treatments is represented by the need of large clinical target volume (CTV) to planning target volume (PTV) margins. A PTV margin of at least 10 mm (with 10–15 mm in anterior-posterior direction) may be considered for the centropelvic CTV and 7–10 mm for the nodal CTV [3].…”

Section: Introductionmentioning

confidence: 99%

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

Boldrini

Chiloiro

Pesce

et al. 2020

Clinical and Translational Radiation Oncology

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CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy

Cited by 13 publications

References 48 publications

Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae

Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae

Total Reference Air Kerma is Associated with Late Bowel Morbidity in Locally Advanced Cervical Cancer Patients Treated with Image-Guided Adaptive Brachytherapy

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

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