Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy

Facondo, Giuseppe; Vullo, Gianluca; Sanctis, Vitaliana De; Valeriani, Maurizio; Ascolese, A.M.; Massaro, Maria; Anzellini, Dimitri; Osti, Mattia Falchetto

doi:10.21873/cdp.10008

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…Historically, multiple attempts to replace brachytherapy with conventionally fractionated radiation therapy have resulted in lower local control rates [ 10 , 11 ]. However, with the advent of highly conformal treatments, such as SBRT, the safety and efficacy of this approach as a boost is being readdressed [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison

Dahbi¹,

Fadila²,

Vinh‐Hung³

2023

Cureus

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Background: The standard treatment for locally advanced cervical cancer involves chemo-radiation followed by brachytherapy. However, some patients are unable to undergo brachytherapy intensification. Recent advancements in radiation technology have provided several techniques, with stereotactic body radiation therapy (SBRT) theoretically able to mimic the dose distribution of brachytherapy with a high dose gradient. Methods: We analyzed 20 high-dose-rate intra-cavity brachytherapy plans for women with cervical cancer and simulated an adjunctive stereotactic radiotherapy plan at the same doses used for brachytherapy (21 Gray [Gy] in three fractions). No planning tumoral volume (PTV) margin was added for SBRT dosimetry. We used the dose constraints for brachytherapy from the EMBRACE trial and the dose constraints for SBRT in three fractions. Dose distribution, maximum dose points on target volumes, bladder, rectum, and dose-volume histograms were compared between the two techniques. Results: The mean volume of the high-risk clinical tumoral volume (CTV) was 64 cm3, and the mean volume of the intermediate-risk CTV was 93 cm3. The mean minimum dose received by 90% of the high-risk CTV (D90 CTV HR) was 17 Gy for brachytherapy versus 8.3 Gy for SBRT. The average minimum dose received by 90% of the intermediate-risk CTV (D90 CTV IR) was 7.5 Gy for brachytherapy versus 8.9 Gy for SBRT. The mean minimum dose delivered to 2cc of the bladder was 74.6 Gy for brachytherapy versus 84.7 Gy for SBRT. The mean minimum dose delivered to 2cc of the rectum was 71.8 Gy for brachytherapy versus 74.7 Gy for SBRT. Conclusion: We confirmed the dosimetric superiority of brachytherapy over SBRT in terms of target volume coverage and organ-at-risk sparing. Therefore, pending the results of further clinical studies, no current radiotherapy technique can replace brachytherapy for cervical cancer boost after external radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison

Dahbi¹,

Fadila²,

Vinh‐Hung³

2023

Cureus

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“…Stereotactic radiotherapy was originally used to treat brain cancers, with stereotactic body radiotherapy (SBRT) representing the application of this technology to the trunk of the body, such as for lung and liver cancers ( Song et al, 2004 ; Donovan and Swaminath, 2018 ; Tandberg et al, 2018 ; Sarudis et al, 2021 ; Ugurluer et al, 2021 ). SBRT has also been shown to be effective against cervical cancer, which is still frequently treated using intracavitary small-source radiotherapy ( Ito et al, 2019 ; Facondo et al, 2021 )…”

Section: Introductionmentioning

confidence: 99%

A single high-dose irradiation changes accumulation of methotrexate and gene expression levels of SLC and ABC transporters in cancer cells

et al. 2023

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Chemoradiotherapy is frequently used to treat cancer. Stereotactic body radiotherapy (SBRT) is a single high-dose radiotherapy used to treat a variety of cancers. The anticancer drug methotrexate (MTX) shows affinity for solute carrier (SLC) and ATP-binding cassette (ABC) transporters. This study investigated relationships between accumulation of methotrexate and gene expression levels of solute carrier and ATP-binding cassette transporters in cancer cells after a single and high-dose X-ray irradiation. Cancer cell lines were selected from lung and cervical cancer cell line that are commonly used for stereotactic body radiotherapy and effective with methotrexate. We examined expression levels of organic anion-transporting polypeptide (OATP)1B1, OATP1B3, OATP1B7, and organic anion transporter (OAT)1 as solute carrier transporters and multidrug resistance-associated protein (MRP)1 and MRP2 as ATP-binding cassette transporters, using real-time polymerase chain reaction and accumulation of 3H-MTX in cancer cells after 10-Gy irradiation, assuming stereotactic body radiotherapy. Cells were divided into three groups: Control without irradiation; 4 h after irradiation; and 24 h after irradiation. In control, gene expression levels of OAT1 in all cells was below the limit of measurement. After irradiation, gene expression levels of OATP1B1/1B3/1B7 showed changes in each cell line. Gene expression levels of MRP1/2 tended to increase after irradiation. Gene expression levels of OATP1B1/1B3/1B7 were much lower than those of MRP1/2. Accumulation of 3H-MTX tended to decrease over time after irradiation. Irradiation of cancer cells thus alters gene expression levels of both solute carrier transporters (OATP1B1/1B3/1B7) and ABC transporters (MRP1/2) and decreases accumulation of 3H-MTX in cancer cells over time due to elevated expression of MRP1/2.

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“…In the last decade, stereotactic body radiotherapy (SBRT) has gained considerable relevance as a treatment option in different settings and stages of gynecological malignancies [ 1 , 2 ]. More recently, the increasing use of imaging exams for cancer diagnosis and follow-up has led to earlier detection of metastases, also in the oligometastatic setting, as defined by Hellman and Weichselbaum.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Patients with Lymph Node Metastases from Gynecological Cancers

Facondo

Vullo

Sanctis

et al. 2023

JPM

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Background: To evaluate clinical outcomes of stereotactic body radiation therapy (SBRT) as a local treatment for lymph node metastases from gynecological cancers. Methods: Between November 2007 and October 2021, we retrospectively analyzed 29 lymph node metastases in 22 oligometastatic/oligoprogressive patients treated with SBRT. The Kaplan–Meier method was used to estimate the rates survival. Univariate analysis for prognostic factors were performed with the log-rank test, and Cox proportional hazards regression was used to estimate hazard ratios (HR). Results: Median age was 62 years (IQR, 50–80 years). Median follow-up was 17 months (IQR 10.5–31 months). The median survival was 22 months (CI 95%: 4.2–39.7, IQR:12.5–34.5 months). Six months, one year and two year overall survival (OS) were 96.6%, 85.2%, and 48.7%, respectively. Median local control (LC) was not reached. Six months, 1one year and 2 year were 93.1%, 87.9%, and 79.9%, respectively. Distant metastasis free survival (DMFS) at one year, and two year was 53% and 37.1%, respectively Four patients (18%) experienced acute G1-G2 toxicities. No G3–4 acute toxicity was reported, and no late toxicity was observed. Conclusions: SBRT for lymph node recurrence offers excellent in-field tumor control with safe profile and low toxicities. Size, number of oligometastases, and time primary tumor to RT seem to be significant prognostic factors.

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Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy

Cited by 7 publications

References 38 publications

Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison

Brachytherapy Versus Stereotactic Body Radiotherapy for Cervical Cancer Boost: A Dosimetric Comparison

A single high-dose irradiation changes accumulation of methotrexate and gene expression levels of SLC and ABC transporters in cancer cells

Clinical Outcomes of Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Patients with Lymph Node Metastases from Gynecological Cancers

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