Salvage brachytherapy as a modern reirradiation technique for local cancer failure: The Phoenix is reborn from its ashes

Quivrin, Magali; Peignaux-Casasnovas, K.; Martin, Étienne; Rouffiac, M.; Thibouw, David; Chevalier, C.; Vulquin, N.; Aubignac, Léone; Truc, G.; Créhange, G.

doi:10.1016/j.canrad.2018.01.005

Cited by 12 publications

(9 citation statements)

References 78 publications

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“…As BT offers one of the best dose distributions in radiotherapy: a high radiation dose to the target volume while better protecting surrounding previously irradiated healthy tissues. Many studies describe BT as a ReRT equipment in local recurrences of previously irradiated prostate (5), gynecological (6-10), breast (11), head and neck (12)(13)(14), rectal cancers (15), brain tumor (16), sarcoma (17), or secondary primary cancers (18) occurring in-field. Generally, current data confirm that BT ReRT is feasible and has acceptable toxicity (18).…”

Section: Discussionmentioning

confidence: 99%

“…However, we could not find any difference in the comparison among BT techniques thus far. At present, the BT technique may be solely used depending on the available utility and ROs' experiences (18). This would likely highlight that experience could lead to more utilization of BT ReRT, as it is likely the responders who have high-level experience with BT would be more likely to perform BT.…”

Section: Such Treatment Decisions Must Be Handled Only By Teamsmentioning

confidence: 99%

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A national surveillance study of the current status of reirradiation using brachytherapy in Japan

et al. 2021

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This study aimed to explore the current status and pattern of practice for reirradiation using brachytherapy (ReRT-BT) through a survey in Japan. MATERIALS AND METHODS:We distributed an e-mail-based questionnaire to 153 institutions equipped with high-dose-rate brachytherapy facilities. RESULTS: We received responses from 76 institutions (49.7%). Forty-three of these institutions performed ReRT-BT and 42 institutions (55%) performed ReRT-BT during 2009e2018. However, 29 of the 42 institutions (69%) reported difficulty in obtaining ReRT-BT case information from their respective databases. Almost all the institutions encountered insufficient database system to extract details about the ReRT-BT cases. Responses from 33 institutions included the number of ReRT-BT cases; this increased from 90 in the period 2009e2013 (institution median 5 0.5; 0e 16) to 172 in the period 2014e2018 (institution median 5 2; 0e26). Nine institutions had to perform ReRT-BT for more than one case per year. The major location for cancer treatment was the pelvis (94%), followed by the head and neck (5%) and others (1%). In six site-specific scenarios, barring uterine corpus cancer recurrence, more than 90% of radiation oncologists agreed to perform ReRT-BT, whereas other areas (head and neck, prostate, and rectal cancer) gained 16e37% agreement. CONCLUSIONS: This decade saw an increase in the number of ReRT-BT cases in Japan and radiation oncologists' interest in ReRT-BT as a viable therapeutic option. However, scarce availability, immature education system, and insufficient database system are barriers to further consensus building.

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Section: Discussionmentioning

confidence: 99%

Section: Such Treatment Decisions Must Be Handled Only By Teamsmentioning

confidence: 99%

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

et al. 2021

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“…Fewer studies have reported results of SBRT in the reirradiation setting for lower GI cancers, and most reported treatments have been in the setting of pre-sacral or nodal recurrences, not anastamotic or luminal recurrences [17], [18]. Brachytherapy is another focal radiation modality frequently used for reirradiation of gynecologic and prostate malignancies [19], [20]. Small series of high dose-rate endorectal and or interstitial brachytherapy have been published looking at treatment in the preoperative setting for the treatment of recurrent rectal cancers [21], [22].…”

Section: Discussionmentioning

confidence: 99%

“…Even though reirradiation using an accelerated, hyperfractionated schedule appears to be safe and effective, as many as one third of patients develop grade 3–4 late toxicities including small bowel obstruction, ureteral stricture, urinary obstruction, anastomotic leak or stricture, chronic diarrhea and fistula formation [5]. As such, more advanced and focal radiation technologies have been studied in an effort to reduce toxicity rates and improve the therapeutic ratio [15], [16], [17], [18], [19], [20], [21], [22]. Particle therapy allows for more conformal radiation delivery by minimizing unnecessary exit dose beyond the tumor target.…”

Section: Introductionmentioning

confidence: 99%

Definitive hyperfractionated, accelerated proton reirradiation for patients with pelvic malignancies

