Current controversies in high‐dose‐rate versus low‐dose‐rate brachytherapy for cervical cancer

Stewart, Alexandra J.; Viswanathan, Akila N.

doi:10.1002/cncr.22054

Cited by 65 publications

(39 citation statements)

References 59 publications

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“…7 While the quality of evidence from these trials was judged to be low to moderate, observational data in general has also reported equivalent survival outcomes for the two types of intracavitary systems. 2,4,7,9,11,20–24 Our population-based data is in accord with these findings; overall, we noted similar survival outcomes for women treated with LDR and HDR brachytherapy.…”

Section: Discussionsupporting

confidence: 87%

“…Brachytherapy allows dose escalation to the cervix and surrounding tissues and is critical in improving local control and decreasing the risk of pelvic relapse. 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…2,4–11 The randomized trials noted similar survival outcomes for the two brachytherapy techniques, however, all four studies were conducted outside of the U.S. and have been criticized for a number of methodologic limitations including the inclusion of diverse patient populations and the utilization of a variety of different radiation techniques. 2,7 Given the limited data describing the safety and use of HDR brachytherapy in the U.S., we performed a population-based analysis to examine the patterns of brachytherapy use and outcomes for women with cervical cancer undergoing primary radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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High versus low-dose rate brachytherapy for cervical cancer

Patankar

Tergas

Deutsch

et al. 2015

Gynecologic Oncology

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Objectives Brachytherapy plays an important role in the treatment of cervical cancer. While small trials have shown comparable survival outcomes between high (HDR) and low-dose rate (LDR) brachytherapy, little data is available in the US. We examined the utilization of HDR brachytherapy and analyzed the impact of type of brachytherapy on survival for cervical cancer. Methods Women with stage IB2–IVA cervical cancer treated with primary (external beam and brachytherapy) radiotherapy between 2003–2011 and recorded in the National Cancer Database (NCDB) were analyzed. Generalized linear mixed models and Cox proportional hazards regression were used to examine predictors of HDR brachytherapy use and the association between HDR use and survival. Results A total of 10,564 women including 2681 (25.4%) who received LDR and 7883 (74.6%) that received HDR were identified. Use of HDR increased from 50.2% in 2003 to 83.9% in 2011 (P<0.0001). In a multivariable model, year of diagnosis was the strongest predictor of use of HDR. While patients in the Northeast were more likely to receive HDR therapy, there were no other clinical or socioeconomic characteristics associated with receipt of HDR. In a multivariable Cox model, survival was similar between the HDR and LDR groups (HR=0.93; 95% 0.83–1.03). Similar findings were noted in analyses stratified by stage and histology. Kaplan-Meier analyses demonstrated no difference in survival based on type of brachytherapy for stage IIB (P=0.68), IIIB (P=0.17), or IVA (P=0.16) tumors. Conclusions The use of HDR therapy has increased rapidly. Overall survival is similar for LDR and HDR brachytherapy.

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Section: Discussionsupporting

confidence: 87%

“…Brachytherapy allows dose escalation to the cervix and surrounding tissues and is critical in improving local control and decreasing the risk of pelvic relapse. 1,2 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High versus low-dose rate brachytherapy for cervical cancer

Patankar

Tergas

Deutsch

et al. 2015

Gynecologic Oncology

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“…The study also reported less late rectal complications in the group treated with HDR, thus it was hypothesized that these results could be due to low HDR brachytherapy doses delivered at point A [26]. A recent literature review concluded that HDR brachytherapy is an acceptable alternative to LDR brachytherapy in certain patients [27]. Overall, the review concluded that there was statistically equivalent local control, overall survival, and complication rates between HDR and LDR, and also found similar toxicity rates between HDR and LDR.…”

Section: The Role Of Radiation Therapy In Laccamentioning

confidence: 89%

Current management of stage IB2 and bulky IIA, locally advanced, and recurrent cervical carcinoma

Rodriguez

Ryu

et al. 2008

Oncol Rev

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Cervical cancer is one of the most common cancers affecting women, with most early disease treated with either surgery or radiation alone with an 85%-95% 5-year survival rate, while locally advanced cervical cancer (LACCA) requires multiple therapeutic modalities. The clear distinction between early and LACCA has, in recent years, blurred as stages IB2 and bulky IIA, which were traditionally thought of as early disease, have been shown to require more treatment than other early stage cervical cancer. LACC is now treated with cisplatin-based chemoradiation therapy based upon the results of the randomized co-operative group studies that demonstrated reduced relative risk of death, local failure rates, and incidence of distant metastases. Recurrent cervical cancer is devastating and is rarely cured. Treatment of recurrent cervical carcinoma depends on the previous therapy, the site of recurrence, and the extent of the recurrence. This review will outline the treatment options for the various stages of cervical cancer.

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“…2 Owing to the increased risk of complications in nearby critical structures, the amount of irradiation that can be delivered is limited and dose escalation is likely not the total solution to radiation resistance. 3 These facts underscore an urgent need for the development of more effective and less toxic novel therapeutic approaches. Therefore, investigators have turned to strategies for sensitizing CCs to radiation, and gene therapy represents one such modality.…”

Section: Introductionmentioning

confidence: 99%

Oncolytic adenovirus armed with human papillomavirus E2 gene in combination with radiation demonstrates synergistic enhancements of antitumor efficacy

et al. 2011

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High-risk human papillomavirus (hr-HPV) E6 and E7 oncogenes are associated with resistance to radiotherapy in cervical cancer. Efforts have been taken to employ HPV E2, a crucial negative transcriptional modulator of HPV E6 and E7 oncogenes, and also an apoptosis-inducing agent, for therapeutic intervention. Despite being conceptually attractive, the potency and feasibility of current hr-HPV E2-based therapies remain limited. Here, we designed a novel recombinant adenovirus, named M5, with a 27-bp deletion in E1A conserved region-2 by which to realize tumor-specific replication, and a total HPV type 16 (HPV16) E2 gene complementary DNA inserted into the E3 coding region. In this design, M5 exploited the adenovirus E3 promoters to express HPV16 E2 gene in a viral replication-dependent manner and preferentially silenced the hr-HPV E6 and E7 oncogenes in HPV-positive cervical cancer cells. In vitro and in vivo assays confirmed that M5 exhibited potent antitumoral efficacy. Moreover, the effects of combined treatment with M5 and radiation treatment resulted in synergistically enhanced potency (Po0.01). The increase in killing efficacy of M5 was also found in HPV-negative cervical cancer cells, for which the pro-apoptotic activity of HPV16 E2 was thus responsible. Our results indicated that the use of M5 that locally delivers HPV16 E2 to cancers has broad therapeutic windows and that the combination therapy with radiation for cervical cancer will be the more effective way of improving survival.

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Current controversies in high‐dose‐rate versus low‐dose‐rate brachytherapy for cervical cancer

Cited by 65 publications

References 59 publications

High versus low-dose rate brachytherapy for cervical cancer

High versus low-dose rate brachytherapy for cervical cancer

Current management of stage IB2 and bulky IIA, locally advanced, and recurrent cervical carcinoma

Oncolytic adenovirus armed with human papillomavirus E2 gene in combination with radiation demonstrates synergistic enhancements of antitumor efficacy

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