Image-guided interstitial high-dose-rate brachytherapy for locally recurrent uterine cervical cancer: A single-institution study

Umezawa, Rei; Murakami, Naoya; Nakamura, Satoshi; Wakita, Akihisa; Okamoto, Hiroyuki; Tsuchida, Keisuke; Kashihara, Tairo; Kobayashi, Kazuma; Harada, Ken; Takahashi, Kana; Inaba, Koji; Ito, Yoshiaki; Igaki, Hiroshi; Masui, Koji; Yoshida, Ken; Jingu, Keiichi; Tselis, Nikolaos; Itami, Jun

doi:10.1016/j.brachy.2017.11.011

Cited by 31 publications

(53 citation statements)

References 36 publications

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“…Despite the patient population receiving previous radiotherapy, we observed fairly impressive local control with SM-ISBT as salvage. Our 2-year actuarial local control rate of 50% is close to some previous studies that have reported a range of 44e53% [16,19,22]. 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.…”

Section: Discussionsupporting

confidence: 83%

“…The 3year local control rate was 71% in patients with previous radiation in the study by Kamran et al [20]. This study reports an overall survival rate of 78% at 2 years but only 38% at 3 years, which is initially higher than previously reported 2-year overall survival rates of 52.5, 67, 52 and 61% [16,19,22,25], but lower than the reported 3year overall survival rate of 54% by Kamran et al [20]. This might be due to inherent limitations in our study, including heterogeneity in patient inclusion and selection bias, as well as a median follow-up of just 2 years.…”

Section: Discussionmentioning

confidence: 52%

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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: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 52%

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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“…Accordingly, a phase III prospective clinical trial by the International Atomic Energy Agency (IAEA) to determine whether ICBT boost after EBRT improves clinical outcomes in NPC patients has failed to show its efficacy, supposedly because of inadequate irradiation dose coverage of the lateral tumor extension with ICBT [ 22 ]. Cumulative knowledge of interstitial brachytherapy (ISBT) in other anatomical sites [ 42 , 43 , 44 , 45 , 46 , 47 ] proved that if the thickness of the tumor is larger than 5 mm, it is unreachable with conventional ICBT, and if interstitial needle application is possible, a boost with HDR-ISBT would be a better option to escalate local dose, while minimizing unnecessary irradiation to surrounding normal tissues [ 26 , 27 , 28 ]. A group from the Thomas Jefferson University reported the usefulness of salvage surgery combined with re-irradiation with intraoperative 131 Cs permanent brachytherapy implant in recurrent head and neck cancer [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects

Murakami

Cheng

Yoshimoto³

et al. 2020

jcb

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Nasopharyngeal cancer generally responds well to concurrent chemoradiotherapy (CCRT). However, there is a small group of patients who respond poorly to CCRT, and experience local residual tumor or local relapse. Although several attempts have been performed to such a group of patients including re-irradiation with external beam radiation therapy (EBRT) or salvage surgery, clinical results remain unsatisfactory. Intracavitary brachytherapy (ICBT) boost after CCRT with EBRT has been explored, however, its efficacy is limited to those with superficial residual tumors. For those residual tumors thickness with more than 5 mm, interstitial brachytherapy (ISBT) boost would be an appropriate modality of choice. Here, we describe technical aspects of the high-dose-rate interstitial brachytherapy (HDR-ISBT) boost for nasopharyngeal cancer (NPC) patients who responded poorly to the CCRT with EBRT.

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“…Studies have shown that interstitial brachytherapy is highly effective for locally advanced gynecologic cancers, with a 2-year locoregional control ranging from 51.3% to 93% [11,12]. Another study found that ISBT had similar overall survival and local control when compared to intracavitary brachytherapy despite the ISBT group including patients with larger tumors [13].…”

Section: Purposementioning

confidence: 99%

Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina

Yen¹,

Tian²,

Hrycushko³

et al. 2018

jcb

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PurposeTo determine risk factors for fistula formation after interstitial brachytherapy (ISBT) in patients with advanced gynecologic cancers.Material and methodsWe performed an Institutional Review Board (IRB) approved retrospective review of 44 patients treated with transperineal template-based ISBT from 2011 to 2017 at a major metropolitan county and university health system. All patients were treated with image-guided high-dose-rate ISBT. Statistical analysis was performed using the χ2 test to identify factors correlated with fistula formation. Survival and tumor control outcomes were calculated using Kaplan Meier analyses.ResultsPatients had a mean age of 53 years (range, 28-81 years), a mean external beam dose of 43.1 Gy (range, 42.5-51.3 Gy), and a mean brachytherapy dose of 22.8 Gy (range, 21.3-30 Gy). Two of 44 patients had fistulas that could be definitively attributed to therapy for a fistula rate of 4.5%. Six additional patients (13.6%) developed fistula after treatment with associated recurrent disease but were included in the causality analysis. We analyzed patient tumor and treatment factors, and on univariate analyses we found that age ≥ 60 years, Hispanic ethnicity, bladder involvement, rectal D2 cc ≥ 70 Gy, and whether patients had post-radiation biopsies were predictors for fistula formation. The 1-year overall survival (OS), progression-free survival (PFS), and local control (LC) were 85%, 58.5%, and 76.9%, respectively, with a mean follow-up time 23 months (range, 4.0-68.8 months).ConclusionsWe identified factors that predict fistula formation in patients with advanced gynecologic tumors treated with ISBT. These factors can be used to stratify patients into a high-risk group, with potential for modification of brachytherapy planning to reduce their risk of fistula formation.

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Image-guided interstitial high-dose-rate brachytherapy for locally recurrent uterine cervical cancer: A single-institution study

Cited by 31 publications

References 36 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

Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects

Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina

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