Single-Institution Experience in 3D MRI-Based Brachytherapy for Cervical Cancer for 239 Women: Can Dose Overcome Poor Response?

Horne, Zachary D.; Karukonda, Pooja; Kalash, Ronny; Edwards, Robert P.; Kelley, Joseph L.; Comerci, John T.; Olawaiye, Alexander; Courtney-Brooks, M.; Bochmeier, Michelle M.; Berger, Jessica; Taylor, S.E.; Sukumvanich, Paniti; Beriwal, Sushil

doi:10.1016/j.ijrobp.2018.12.042

Cited by 18 publications

(17 citation statements)

References 24 publications

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“…Our series included many patients with advanced extent of disease and at the time of BT due to suboptimal response to chemoradiation therapy, which necessitated BT dose escalation and the use of hybrid applicator. Local control within our series is around 80% at 1 year, compared with greater than 90% local control rates at 3 years in other series, including previously reported data from our own institution in a more varied group of patients with cervical cancer treated with definitive chemoradiation therapy with HDR BT boost [14,16,19,20]. Median HR-CTV at the time of BT within our cohort was 31.95 cc (IQR 24.5e48.1 cc).…”

Section: Discussionsupporting

confidence: 42%

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Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

et al. 2021

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The Vienna and Venezia (Elekta) are hybrid intracavitary/interstitial brachytherapy (BT) applicators for cervical cancers unsuitable for intracavitary BT alone to improve target coverage or reduce critical organ dose. There is limited outcome data with the use of these applicators outside published experience of the EMBRACE group. We report feasibility and early outcomes with the use of these hybrid applicators at our institution. METHODS AND MATERIALS: Hybrid applicators were used to treat 61 patients with cervical cancer from November 2011 to December 2019. Indications for hybrid applicator use were involvement of the vagina in 10 patients (16%), residual central or parametrial disease in 46 patients (75%), and a narrow introitus in 5 patients (9%). Toxicities were graded using the CTCAE v4.0. Outcomes were assessed with the KaplaneMeier method. RESULTS: Median follow-up was 16 months (IQR 9e32 mos). Median HRCTV volume was 31.6 cm 3 (IQR 25e48 cm 3 ). Median HRCTV D90 was 86.1 Gy (IQR 84.3e88.0 Gy). In 54 patients with follow-up PET/CT at 3 months, complete initial imaging response locally was seen in 46 patients.Estimated 12-month KaplaneMeier overall survival, locoregional control, distant control, and recurrence-free survival estimates were 86.9%, 80.6%, 73.8%, and 65.9%, respectively. The 12month incidence of Grade 3þ GI/GU chronic toxicities was 5.7%, consisting of vesicovaginal fistula, rectovaginal fistula, and ureterovesical fistula. CONCLUSIONS: Our single-institution data support the use of the hybrid applicators, as an alternative to traditional BT applicators when clinically warranted. Use of hybrid applicators is feasible with adequate coverage of disease in the vagina and parametrium.

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Section: Discussionsupporting

confidence: 42%

“…Previously published data from our institution suggest that poor outcomes after a poor response to chemoradiation therapy may be difficult to overcome with radiation dose escalation alone due to increased rates of extrapelvic failure. There is a need for alternate strategies of treatment intensification to control extrapelvic disease [19].…”

Section: Discussionmentioning

confidence: 99%

Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

et al. 2021

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“…MRI has been recommended as gold standard imaging for cervical cancer contours, with some comparative studies previously published ( 14 , 23 , 24 ), and for MR-IGABT (repetitive MRI during complete brachytherapy treatment), several studies reported its clinical efficacy for LACC patients in Europe ( 7 , 25 ) and North America ( 26 ). This study aimed to report the treatment outcomes of MR-IGABT for 97 Chinese LACC patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

et al. 2022

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PurposeThis study aims to evaluate clinical outcomes of MRI-guided adaptive brachytherapy (MR-IGABT) for each brachytherapy fraction in patients with locally advanced cervical cancer (LACC).Methods and MaterialsA retrospective analysis was performed on 97 consecutive patients with LACC treated with 44.0–50.4 Gy external beam radiotherapy (EBRT) ± concurrent platinum-containing chemotherapy followed by 4 × 7 Gy MR-IGABT between September 2014 and April 2019. Intracavitary (IC)/interstitial (IS)/hybrid intracavitary and interstitial (IC/IS) brachytherapy was used in MR-IGABT. Brachytherapy planning and dose reporting followed the GEC-ESTRO recommendations. Clinical outcomes including overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), local control (LC), and treatment-related toxicity evaluated by the RTOG criteria were analyzed. Kaplan–Meier and univariable and multivariable Cox regression analyses were used to analyze the prognostic factor.ResultsMedian follow-up was 21.1 months. Median dose to 90% (D90) of the high-risk clinical target volume (HR-CTV) was 91.7 Gy (range 76.7~107.2 Gy). Two-year OS, CSS, PFS, and LC were 83.5%, 84.1%, 71.1%, and 94.8%, respectively. Four patients (4.1%) suffered from grade 3 late gastrointestinal radiation toxicity, and no other grade 3 or greater radiation toxicity occurred. Initial HR-CTV was an independent factor of OS (p = 0.001, HR = 1.018/cm3), PFS (p = 0.012, HR = 1.012/cm3), and LC (p = 0.011, HR = 1.028/cm3). The HR-CTV D90 (p = 0.044, HR = 0.923/Gy) was an independent factor of PFS. Age was an independent factor of LC (p = 0.010, HR = 1.111/year).ConclusionFor patients with LACC, MR-IGABT was effective and safe. It showed favorable LC, OS, and minimal toxicity. Moreover, initial HR-CTV, HR-CTV D90, and age were significant prognostic factors.

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“…The American experience with 3D MRI-based brachytherapy is best represented by the University of Pittsburgh study, which accrued patients from 2007 to 2018 [ 24 ]. A total of 239 women were studied.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AC, poor response to EBRT, or HR-CTV >40 cm 3 had inferior LC independent of any increase in doses above 85 Gy. An IC/IS hybrid device was used in 38.9% of the cases [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States

Ahmed¹,

Vijayakumar²,

Duggar³

et al. 2021

Cureus

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Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting. The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.

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Single-Institution Experience in 3D MRI-Based Brachytherapy for Cervical Cancer for 239 Women: Can Dose Overcome Poor Response?

Cited by 18 publications

References 24 publications

Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States

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