Palliative pelvic radiotherapy for gynaecologic cancer

Skliarenko, Julia; Barnes, Elizabeth A.

doi:10.1007/s13566-012-0050-y

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…Exenteration is associated with only a 40% 5-year overall survival [4], and with considerable morbidity and effect on quality of life [5,6], particularly when carried out in the context of prior pelvic radiation. Previous reports have shown a 23% risk of fistula and a 33% risk of bowel obstruction [7], with overall morbidity rates of up to 65% [8].…”

Section: Introductionmentioning

confidence: 97%

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: Introductionmentioning

confidence: 97%

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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“…When comparing both modalities, the 3-year OS ranged from 42% to 68% in several re-RT IGBT studies and the 5-year OS was 39.5% in another, whereas 5-year survival rate varies between 10% and 56% in surgical studies [ 8 , 9 , 10 , 47 , 48 , 49 , 50 , 51 ]. Pelvic exenteration as salvage surgery, in previously irradiated tissues, comes at a high cost of complications, with associated morbidity ranging between 30% and 76%, high perioperative morbidity rates ranging between 22 and 66%, peri-operative mortality rates up to 5.5%, and with disabling long-term toxicities (fistula, bowel obstruction, need of permanent urinary and/or bowel derivations) [ 8 , 9 , 10 , 11 , 12 , 48 , 49 , 50 , 51 , 52 ]. As a result, a vast amount of patients experience long-term quality of life detriments, especially in the elderly [ 13 ].…”

Section: Discussion and Highlightsmentioning

confidence: 99%

Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review

Bockel

Espenel

Sun

et al. 2021

Cancers

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Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for reirradiation in the context of local recurrences from gynecological malignancies. Methods: We conducted a large-scale literature research, and 15 original studies, responding to our research criteria, were finally selected. Results: Local control rates ranged from 44% to 71.4% at 2–5 years, and overall survival rates ranged from 39.5% to 78% at 2–5 years. Grade ≥3 toxicities ranged from 1.7% to 50%, with only one study reporting a grade 5 event. Results in terms of outcome and toxicities were highly variable depending on studies. Several studies suggested that local control could be improved with 2 Gy equivalent doses >40 Gy. Conclusion: IGBT appears to be a feasible alternative to salvage surgery in inoperable patients or patients refusing surgery, with an acceptable outcome for patients who have no other curative therapeutic options, however at a high cost of long-term grade ≥3 toxicities in some studies. We recommend that patients with local recurrence from gynecologic neoplasm occurring in previously irradiated fields should be referred to highly experienced expert centers. Centralization of data and large-scale multicentric international prospective trials are warranted. Efforts should be made to improve local control while limiting the risk of toxicities.

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“…For palliation, hypofractionated schedules like 30 Gy in ten fractions, 20 Gy in five fractions, or single fractions of 5-10 Gy are used in clinical practice [9].…”

Section: Discussionmentioning

confidence: 99%

Fractionated Palliative Pelvic Radiotherapy as an Effective Modality in the Management of Recurrent/Refractory Epithelial Ovarian Cancers: An Institutional Experience

Bansal

Rai

Kumar

et al. 2016

J Obstet Gynecol India

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Background The advent of effective chemotherapeutic agents for ovarian carcinoma has made radical abdominopelvic radiation redundant. Nevertheless, palliative pelvic radiotherapy still has a role in palliating local symptoms. However, its effect on progression-free survival (PFS) may be debated. Aims To study the outcome of fractionated palliative pelvic radiotherapy in relapsed ovarian cancers in terms of symptom control and PFS. Methods Twenty-three patients of ovarian cancers, heavily pretreated with chemotherapy and with recurrent or residual pelvic masses, were planned for palliative pelvic radiotherapy to the dose of 46-50 Gy in 23-25 fractions in 4.5-5 weeks. Symptom control and outcomes have been analyzed.

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Palliative pelvic radiotherapy for gynaecologic cancer

Cited by 15 publications

References 26 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 Brachytherapy for Salvage Reirradiation: A Systematic Review

Fractionated Palliative Pelvic Radiotherapy as an Effective Modality in the Management of Recurrent/Refractory Epithelial Ovarian Cancers: An Institutional Experience

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