GEC-ESTRO (ACROP)–ABS–CBG Consensus Brachytherapy Target Definition Guidelines for Recurrent Endometrial and Cervical Tumors in the Vagina

Kamrava, Mitchell; Leung, Eric; Bachand, François; Beriwal, Sushil; Chargari, Cyrus; D’Souza, David; Erickson, Beth; Fokdal, Lars; Han, Kathy; Harkenrider, Matthew M.; Lin, Lilie L.; Mahantshetty, Umesh; Nesvacil, N.; Ravi, Ananth; Schmid, Max; Vigneault, Éric; Westerveld, Henrike; Yashar, Catheryn M.; Nout, Remi A.

doi:10.1016/j.ijrobp.2022.09.072

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…Target definition of brachytherapy for vaginal cancer had always been a focus, and in October 2022, brachytherapy target definition guidelines for recurrent endometrial and cervical tumors in the vagina were published [ 22 ]. The guidelines provided definitions and comments on gross tumor volume (GTV) res , clinical target volume (CTV)-T HR , and CTV-T IR .…”

Section: Discussionmentioning

confidence: 99%

3D-printed vaginal cylindrical template with curved needle channels in MRI-guided vaginal cuff brachytherapy

Mao,

Zhao

2023

jcb

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Purpose To present a new technique for the treatment of vaginal cuff recurrences using 3D-printed vaginal cylindrical template (3D-PVCT) with curved needle channels in brachytherapy. Material and methods Two patients with vaginal cuff tumor treated with external beam radiotherapy and MRI-guided interstitial brachytherapy were selected for the present study. Prior to treatment, a vaginal cylinder with the same size as 3D-PVCT was inserted into the vagina. Magnetic resonance scan was performed to identify target volumes and organs at risk (OARs). By registration techniques, the implantation angle was determined, appropriate needle channels were selected, and the depth of each needle position was recorded. During the actual treatment, patients were under general anesthesia, and real-time guidance of trans-rectal ultrasound was applied referring to a pre-determined treatment plan. Results For patient No. 1, 9 needles were inserted into the tumor, with 4 curved needle channels and 5 straight channels. For patient No. 2, 7 needles were inserted into the vaginal cuff tumor, with 6 curved needle channels and 1 straight channel. Doses delivered to volumes of targets and OARs for both patients met the EMBRACE II dose constraints. After follow-up of 15 and 18 months, respectively, both patients showed complete response, with no evidence of tumor recurrence. No significant acute or late toxicities were reported. Conclusions With careful pre-planning, 3D-PVCT provides good target coverage and sparing of OARs. The results from these two patients indicate that this approach is very promising due to its flexibility and potential widespread application in the future.

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Section: Discussionmentioning

confidence: 99%

3D-printed vaginal cylindrical template with curved needle channels in MRI-guided vaginal cuff brachytherapy

Mao,

Zhao

2023

jcb

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“…Achieving good implant geometry is crucial in all BT applications, as no optimisation process can correct for a poor implant. Poor implant geometry or inadequate applicator choice can compromise the dose to the target volume and OARs and negatively impact local control, acute and late toxicity [ 2 , 12 ]. In two prospective trials, patients whose implant was classified as inadequate had a higher risk of local failure compared to those treated with an adequate implant (HR = 2.5, p = 0.04).…”

Section: The Rationale For Development Of 3d-printed Applicatorsmentioning

confidence: 99%

“…Gynaecological cancers represent an important health care burden, with cervical and endometrial cancer being the fourth and sixth most common cancers in women worldwide, respectively, and together account for more than 10% of all newly diagnosed cancers in women in 2020 [ 1 ]. Radiotherapy, including image-guided adaptive brachytherapy (IGABT) based on magnetic resonance (MR), is the standard of care in locally advanced cervical and vaginal cancer and also an integral part of curative treatment of (medically) inoperable endometrial cancer, locally recurrent cervical and endometrial cancer [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

Segedin,

Kobav,

Zobec Logar

2023

Cancers

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Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy.

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“…Vaginal recurrences from gynecological malignancies pose clinical challenges. Organ-preserving approaches with EBRT and IGBT play an important roles in the treatment of vaginal recurrence from endometrial cancer and cervical cancer [ 10 – 13 ]. It has been shown that brachytherapy (BT) can improve survival and is an important component of definitive radiotherapy in vaginal cancer [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer

Wang,

Guo,

Zhao

2024

BMC Cancer

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Objective This study aimed to establish the dose-response relationship between volume base dose and tumor local control for vaginal cancer, including primary vaginal cancer and recurrent gynecologic malignancies in the vagina. Materials and methods We identified studies that reported volume base dose and local control by searching the PubMed, the Web of Science, and the Cochrane Library Database through August 12, 2023. The regression analyses were performed using probit model between volume based dose versus clinical outcomes. Subgroup analyses were performed according to stratification: publication year, country, inclusion time of patients, patients with prior radiotherapy, age, primaries or recurrent, tumor size, concurrent chemoradiotherapy proportion, dose rate, image modality for planning, and interstitial proportion. Results A total of 879 patients with vaginal cancer were identified from 18 studies. Among them, 293 cases were primary vaginal cancer, 573 cases were recurrent cancer in the vagina, and 13 cases were unknown. The probit model showed a significant relationship between the HR-CTV (or CTV) D90 versus the 2-year and 3-year local control, P values were 0.013 and 0.014, respectively. The D90 corresponding to probabilities of 90% 2-year local control were 79.0 GyEQD2,10 (95% CI: 75.3–96.6 GyEQD2,10). Conclusions A significant dependence of 2-year or 3-year local control on HR-CTV (or CTV) D90 was found. Our research findings encourage further validation of the dose-response relationship of radical radiotherapy for vaginal cancer through protocol based multicenter clinical trials.

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GEC-ESTRO (ACROP)–ABS–CBG Consensus Brachytherapy Target Definition Guidelines for Recurrent Endometrial and Cervical Tumors in the Vagina

Cited by 15 publications

References 30 publications

3D-printed vaginal cylindrical template with curved needle channels in MRI-guided vaginal cuff brachytherapy

3D-printed vaginal cylindrical template with curved needle channels in MRI-guided vaginal cuff brachytherapy

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer

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