Selection Criteria and Clinical Outcomes of Patients With Asymmetrical Cervical Cancer Treated With Various High-dose-rate Brachytherapy Techniques

Murofushi, Keiko; Yoshioka, Yasuo; Ishikawa, Hitoshi; Sumi, Minako; Okumura, Toshiyuki; Oguchi, Masahiko; Sakurai, Hideyuki

doi:10.21873/anticanres.14034

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Accurate patient positioning and set-up verification are the best tools to prevent RP (104). Traditional DVH constraint analysis systems seem reliable; however, new approaches to assess the rectal dose are gradually carving out more space in clinical practice, as they are potentially more effective in predicting the risk of proctitis, such as by means of DSM.…”

Section: Discussionmentioning

confidence: 99%

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Ferini¹,

Pergolizzi

2021

In Vivo

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This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.

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Section: Discussionmentioning

confidence: 99%

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Ferini¹,

Pergolizzi

2021

In Vivo

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“…Our previous studies mention more details about selection of brachytherapy type [ 9 , 10 ]. The residual tumor was defined as the high T2WI area on the pre-brachytherapy MRI.…”

Section: Methodsmentioning

confidence: 99%

“…In our previous study, high-dose-rate (HDR) brachytherapy selection based on pre-brachytherapy MRI findings has achieved an LC rate of up to 90% among patients with locally advanced cervical cancer [ 9 , 10 ]. Furthermore, LC among patients treated with unsuitable brachytherapy, i.e., brachytherapy other than that selected based on pre-brachytherapy MRI findings, was worse than that among patients treated with appropriate brachytherapy ( p < 0.01) [ 10 ].…”

Section: Purposementioning

confidence: 99%

Impact of pre-brachytherapy magnetic resonance imaging on dose-volume histogram of locally advanced cervical cancer patients treated with radiotherapy including high-dose-rate brachytherapy

Murofushi

Ishida

Baba

et al. 2021

jcb

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Purpose: This study investigated the suitability of brachytherapy technique selection based on pre-brachytherapy magnetic resonance imaging (MRI) findings in cervical cancer by evaluating dose-volume histogram parameters. Material and methods: We retrospectively evaluated data from 61 patients with cervical cancer who underwent pre-brachytherapy MRI within 7 days before their first high-dose-rate brachytherapy treatment, selected according to pre-brachytherapy MRI findings. Combined intracavitary brachytherapy with interstitial techniques (IC/ISBT) or interstitial brachytherapy (ISBT) were favored treatments for poor-responding tumors after concurrent chemoradiotherapy, asymmetrical tumors, bulky parametrial extensions, bulky primary disease, and extensive paravaginal or distal vaginal involvement. Intracavitary brachytherapy (ICBT) was the preferred treatment for small tumors without extensive involvement of the vagina and parametrium. Results: The median tumor size was 58 mm on pre-treatment MRI and 38 mm on pre-brachytherapy MRI. On pre-brachytherapy MRI, 13 patients had a tumor with severe vaginal invasion, 15 patients presented with an asymmetrical bulky tumor, and 4 patients had bulky residual tumors. IC/ISBT or ISBT were administered to 26 patients (43%). Median equivalent dose in 2 Gy fractions of clinical target volume D 90 was 70.8 Gy for all patients. Median clinical target volume D 90 in each brachytherapy session exceeded the prescribed dose in both patients treated with ICBT and IC/ISBT or ISBT. Median equivalent dose in 2 Gy fractions of D 2cc to the bladder, sigmoid colon, and rectum was 69.5, 52.0, and 58.4 Gy, respectively. All cases remained within the doses recommended for organs at risk. Conclusions: Pre-brachytherapy MRI may be helpful in selecting suitable candidates for each type of brachytherapy and deliver the recommended doses to the tumor and organs at risk, particularly in cases with large tumors, poor response to concurrent chemoradiotherapy, asymmetrical tumors, severe vaginal invasion, extensive parametrial invasion, and/or corpus invasion.

