Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

Kirchheiner, Kathrin; Nout, Remi A.; Tanderup, Kari; Lindegaard, Jacob Christian; Westerveld, Henrike; Haie-Méder, Christine; Petrič, Primož; Mahantshetty, Umesh; Dörr, Wolfgang; Pötter, Richard

doi:10.1016/j.ijrobp.2014.01.032

Cited by 113 publications

(55 citation statements)

References 17 publications

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“…The toxicity outcomes of previous EMBRACE studies evaluating MRI based 3D-BT have shown favorable results. The 2-year actuarial probability of severe vaginal morbidity was 3.6%, which was less than has been reported from earlier studies of ~30% (4,23).…”

Section: Discussioncontrasting

confidence: 59%

Impact of brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: A Systematic Review and Meta-analysis

Kim¹,

Kang²,

Kim³

2020

Preprint

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Background: To perform a systematic review and meta-analysis of the impact of brachytherapy (BT) technique (two-dimensional [2D] or three-dimensional image-guided [3D]) on outcomes of cervical cancer patients.Methods: PubMed and Embase databases were searched up to April 16, 2019, for studies which evaluated the effect of 3D-BT compared to 2D-BT in cervical cancer, and endpoints included cumulative incidence of severe toxicity, locoregional recurrence-free survival (LRRFS), progression-free survival (PFS), and overall survival (OS). Hazard ratios (HRs) were pooled in the meta-analysis using the random-effects model.Results: Six studies of 8 cohorts were included in the quantitative synthesis. The pooled hazard ratio (HR) regarding toxicity was evaluated in 5 cohorts in 3 studies, and the HR of 3D-BT compared to 2D-BT was 0.54 (95% confidence interval [CI], 0.37-0.77). All 6 studies were included for the synthesis for LRRFS, and the pooled HR favors 3D-BT (0.61 [95% CI, 0.40-0.93]). For PFS, 3 studies were included for analysis and 3D-BT was superior to 2D-BT (HR = 0.75 [95% CI, 0.0.59–0.96]). Five studies were included for the pooled HR regarding OS, and pooled HR of 3D-BT compared to 2D-BT was 0.65 (95% CI, 0.40–1.06).Conclusions: 3D-BT might reduce severe toxicity and improve LRRFS, and PFS in patients with cervical cancer. 3D-BT should be considered for standard management of cervical cancer, and efforts for adopting this procedure in Korea should be pursued.

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Section: Discussioncontrasting

confidence: 59%

Impact of brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: A Systematic Review and Meta-analysis

Kim¹,

Kang²,

Kim³

2020

Preprint

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“…53 Temporally, VS is most likely to occur within the first year of treatment but has been observed in as short a time as 26 days and as far out as 5.5 years from definitive therapy. 44,45 The distal vaginal mucosa has less radiation tolerance than the mucosa in the upper region, and vaginal shortening may begin during the course of RT. 54 One randomized trial demonstrated higher rates of VS with higher vaginal brachytherapy doses.…”

Section: Time Course Of Sexual Dysfunctionmentioning

confidence: 99%

“…VS is defined as narrowing or shortening of the vaginal canal that may interfere with physical examination or sexual function. The incidence ranges from 20% to 88% of patients . Other series have demonstrated that patients who undergo surgery and receive HDR vaginal brachytherapy alone have an incidence of VS from as low as 2.5%, with the lowest rates reported in those who receive low‐dose‐per‐fraction regimens, to as high as 54% with tandem/ovoid treatments.…”

Section: Introductionmentioning

confidence: 99%

Complications of pelvic radiation in patients treated for gynecologic malignancies

Viswanathan

Lee

Eswara

et al. 2014

Cancer

147

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Radiation therapy is a critical treatment modality in the management of patients with gynecologic tumors. New highly conformal external‐beam and brachytherapy techniques have led to important reductions in recurrence and patient morbidity and mortality. However, patients who receive pelvic radiation for gynecologic malignancies may experience a unique constellation of toxicity because of the anatomic locations, combination with concurrent chemotherapy and/or surgery, as well as potential surgical interventions. Although side effects are often categorized into acute versus late toxicities, several late toxicities represent continuation and evolution of the same pathologic process. Comorbidities and radiation dose can significantly increase the risk of morbidity. Current understanding of the incidence of various morbidities in patients treated with current radiation techniques for gynecologic malignancies, the impact of chemotherapy and surgery, treatment options for those effects, and future areas of research are highlighted. Cancer 2014;120:3870–3883. © 2014 American Cancer Society.

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“…In LACC patients, mild and intermediate vaginal [11], rectal- [12], urinary- [13] and gastrointestinal [14] morbidity that potentially impacts the patient's quality of life is prevalent. Non-organ-related morbidity such as fatigue, insomnia and hot flashes as well as pelvic insufficiency fractures and limb edema has also been reported [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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A B S T R A C TBackground and purpose: Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach. Materials and methods: In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume + remaining cervix) and low risk (LR) CTV-T (CTV-T HR + uterus + parametriae + upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45 Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75 Gy) and CTV-T LR (aim 40 Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging. Results: Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5-2.2 and 1.0-2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7 Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2-1.8 Gy), and 3 patients did not benefit from re-planning. Conclusions: Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.

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Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

Cited by 113 publications

References 17 publications

Impact of brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: A Systematic Review and Meta-analysis

Impact of brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: A Systematic Review and Meta-analysis

Complications of pelvic radiation in patients treated for gynecologic malignancies

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

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