Reirradiation using high-dose-rate brachytherapy in recurrent carcinoma of uterine cervix

Mahantshetty, Umesh; Kalyani, N.; Engineer, Reena; Chopra, Supriya; Swamidas, Jamema; Ghadi, Yogesh; Deshpande, Deepak D.; Shrivastava, Shyamkishore

doi:10.1016/j.brachy.2014.06.005

Cited by 40 publications

(41 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our median delivered HR-CTV D90 of 29.1 Gy over three to six fractions is comparable with doses in three of the previous reports [18,22,25]. Mahantshetty et al [16] reported a median SM-ISBT EQD2 of 42 Gy (IQR 37e46 Gy), which is higher than our median HR-CTV D90. Despite the higher dose, they reported local control of 44% at 2 years, which is comparable with the 50% in our patient population.…”

Section: Discussionsupporting

confidence: 83%

“…Despite the patient population receiving previous radiotherapy, we observed fairly impressive local control with SM-ISBT as salvage. Our 2-year actuarial local control rate of 50% is close to some previous studies that have reported a range of 44e53% [16,19,22]. At 3 years, Yoshida et al [27] reported a local control rate of 75% for patients with cervical cancer who had initial radical hysterectomy and adjuvant radiotherapy, and 46% for patients who had initial definitive radiation, and explained the difference with the lower initial radiation dose for patients who received adjuvant radiation.…”

Section: Discussionsupporting

confidence: 83%

“…The 3year local control rate was 71% in patients with previous radiation in the study by Kamran et al [20]. This study reports an overall survival rate of 78% at 2 years but only 38% at 3 years, which is initially higher than previously reported 2-year overall survival rates of 52.5, 67, 52 and 61% [16,19,22,25], but lower than the reported 3year overall survival rate of 54% by Kamran et al [20]. This might be due to inherent limitations in our study, including heterogeneity in patient inclusion and selection bias, as well as a median follow-up of just 2 years.…”

Section: Discussionmentioning

confidence: 51%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 51%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Re-irradiation is associated with 44% 2-year local control and 52% OS in carefully selected patients. 68 Patients who are not candidates for surgical or radiation salvage should be considered for systemic chemotherapy and be reassessed for BT or surgery. If local salvage is not feasible, then additional chemotherapy should be considered on the basis of response and the general condition of the patient 69 …”

Section: Managementmentioning

confidence: 99%

National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer

Chopra¹,

Mathew

Maheshwari

et al. 2018

JGO

Self Cite

View full text Add to dashboard Cite

Standard guidelines for the management of early and locally advanced cervical cancer are available from various academic consortiums nationally and internationally. However, implementing standard-of-care treatment poses unique challenges within low- and middle-income countries, such as India, where diverse clinical care practices may exist. The National Cancer Grid, a consortium of 108 institutions in India, aims to homogenize care for patients with cervical cancer by achieving consensus on not only imaging and management, but also in addressing potential solutions to prevalent challenges that affect the homogenous implementation of standard-of-care treatment. These guidelines therefore represent a consensus statement of the National Cancer Grid gynecologic cancer expert group and will assist in homogenization of the therapeutic management of patients with cervical cancer in India.

show abstract

“…The outcome with salvage re‐irradiation is better with a longer disease‐free interval and if there are no late toxicities from prior radiotherapy. This is achieved with higher brachytherapy doses [17].…”

Section: Radiation Therapy In Cervical Cancermentioning

confidence: 99%

Principles of radiation therapy in low‐resource and well‐developed settings, with particular reference to cervical cancer

Shrivastava

Mahantshetty

Narayan

2015

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

Reirradiation using high-dose-rate brachytherapy in recurrent carcinoma of uterine cervix

Cited by 40 publications

References 17 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

National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer

Principles of radiation therapy in low‐resource and well‐developed settings, with particular reference to cervical cancer

Contact Info

Product

Resources

About