HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Żółciak-Siwińska, Agnieszka; Bijok, Michał; Jońska-Gmyrek, Joanna; Kawczyńska, Maria; Kępka, Lucyna; Bujko, Krzysztof; Michalski, Wojciech

doi:10.1016/j.ygyno.2013.10.018

Cited by 41 publications

(51 citation statements)

References 26 publications

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“…With regards to the risk of late toxicities, cumulative EQD2 of past radiotherapy and present salvage SM-ISBT may be relevant. In the present study, the median cumulative EQD2 of 91.8 Gy is considerably lower than the 133.5 Gy reported by Zolciak-Siwinska et al [28]. Although their 3-year local control of 45% is higher than the 34% reported in our series, they also reported 50% grade 3 or higher toxicities, which might partly be due to a higher cumulative dose.…”

Section: Discussioncontrasting

confidence: 82%

“…At 3 years, Yoshida et al [27] reported a local control rate of 75% for patients with cervical cancer who had initial radical hysterectomy and adjuvant radiotherapy, and 46% for patients who had initial definitive radiation, and explained the difference with the lower initial radiation dose for patients who received adjuvant radiation. Zolciak-Siwinska et al [28] reported a 3-year local control rate of 45% after definitive or adjuvant radiation for cervical or vaginal cancer. The 3year local control rate was 71% in patients with previous radiation in the study by Kamran et al [20].…”

Section: Discussionmentioning

confidence: 99%

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Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

et al. 2020

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Aims: Recurrent gynaecological tumours can cause significant morbidity with limited salvage options. This study investigates the strategy of salvage singlemodality interstitial brachytherapy (SM-ISBT) for recurrent gynaecological pelvic cancer at two specialised ISBT centres. Materials and methods: Patients who had received salvage SM-ISBT for pelvic recurrence of gynaecological cancers from September 2008 to January 2017 were included. None had distant metastasis at the time of recurrence. Local control, progression-free and overall survival and long-term toxicities were evaluated. Results: Twenty-six patients with a median follow-up of 24 months (range 2.5e106.3 months) after SM-ISBT were included. Primary cancer sites were endometrium (20), cervix (4), vulva (1) and vagina (1). All patients had prior whole-pelvic external beam irradiation and 16 had prior brachytherapy. The median disease-free survival prior to SM-ISBT was 20.3 months (interquartile range 9.9e30.5). SM-ISBT was delivered with high dose rate technique over three to six fractions. The median high-risk clinical target volume was 34.6 cm 3 , with a median D90 of 29.1 Gy (range 16.1e64.6). The median bladder, rectum and sigmoid D2cm 3 were 15.5, 18.7 and 3.7 Gy, respectively. After SM-ISBT, complete and partial responses were achieved in 17 (64%) and 5 (19%) patients, respectively. Two (7.4%) patients had grade 3 toxicities (both vaginal stenosis), with no grade 4 complications. Eighteen patients (69%) recurred, including local, regional and metastatic in 14 (54%), 8 (30%) and 5 (19%) patients, respectively. Two-year local control, progression-free survival and overall survival were 50, 38 and 78%, respectively. In follow-up, 12 patients (46%) remained in local control. Conclusions: Salvage SM-ISBT re-irradiation for pelvic recurrence of gynaecological malignancies was feasible and safe. With limited salvage options, the local control obtained in more than a quarter of patients seems reasonable. Further efforts are needed to establish a consensus about the optimal patient selection, dose fractionation, implant technique and combination with systemic therapies.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

et al. 2020

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“…It reduces treatment time and irradiated volume, thus offering relief in ulcerated and painful tumors [14,24]. This is especially important in patients who have undergone previous EBRT in the treated area [25].…”

Section: Discussionmentioning

confidence: 99%

“…Smaller tumor volume resulted in improved OS. It is well described in literature that tumor volume has a great impact on treatment results and survival: larger tumors have worse prognosis [19,25,26]. Patients with primary advanced disease were older with severe comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the total doses in both groups were similar (except patients with BT boost). In the available literature, HDR-ISBT doses range between 30-42 Gy as a standalone treatment [13] and [16][17][18][19][20] Gy in combination with EBRT [25]. Beriwal et al investigated a group of patients with primary and recurrent vulvovaginal malignancy.…”

Section: Discussionmentioning

confidence: 99%

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Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer

Kellas-Ślęczka¹,

Białas²,

Fijałkowski³

et al. 2016

jcb

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Purpose: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer.Material and methods: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy).Results: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3).Conclusions: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.

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Gynecological Malignancies

Croke¹,

Leung²,

Fyles³

2016

Re-Irradiation: New Frontiers

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HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Cited by 41 publications

References 26 publications

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

Salvage Re-irradiation With Single-modality Interstitial Brachytherapy for the Treatment of Recurrent Gynaecological Tumours in the Pelvis: A Multi-institutional Study

Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer

Gynecological Malignancies

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