Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: Efficacy and toxicity of a low cumulative radiation dose schedule

Toita, Takafumi; Kitagawa, Ryo; Hamano, Tetsutaro; Umayahara, Kenji; Hirashima, Yasuyuki; Aoki, Yoichi; Oguchi, Masahiko; Mikami, Mikio; Takizawa, Ken

doi:10.1016/j.ygyno.2012.04.036

Cited by 108 publications

(99 citation statements)

References 29 publications

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“…Answer to the second clinical questionVefficacy of the Japanese RT schedulesVwas reported elsewhere. 21 Herein, we report the feasibility and acute toxicities that resulted from application of the global standard regimen of chemotherapy in CCRT for Japanese patients with cervical cancer.…”

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confidence: 99%

ATL: Results of a Multi-Institutional Phase 2 Study (JGOG1066)

Toita

Kitagawa

Hamano

et al. 2012

Int J Gynecol Cancer

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confidence: 99%

ATL: Results of a Multi-Institutional Phase 2 Study (JGOG1066)

Toita

Kitagawa

Hamano

et al. 2012

Int J Gynecol Cancer

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“…The EBRT and the brachytherapy in this study do not reflect the modern method of European practice (17). In phase II JCOG 1066 study of concurrent chemoradiation with HDR-ICBT in patients with locally advanced (FIGO stages III -IVA) uterine cervical cancer, Toita et al (21) reported efficacy and toxicity of a low cumulative radiation dose schedule. They demonstrated that CCRT using HDR-ICBT with a low cumulative RT dose schedule, in which the cumulative linear quadratic equivalent dose (EQD2) was 62 -65 Gy prescribed at point A, achieved comparable outcome as those achieved with global dose schedules (EQD2 ¼ 85 Gy) with a lower incidence of late toxicity for locally advanced uterine cervical cancer in a Japanese population of 72 patients.…”

Section: Discussionmentioning

confidence: 84%

High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

Yamashita

Niibe

Toita

et al. 2013

Japanese Journal of Clinical Oncology

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Background: The current study was designed to evaluate the clinical outcomes of curative intent radiation therapy for young patients with invasive uterine cervical carcinoma in Japan. Methods: One hundred and eighteen patients aged 40 were registered in the multi-institutional study of the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) from 26 major institutions in Japan. The age range was 24 -39 years and the maximum tumor diameter was 2.0 -9.2 cm. The International Federation of Gynecology and Obstetrics clinical stages were Ib, IIa, IIb, IIIa, IIIb and IVa in 17, 6, 40, 2, 50 and 3, respectively. Curative intent radiation therapy consisted of the combination of external beam radiation therapy and highdose rate intra-cavitary brachytherapy. The total dose of external beam radiation therapy ranged between 44 and 68 Gy. Both the median and mode of total high-dose-rate intra-cavitary brachytherapy dose to point A were 24 Gy in four fractions. Ninety-six patients (58%) received chemotherapy. Results: The 5-year overall survival rate and local control rate of all patients were 61 and 65%, respectively. The 5-year overall survival rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 88, 100, 75, 100, 37 and 0%, respectively. The 5-year local control rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 82, 75, 75, 100, 51 and 0%, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity. Conclusions:The 5-year overall survival rate of young patients with Stage IIIb was comparatively low at 37%.

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“…Until recently, position-checking and treatment-planning at Nihon University School of Medicine were performed using a 2D method that used X-ray film, as CT was not available in the treatment room, and it was therefore difficult to obtain CT images with the patient in a proper position and with the applicators inserted properly. A standard fixed dose of 6 Gy per fraction was prescribed to the point A, according to the Japanese Gynecologic Oncology Group 1066 prospective study (15). However, the present patient had a complete septate uterus with left and right uterine canals.…”

Section: Discussionmentioning

confidence: 98%

“…The standard treatment for locally advanced uterine cervical cancer is EBRT with concurrent cisplatin chemotherapy and BT (14,15). For BT, a prescribed dose of irradiation is traditionally applied to the Manchester point A.…”

Section: Discussionmentioning

confidence: 99%

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

et al. 2018

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Abstract. Brachytherapy is a standard treatment modality for locally advanced cervical cancer. In patients with uterine anomalies, the radiation dose to the target volume and the organs at risk can vary depending on the positioning of the brachytherapy tandem implant. However, there have been few reports concerning the use of brachytherapy in patients with uterine anomalies. The present study reports the case of a 55-year-old woman with locally advanced squamous cell carcinoma of the cervix and complete septate uterus. The patient was treated with external-beam radiation therapy, cisplatin chemotherapy, and brachytherapy. Computed tomography-based planning was performed for image-guided brachytherapy with the tandem implant alternately in the right and left uterine canals and using the right and left point A. A comparison of the resulting dose-volume histograms revealed wide variations in the projected dose to the clinical target volume and organs at risk. Tandem implant positioning for brachytherapy was chosen to optimize the dose-volume distribution. At the point of writing, the patient has not experienced local recurrence. IntroductionThe standard treatment for locally advanced cervical cancer is pelvic external beam radiation therapy (EBRT) with concurrent cisplatin chemotherapy and brachytherapy (BT) (1-3).Recently, 3D image-guided brachytherapy (IGBT), which uses computed tomography (CT) or magnetic resonance imaging (MRI) to obtain images of inserted applicators, has come into widespread use (4-6). The present study reports the use of BT in a patient with locally advanced cervical cancer involving a complete septate uterus with right and left uterine canals. Prior to treatment, CT images were obtained with a tandem implant inserted alternately into the right and left uterine canals. A treatment-planning system was used to compare the resulting dose volumes; the uterine canal that was associated with optimal distribution of the dose volume was chosen for BT. There have been only a few reports of BT in patients with uterine anomalies. To the best of our knowledge, this is the first case in which the dose-volume difference between tandem implant placement in the right versus left uterine canal was examined. Case report Patient presentation and diagnosis.A 55-year-old woman presented with a 1-month history of general malaise. A high creatinine level of 2.26 mg/dl (normal range, 0.46-0.79 mg/dl) was found upon hematological examination; CT revealed that a cervical tumor was causing bilateral hydronephrosis involving the bilateral ureters. Therefore, bilateral ureteral stents were inserted. Tissue biopsy of the cervical tumor led to a diagnosis of squamous cell carcinoma. MRI revealed that the endometrial cavity was separated into right and left canals by a septum on the cranial side of the cervical tumor (Fig. 1A and B). The septum reached the level of the internal cervical os, indicating a complete septate uterus corresponding to class V of the American Society of Reproductive Medicine classification (7) and ...

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Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: Efficacy and toxicity of a low cumulative radiation dose schedule

Cited by 108 publications

References 29 publications

ATL: Results of a Multi-Institutional Phase 2 Study (JGOG1066)

ATL: Results of a Multi-Institutional Phase 2 Study (JGOG1066)

High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

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