High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFSdRT: 55%, SD: 10; CRT: 65%, SD: 7; OSdRT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1–6% and for chemoRT 2–20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4–11% and for chemoRT, 1–11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1–2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.

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“…For the retrospective series, there are 37 studies provide a weighted mean OS for the RT: 54%; SD: 18 (18, 90) and CRT: 66%, SD: 17 (33, 99). …”

Section: Methodsmentioning

confidence: 99%

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

et al. 2017

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“…Mulheres em tratamento por câncer cervical e vulvar apresentam sintomas físicos importantes, como incontinência urinária e fecal (YAMASHITA et al, 2013), bexiga hiperativa, constipação, vômitos (JHINGRAN et al, 2013;LEE et al, 2013), sangramentos durante a relação sexual, estenose vaginal e disfunções sexuais (KHOR et al, 2007;FRIEDMAN et al, 2011). Estratégias negativas, como a evitação e a negação, parecem estar relacionadas à má adaptação ao desenvolvimento do câncer, enquanto as estratégias positivas, ativas e de confronto estão relacionadas às melhores adaptações e a uma boa qualidade de vida (CULVER et al, 2004).…”

Section: Introductionunclassified

Processo De Recuperação Físico E Emocional No Pós-Câncer Ginecológico

Toriy¹,

Pires²,

Zomkowski³

et al. 2015

CTO

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Resumo: Introdução: O câncer ginecológico é uma doença que abrange as malignidades do colo uterino, dos ovários, do endométrio e da vagina ou vulva, sendo considerado um problema de saúde pública, visto que há declínio na qualidade de vida (QV). Objetivo: Identificar as implicações físico-emocionais e comparar a qualidade de vida na pré e na pós-braquiterapia. Método: Estudo prospectivo com abordagem qualiquantitativa. Foi realizado no Centro de Pesquisas Oncológicas e foram avaliadas 20 mulheres sobreviventes do câncer ginecológico entre 18 e 70 anos (49,55 ± 16,98). Utilizou-se o instrumento EORTC QLQ -C30 para avaliar a QV e a entrevista semiestruturada com perguntas acerca da problemática. Resultados: As características sociodemográficas demonstraram predominância no diagnostico de câncer de colo de útero, com estadiamento tipo IIB. Com relação à qualidade de vida, observou-se diferença significativa após a braquiterapia nos itens Constipação (p= 0,027) e Diarreia (p= 0,004). Os domínios função física, emocional, cognitiva, social e desempenho de papéis tiveram decréscimo das funções. Os temas construídos a partir da análise das verbalizações foram: 1) alterações físicas: a) lidando com a dor e o sofrimento; b) enfrentando as dificuldades físicas; 2) alterações emocionais: a) superando a ansiedade, medo, angústia e depressão; b) enfrentando as implicações emocionais, e 3) alterações físico-emocionais. Conclusão: As implicações emocionais proporcionam um impacto importante na resposta física. As alterações no estado de saúde em geral e na qualidade de vida destas mulheres após a braquiterapia determinam a necessidade de readequar práticas cotidianas estimuladas por multiprofissionais da saúde. Palavras-chave: Qualidade de Vida, Braquiterapia, Atividades Cotidianas. Process of physical and emotional recovery in post-gynecological cancerAbstract: Introduction: The gynecological cancer is a disease that includes the malignancies of the cervix, ovaries, endometrium, vagina or vulva and is considered a public health problem, as it reduces the quality of life (QOL). Objective: To identify the physical and emotional implications and compare the quality of life in pre-and post-brachytherapy. Method: Prospective study with qualitative and quantitative approach. The study was held at the Oncology Research Center and 20 women survivors of gynecological cancer between 18 and 70 years were evaluated. We used the EORTC QLQ instrument -C30 to assess QOL and semi -structured interview with questions on the issue. Results: The sociodemographic features showed predominance in the diagnosis of cervical cancer, with type IIB staging. Regarding quality of life, it was observed a significant post-brachytherapy difference in constipation (p = 0.027) and diarrhea (p = 0.004). The physical function, emotional, cognitive, social and role play domains had a decrease of function. The themes built from the analysis of utterances were: 1) physical changes: a) dealing Processo de recuperação físico-emocional no pós-câncer ginecológico

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Sexual function and quality of life in gynecological cancer pre- and post-short-term brachytherapy: a prospective study

Zomkowski

Toryi

Sacomori

et al. 2016

Arch Gynecol Obstet

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High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

Cited by 5 publications

References 19 publications

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

Processo De Recuperação Físico E Emocional No Pós-Câncer Ginecológico

Sexual function and quality of life in gynecological cancer pre- and post-short-term brachytherapy: a prospective study

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