Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

Fokdal, Lars; Sturdza, Alina; Mazeron, R.; Haie-Méder, Christine; Tan, Li Tee; Gillham, Charles; Šegedin, Barbara; Jürgenliemk-Schultz, I.; Kirisits, Christian; Hoskin, Peter; Pötter, Richard; Lindegaard, J.C.; Tanderup, Kari

doi:10.1016/j.radonc.2016.03.020

Cited by 265 publications

(207 citation statements)

References 24 publications

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“…Patients with large tumors and lymph node involvement were at highest risk of treatment failure. They might benefit from an intensified treatment, such as dose escalation in the high-risk clinical target volume,3 optimal use of combined intracavitary-interstitial brachytherapy techniques,12 and reducing overall treatment time to <50 days 17…”

Section: Discussionmentioning

confidence: 99%

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

Horeweg

Creutzberg

Rijkmans

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the efficacy and toxicity of primary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer and to identify predictors of treatment failure and toxicity.MethodsRetrospective analysis of 155 stage IB-IVA cervical cancer patients treated from 2008 to 2016 with chemoradiation and image-guided adaptive brachytherapy. Treatment consisted of external beam radiotherapy (45 – 48.6 Gy in 1.8 – 2 Gy fractions) with concurrent weekly cisplatin (40 mg/m2, 5 – 6 cycles) and image-guided adaptive brachytherapy (3−4 × 7 Gy high dose rate) using intracavitary or combined intracavitary-interstitial techniques according to GEC-ESTRO (Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology) recommendations. Incidences of all outcomes were calculated using Kaplan-Meier’s methodology. Risk factors for treatment failure and toxicity were identified using Cox’s proportional hazards model and the Kruskal-Wallis H-test respectively.ResultsMedian follow-up was 57 months. Five-year local control was 90.4 %. Five-year para-aortic lymph node metastasis-free and distant metastasis-free survival were 85.3 % and 70.2 % respectively. Tumor size and lymph node metastasis were independent risk factors for treatment failure. Cumulative incidences of severe late bladder, rectal, bowel, and vaginal toxicity were 0.8%, 3.3%, 3.6%, and 1.4% respectively at 5 years of follow-up. Combined intracavitary-interstitial brachytherapy techniques were associated with less vaginal morbidity.ConclusionsPrimary chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer is a highly effective local and loco-regional treatment. However, survival is compromised by the occurrence of distant metastasis. Patients with large tumors and nodal involvement at diagnosis are at increased risk and may benefit from intensified treatment. Severe late gastrointestinal and urogenital toxicity is limited and may be further reduced by increasing conformity, using combined intracavitary-interstitial techniques and lowering doses to organs at risk.

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Section: Discussionmentioning

confidence: 99%

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

Horeweg

Creutzberg

Rijkmans

et al. 2019

Int J Gynecol Cancer

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“…Ten centres use needles for dose optimisation, and one is planning to do so in the near future. The use of needles improves adequate target coverage and is related to improved local control without exceeding the dose constraints for OAR [28,29]. In the future, tumour coverage might be further improved with the possibility of using 'angulated' needle positions.…”

Section: Discussionmentioning

confidence: 99%

Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer

Boer

Jürgenliemk-Schulz

Westerveld

et al. 2017

Radiotherapy and Oncology

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“…The purpose has been to facilitate the transition to MRI-based brachytherapy, incorporating “tailored” treatments with new applicators. Better results, increased local control, and decreased toxicity have been reported [26, 27, 28, 29, 30, 31, 32, 33] in on-going international protocols (EMBRACE, Retro EMBRACE, and EMBRACE II) that include hundreds of patients [34, 35, 36, 37]. …”

Section: Discussionmentioning

confidence: 99%

Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience

Villalba

Sancho

Palacin

et al. 2016

jcb

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PurposeTo study outcome and toxicity in 59 patients with locally advanced cervix carcinoma treated with computed tomography (CT)-based Martinez universal perineal interstitial template (MUPIT) and the new magnetic resonance imaging (MRI)-compatible template Benidorm (TB).Material and methodsFrom December 2005 to October 2015, we retrospectively analyzed 34 patients treated with MUPIT and 25 treated with the TB. Six 4 Gy fractions were prescribed to the clinical target volume (CTV) combined with external beam radiotherapy (EBRT). The organs at risk (OARs) and the CTV were delineated by CT scan in the MUPIT implants and by MRI in the TB implants. Dosimetry was CT-based for MUPIT and exclusively MRI-based for TB. Dose values were biologically normalized to equivalent doses in 2 Gy fractions (EQD2).ResultsMedian CTV volumes were 163.5 cm3 for CT-based MUPIT (range 81.8-329.4 cm3) and 91.9 cm3 for MRI-based TB (range 26.2-161 cm3). Median D90 CTV (EBRT + BT) was 75.8 Gy for CT-based MUPIT (range 69-82 Gy) and 78.6 Gy for MRI-based TB (range 62.5-84.2 Gy). Median D2cm3 for the rectum was 75.3 Gy for CT-based MUPIT (range 69.8-132.1 Gy) and 69.9 Gy for MRI-based TB (range 58.3-83.7 Gy). Median D2cm3 for the bladder was 79.8 Gy for CT-based MUPIT (range 71.2-121.1 Gy) and 77.1 Gy for MRI-based TB (range 60.5-90.8 Gy). Local control (LC) was 88%. Overall survival (OS), disease free survival (DFS), and LC were not statistically significant in either group. Patients treated with CT-based MUPIT had a significantly higher percentage of rectal bleeding G3 (p = 0.040) than those treated with MRI-based TB, 13% vs. 2%.ConclusionsTemplate Benidorm treatment using MRI-based dosimetry provides advantages of MRI volume definition, and allows definition of smaller volumes that result in statistically significant decreased rectal toxicity compared to that seen with CT-based MUPIT treatment.

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Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

Cited by 265 publications

References 24 publications

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

Efficacy and toxicity of chemoradiation with image-guided adaptive brachytherapy for locally advanced cervical cancer

Patterns of care survey: Radiotherapy for women with locally advanced cervical cancer

Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience

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