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“…There were three such cases in the current study, one of which developed local recurrence, suggesting insufficient dose delivery to the tumor. In such cases, image guided brachytherapy (IGBT) utilizing intracavitary and interstitial approach may represent a potential treatment strategy to deliver enough dose to the tumor without increasing the dose to OARs (48,49).…”

Section: Comparison With 3d-crt Studies (Outcomes and Toxicities)mentioning

confidence: 99%

Treatment Outcome of the Combination Therapy of High-dose rate Intracavitary Brachytherapy and Intensity-modulated Radiation Therapy With Central-shielding for Cervical Cancer

Mukai

Minagawa

Inoue

et al. 2020

In Vivo

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Background/Aim: This study aimed to evaluate the clinical outcome of intensity-modulated radiation therapy (IMRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) in uterine cervical cancer (UCC). IMRT consisted of whole-pelvic radiation therapy (WPRT) and sequential WPRT with central-shielding (WPRT-CS).Patients and Methods: Thirty UCC patients treated with IMRT using TomoTherapy, were retrospectively analyzed. Results: The median dose of Gy and the median total dose of these was 50 Gy in 25 fractions (Fr). Median HDR-ICBT dose/Fr to Point A was 25 Gy/5 Fr. Median 2 Gy per fraction-equivalent dose (EQD2) of combined WPRT and HDR-ICBT to Point A (α/β=10) was 71.0 Gy. The 3-year local control, disease-free survival, and overall survival rates were 89.9%, 83.3%, and 86.3%. Conclusion: IMRT of WPRT and WPRT-CS given in combination with HDR-ICBT was a feasible therapy resulting in good disease control and tolerance in patients with UCC.With recent increases in the rate of uterine cervical cancer (UCC) in Japan, the role of radiation therapy (RT) in this disease has become more important. Standard RT for UCC includes the combination of external beam radiation therapy (EBRT) to whole pelvis (WP) using three-dimensional conformal radiation therapy (3D-CRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) (1-3). Several recent reports have described the use of intensity-modulated radiation therapy (IMRT) for WPRT instead of 3D-CRT (4-7). This strategy appears to provide excellent dose distribution and fewer acute adverse effects compared with 3D-CRT (4, 8-11). In Western countries, 45-50 Gy of WPRT followed by HDR-ICBT is recommended as standard therapy for UCC. However, Asian women typically have a smaller physique than Caucasian women and may have a smaller uterus and vagina surrounded by a thinner layer of fatty tissue. It can be challenging to maintain sufficient space between the HDR-ICBT source and rectal wall during treatment for UCC, resulting in excess exposure to the rectum. Therefore, in Japan and in other Asian countries, standard EBRT includes the combination of WPRT and sequential WPRT with central shielding (WPRT-CS) to avoid overexposure of the rectum in advance of HDR-ICBT. In 3D-CRT, CS comprises a simple rectangular midline block of 4 cm in width, formed by multi-leaf collimators (MCL) (12,13).In the present study, we applied IMRT consisting of WPRT and WPRT-CS instead of 3D-CRT for the treatment of patients with UCC and evaluated the feasibility, treatment outcome, and tolerance of this strategy. To our knowledge, this is the first report of the combination of WPRT and WPRT-CS using IMRT.

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Selection Criteria and Clinical Outcomes of Patients With Asymmetrical Cervical Cancer Treated With Various High-dose-rate Brachytherapy Techniques

Cited by 4 publications

References 20 publications

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Impact of pre-brachytherapy magnetic resonance imaging on dose-volume histogram of locally advanced cervical cancer patients treated with radiotherapy including high-dose-rate brachytherapy

Treatment Outcome of the Combination Therapy of High-dose rate Intracavitary Brachytherapy and Intensity-modulated Radiation Therapy With Central-shielding for Cervical Cancer

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