Increasing Brachytherapy Dose Predicts Survival for Interstitial and Tandem-Based Radiation for Stage IIIB Cervical Cancer

Viswanathan, Akila N.; Cormack, Robert A.; Rawal, Bhupendra; Lee, Hang

doi:10.1111/igc.0b013e3181b62e73

Cited by 53 publications

(26 citation statements)

References 22 publications

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“…1 Survival rates decrease significantly for patients who cannot receive BT to the primary tumor for various reasons. 2,3 BT requires that a tandem be inserted into the uterus 4 to bring the primary cervical tumor to doses in the range of 80–90 Gy, depending on tumor size, with the dose historically recorded at Point A. 5 Proper applicator placement significantly improves local control and disease-free survival.…”

Section: Introductionmentioning

confidence: 99%

Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

Viswanathan

Erickson

Gaffney

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objective To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3 Tesla (3T) magnetic resonance (MR) image-based cervical-cancer brachytherapy Materials/Methods Twenty-three gynecologic radiation oncology experts contoured the same 3 cervical-cancer brachytherapy cases: one Stage IIB near-complete response (CR) case with a tandem and ovoid, one Stage IIB partial response (PR) case with ovoid with needles and one Stage IB2 CR case with a ring applicator. CT contours were completed before MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. The conformity index (CI) was calculated for each of the six data sets. Dice coefficients were generated to compare CT and MR contours of the same case. Results For all 3 cases, the mean tumor volume was smaller on MR than on CT (p<0.001). Kappa and CI estimates were slightly higher for CT, indicating a higher level of agreement on CT. DICE coefficients were 89% for the Stage IB2 case with a CR, 74% for the Stage IIB case with a PR, and 57% for the Stage IIB case with a CR. Conclusion When comparing MR- to CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast visible on the images at the time of brachytherapy. The largest difference at the time of brachytherapy was in the case with parametrial extension at diagnosis that had a near-complete response, due to the appearance of the parametria on CT but not on MR. Based on these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases.aspx.

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Section: Introductionmentioning

confidence: 99%

Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

Viswanathan

Erickson

Gaffney

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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174

141

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“…14,19 Although perineal templates can ensure a high dose to lateral parametrial extension, the dose to the fundus and cervical central tumors, which is achieved mainly by intrauterine tandem, may be insufficient. 20,21 Furthermore, the other disadvantages of perineal template IS BT include uncertainty of the needle position because of the long distance between the template and the tumor, requirement of multiple needles, and serious complications. The combined IC/IS BT using Utrecht or Vienna applicators has improved the DVH parameters and resulted in significant improvement in increasing the local tumor control rate and reducing late toxicity.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

Guo

Zhao

Xia

et al. 2017

Int J Gynecol Cancer

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ObjectiveWe present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.Materials/MethodsInterstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT.ResultsThe mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications.ConclusionsThe IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.

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“…Radiation dose escalation has been shown in multiple cancer disease sites to be associated with an improvement in local control and/or survival[16,17] with recent population based study showing decreased survival in patients receiving <40Gy compared with those receiving ≥55Gy in unresectable PAC. [18] The amount of dose escalation that can be achieved is largely limited by the normal tissue tolerance of nearby structures.…”

Section: Discussionmentioning

confidence: 99%

Dose escalation with a vessel boost in pancreatic adenocarcinoma treated with neoadjuvant chemoradiation

Wang

Shaikh

Handorf

et al. 2015

Practical Radiation Oncology

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Purpose Pancreatic adenocarcinoma (PAC) patients are often treated with neoadjuvant chemoradiation (NACRT) in hopes of downstaging their disease for potential surgical resection. We hypothesized that increasing the radiation dose to the area of the tumor abutting the vessel(s) of concern increases the rate of surgical resection in borderline resectable (BR) and locally advanced (LA) patients treated with NACRT. Methods and Materials We retrospectively reviewed consecutive cases of BR and LAPAC treated with NACRT from January 2006 to December 2013, with or without a vessel boost (VB), at a single institution. The primary endpoints were rate of R0/R1 potentially curative surgical resection and acute toxicity. Univariate analysis using Fisher’s exact test was performed to evaluate effect of each variable. Multiple logistic regression was used to adjust for the following covariates: year of diagnosis, age, gender, CA19-9 at diagnosis, and BR or LA. Results Of the 104 patients identified, 22% (n=23) received a VB (median 54Gy, range 54–64Gy) and 78% (n=81) received no boost (median 50.4Gy, range 48.6–52.2Gy). More patients in the VB group were treated from 2010–2013(p<0.001) and with IMRT(p=0.002). Other baseline characteristics were balanced. After adjusting for covariates, there was a statistical trend toward increased surgical resection in patients who received a VB(OR=2.77[0.89–8.57], p=0.077). Age (≥70, OR=0.42[0.16–1.05], p=0.064) and LAPAC (OR=0.32[0.09–1.09], p=0.068) also trended towards significance. CA19-9≥47.9U/mL (OR=0.24[0.08–0.71], p=0.010) was significant on multivariate analysis. There was no significant difference in acute or late toxicity between groups. Conclusions In our retrospective series, dose escalation was associated with an improved surgical resection rate in BR and LAPAC patients treated with NACRT, although this improvement was not statistically significant.

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Increasing Brachytherapy Dose Predicts Survival for Interstitial and Tandem-Based Radiation for Stage IIIB Cervical Cancer

Cited by 53 publications

References 22 publications

Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

Comparison and Consensus Guidelines for Delineation of Clinical Target Volume for CT- and MR-Based Brachytherapy in Locally Advanced Cervical Cancer

Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

Dose escalation with a vessel boost in pancreatic adenocarcinoma treated with neoadjuvant chemoradiation

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