Late Effects After Radiotherapy for Locally Advanced Cervical Cancer: Comparison of Two Brachytherapy Schedules and Effect of Dose Delivered Weekly

Hellebust, Taran Paulsen; Kristensen, Gunnar B.; Olsen, Dag Rune

doi:10.1016/j.ijrobp.2009.02.024

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…However, it is well known that acute and late radiation morbidity may be correlated with each other [36], which argues against combining concomitant chemotherapy involving multiple drug regimens [37] with high-dose-rate brachytherapy or accelerated radiotherapy regimens requiring a high weekly cumulative dose [38,39]. Most institutions using HDR would therefore not give more than 2 BT fractions per week for a cumulative prescribed BT dose of 15-18 Gy (EQD2).…”

Section: Implant and Fractionation Strategies For Image-guided Bt In mentioning

confidence: 99%

Clinical Aspects of Treatment Planning

Lindegaard

Pötter

Limbergen³

et al. 2010

Gynecologic Radiation Therapy

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The goal of treatment planning in image-guided brachytherapy (BT) is to widen the therapeutic window, i.e., to obtain the best possible chance for an uncomplicated cure of the patient [1] by optimizing the organization and delivery of the treatment. If a medical compromise has to be accepted it is vital to have maximal information about the consequences of any decisions taken during the treatment planning process. From quantitative radiobiology [2] and clinical experience [3,4] we know that the dose-response curves for many organs at risk (OAR) in the pelvis are almost as steep as the dose fall-off curve of BT, implying that we may often balance on the knife's edge between success and failure in our attempt to selectively deliver a high curative dose to the tumor.Over decades of traditional X-ray-based two-dimensional BT for gynecological cancer, invaluable experience has been gained in treatment planning [4][5][6][7][8]. With the advent of image-based BT, new volumetric (3D) and temporal (4D) information has deepened our understanding of BT thus far [9][10][11][12][13][14][15][16][17][18] but also presents us with new medical challenges and concepts that must be understood and interpreted correctly to reap the potential benefit of image-based BT treatment planning [19].

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Section: Implant and Fractionation Strategies For Image-guided Bt In mentioning

confidence: 99%

Clinical Aspects of Treatment Planning

Lindegaard

Pötter

Limbergen³

et al. 2010

Gynecologic Radiation Therapy

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“…Some studies attempting to shorten the OTT also reported increased complication rates . Erridge et al.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings support this hypothesis. Because radiotherapy for cervical cancer includes EBRT and ICBT, Some studies attempting to shorten the OTT also reported increased complication rates [17][18][19]. Erridge et al also noted that patients with the shortest OTT had an increased incidence of late morbidity without the involvement of cause-specific survival [20].…”

Section: Discussionmentioning

confidence: 99%

Impact of treatment time‐related factors on prognoses and radiation proctitis after definitive chemoradiotherapy for cervical cancer

et al. 2016

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This study aimed to investigate the impact of treatment time‐related factors on outcomes and radiation proctitis in patients undergoing concurrent chemoradiotherapy (CCRT) for cervical cancer. From September 2001 to December 2012, 146 patients with stage IIB cervical squamous cell carcinoma treated with CCRT were reviewed from a prospective cohort. Patients who received the same dose (45 Gy) of external beam radiation therapy (EBRT) were included in the analysis (n = 125). The same equivalent dose of 2 Gy (EQD2) of high‐dose‐rate intracavitary brachytherapy (HDR‐ICBT) was delivered at either 4 fractions of 6 Gy or 6 fractions of 4.5 Gy. The effects of the overall treatment time (OTT) and interval between EBRT and HDR‐ICBT on the cancer‐specific survival (CSS), local recurrence (LR), and incidence of proctitis were compared. The treatment time‐related factors did not adversely affect the CSS and LR rates. The multivariate analyses did not identify the OTT as an independent factor of CSS (P = 0.839) and LR (P = 0.856). However, OTT ≤56 days (P = 0.026) was identified as the only independent factor of overall proctitis. The 5‐year Grade 2 or greater proctitis rates were 14.9% and 0% (P = 0.001) in patients with the EBRT to ICBT interval ≤5 days and >5 days, respectively. To reduce rectal damage without compromising prognosis, the gap between EBRT and HDR‐ICBT should exceed 5 days in cervical cancer patients undergoing CCRT. Strictly limiting the OTT to 56 days may result in radiation proctitis without improvements in prognosis.

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“…However, the dose distribution from RALS is highly inhomogeneous, and several different methods of specifying the dose constraints have been published. Moreover, the risk assessment is also complicated because the dose contribution from EBRT and RALS varies considerably from study to study [4–6, 7–8]. …”

Section: Discussionmentioning

confidence: 99%

Radiation therapy for carcinoma of the uterine cervix: comparison of two brachytherapy schedules

Chatani

Tsuboi

Yagi

et al. 2014

Journal of Radiation Research

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We compared the survival rates and late effects for two groups of cervical cancer patients treated with almost the same external radiotherapy but different remote afterloading systems (RALS) for high-dose-rate intracavitary radiation therapy regimens. A total of 218 patients with carcinoma of the uterine cervix were treated. For 98 patients, intracavitary brachytherapy was delivered with 6–7.5 Gy/fraction to Point A (Group A), and for 120, 5 Gy/fraction with a modified source step size (Group B). The 3-year cause-specific survival rates by stage and treatment schedule were Group A: 91% and Group B: 96% in Stage I, 89% and 92% in Stage II, 64% and 75% in Stage III, 44% and 69% in Stage IV. The survival curves did not reveal any statistically significant differences at any stage. The 3-year cumulative local failure rates were 14% in Group A and 7% in Group B (P = 0.1202), while the actuarial rates of developing rectal complication (Grade 2 or more) at 3 years were 25% in Group A and 4% in Group B (P < 0.0001). This retrospective analysis suggests that a low dose per fraction with modified source step size is advantageous because of yielding almost the same local control but with fewer rectal complications.

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Late Effects After Radiotherapy for Locally Advanced Cervical Cancer: Comparison of Two Brachytherapy Schedules and Effect of Dose Delivered Weekly

Cited by 8 publications

References 32 publications

Clinical Aspects of Treatment Planning

Clinical Aspects of Treatment Planning

Impact of treatment time‐related factors on prognoses and radiation proctitis after definitive chemoradiotherapy for cervical cancer

Radiation therapy for carcinoma of the uterine cervix: comparison of two brachytherapy schedules

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