Moningi

Ludmir

Polamraju

et al. 2019

Clinical and Translational Radiation Oncology

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Introduction: Pelvic reirradiation (re-RT) presents challenges due to concerns for late toxicity to tissuesat-risk including pelvic bone marrow (PBM). We routinely utilize a hyperfractionated, accelerated re-RT for recurrent rectal or anal cancer in the setting of prior radiation. We hypothesized that proton beam radiation (PBR) is uniquely suited to limit doses to pelvic non-target tissues better than photon-based approaches. Materials and methods: All patients who received hyperfractionated, accelerated PBR re-RT to the pelvis from 2007 to 2017 were identified. Re-RT was delivered twice daily with a 6 h minimum interfraction interval at 1.5 Gray Relative Biological Effectiveness (Gy(RBE)) per fraction to a total dose of 39-45 Gy (RBE). Concurrent chemotherapy was given to all patients. Comparison photon plans were generated for dosimetric analysis. Dosimetric parameters compared using a matched-pair analysis and the Wilcoxon signed-rank test. Survival analysis was performed Kaplan Meier curves. Results: Fifteen patients were identified, with a median prior pelvic RT dose of 50.4 Gy (range 25-80 Gy). Median time between the initial RT and PBRT re-RT was 4.7 years (range 1.0-36.1 years). In comparison to corresponding photon re-RT plans, PBR re-RT plans had lower mean PBM dose, and lower volume of PBM getting 5 Gy, 10 Gy, 20 Gy, and 30 Gy (p < 0.001, p < 0.001, p < 0.001, and p = 0.033, respectively). With median 13.9 months follow-up after PBR re-RT, five patients had developed local recurrences, and four patients had developed distant metastases. One-year overall survival following PBR re-RT was 67.5% and one-year progression free survival was 58.7%. No patients developed acute or late Grade 4 toxicity. Conclusion: PBR re-RT affords improved sparing of PBM compared with photon-based re-RT. Clinically, PBR re-RT is well-tolerated. However, given modest control rates with definitive re-RT without subsequent surgical resection, a multidisciplinary approach should be favored in this setting when feasible.

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“…The addition of a further course of adjuvant radiotherapy after SBCS might reduce the risk of local recurrence, and some recent guidelines have strongly suggested to consider the conservative approach including reirradiation along with salvage mastectomy. The possibility of an early diagnosis and the availability of high precision EBRT techniques offered by current technological advances has paved the way for salvage breast conservation based on wide local excision partial breast reirradiation [13,14,15,16,17,18,19,20,21,22,23,24,25].…”

Section: Purposementioning

confidence: 99%

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

Vavassori

Riva

Cavallo

et al. 2020

jcb

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To evaluate clinical results of catheter-based interstitial high-dose-rate (HDR) brachytherapy (BT) as adjuvant treatment in previously irradiated recurrent breast cancer. Material and methods: Between January 2011 and September 2015, 31 consecutive patients with histologically confirmed recurrent breast cancer after conservative surgery and conventional whole breast radiotherapy, were retreated with a second conservative surgical resection and reirradiated with adjuvant interstitial HDR-BT. None of the brachytherapy implant was performed during the quadrantectomy procedure. A dose of 34 Gy in 10 fractions, 2 fractions per day, with a minimal interval of 6 hours was delivered. Results: At the time of the implant, the median age of patients was 59.7 years (range, 39.3-74.9 years). The median time from first treatment until BT for local recurrence was 11.9 years (range, 2.5-27.8 years). The median interval between salvage surgery and BT was 3.6 months (range, 1-8.2 months). No acute epidermitis or soft tissue side effects higher than grade 2 were recorded, with good cosmetic results in all patients. Most of the patients presented grade 1-2 late side effects. Only one patient developed grade 3 liponecrosis. After a median follow-up of 73.7 months (range, 28.8-102.4 months), the overall survival and cancer specific survival were 87.1% and 90.3%, respectively; 5-year local control and 5-year progression-free survival rate were 90.3% and 83.9%, respectively. Conclusions: Our preliminary analysis showed that HDR-BT is a feasible treatment for partial breast reirradiation offering very low complications rate and fast procedure. Higher patients' cohort is warranted in order to define the role of this treatment modality in the breast conservative management of local recurrence.

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Salvage brachytherapy as a modern reirradiation technique for local cancer failure: The Phoenix is reborn from its ashes

Cited by 12 publications

References 78 publications

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

Definitive hyperfractionated, accelerated proton reirradiation for patients with pelvic malignancies

High-dose-rate Brachytherapy as Adjuvant Local rEirradiation for Salvage Treatment of Recurrent breAst cancer (BALESTRA): a retrospective mono-institutional study

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