Stereotactic radiotherapy in recurrent gynecological cancer: A case series

Deodato, Francesco; Macchia, G.; Grimaldi, Luca; Ferrandina, Gabriella; Lorusso, Domenica; Salutari, Vanda; Cilla, Savino; Valentini, Vincenzo; Cellini, Numa; Piermattei, Angelo; Morganti, Alessio Giuseppe

doi:10.3892/or_00000453

Cited by 20 publications

(11 citation statements)

References 22 publications

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“…Recurrences treated with SBRT are described in the literature, albeit with a small or heterogenous patient population. Some studies combine the results of primary and recurrent tumors (21, 22), others include non-gynecologic primaries (23–26), and some have less than 10 patients (27–29). Guckenberger et al reported an 81% 3-year local control (LC) rate and median overall survival of 25 months in (mostly central) pelvic recurrences treated with EBRT and an SBRT boost (30).…”

Section: Introductionmentioning

confidence: 99%

Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy

et al. 2016

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PurposeTo define prognostic factors associated with improved survival and local control (LC) for gynecologic cancer recurrences limited to the pelvis and para-aortic (PA) region using stereotactic body radiation therapy (SBRT).MethodsBetween 2/2008 and 7/2014, 30 women (35 targets) with pelvic or PA recurrence of endometrioid (n = 12), cervical (n = 11), ovarian (n = 3), uterine-serous (n = 2), or carcinosarcoma (n = 2) cancer were treated with SBRT. Eleven recurrences were located in the central pelvis, 11 along the pelvic sidewall (PSW), and 13 in the PA region.ResultsFive-year survival for all patients was 42% with a median survival of 43.4 months. Multivariate analysis revealed better performance status (PS), and smaller clinical tumor volume was significant for improved survival (p < 0.05).ConclusionSBRT is a local therapy for recurrent gynecological malignancies in the pelvis and PA region with curative potential. SBRT is especially effective for LC when targeting PSW or PA recurrence and for patients with a cervical/endometrioid uterine primary. Survival is improved for patients with better PS and smaller recurrence volume prior to SBRT.

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Section: Introductionmentioning

confidence: 99%

Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy

et al. 2016

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“…2, respectively, contributing to the difference. The use of oral gastrografin in the planning of EBRT for UCC has been reported previously [10,11]. However, to the best of our knowledge, this is the first study to report the use of oral gastrografin for target delineation in CT-based 3D-IGBT and to demonstrate its beneficial effects in representative cases.…”

Section: Discussionmentioning

confidence: 80%

Oral Gastrografin Facilitates Delineation of Intestinal Tracts in CT-Based Brachytherapy for Uterine Cervical Cancer

Irie¹,

Murata²,

Kaminuma³

et al. 2020

Cureus

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Three-dimensional image-guided brachytherapy (3D-IGBT) using computed tomography (CT) is an essential component of definitive radiation therapy for uterine cervical cancer (UCC). Treatment planning for CT-based 3D-IGBT requires delineating the high-risk clinical target volume (CTV HR) and the organs at risk (OARs), which is difficult when the small intestine is adjacent to those delineation targets. Uncertainty in target delineation threatens the validity of 3D-IGBT treatment plans. To address this issue, we introduce the use of diatrizoate meglumine and diatrizoate sodium (gastrografin), an orally administrable iodine-based radiopaque contrast agent. We present two cases of UCC treated with CT-based 3D-IGBT and describe how intraluminal enhancement of the small intestine by oral gastrografin pretreatment facilitated discrimination between the small intestine and the adjacent CTV HR (case no.1) or the rectosigmoid colon (case no. 2). Oral gastrografin pretreatment is a simple and cost-effective method that allows distinguishing the small intestine from the adjacent delineation target (i.e., CTV HR and the OARs) in CT-based 3D-IGBT for UCC.

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“…Two cases of local progression [19,23] and only one of distant recurrence (but not specified) [23] were observed.…”

Section: Resultsmentioning

confidence: 95%

“…The study populations were heterogeneous. Six studies included patients with primary cervical [17,[19][20][21]23,27] and endometrial cancer [17][18][19]21,23,27]. Two studies reported a combination of patients with primary vulvar cancer [23,27], vaginal cancer [23] and ovarian cancer [17,21].…”

Section: Resultsmentioning

confidence: 99%

“…Quality assessment score of included studies was assessed according to checklist for quality appraisal of case series studies produced by Institute of Health Economics (IHE) and modified to improve applicability (Table 1, Ref. [17][18][19][20][21]23,27]). Risk of bias was assessed for each article using quality assessment tool for domain of hypothesis stated, multicentric studies, prospective study, patients' selection, consecutive patients, described characteristics of patients, clearly stated eligibility criteria, described intervention, reported losses to follow-up and adverse events.…”

Section: Study Selectionmentioning

confidence: 99%

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Recurrent Gynecological Tumors in Previously Irradiated Patients. Does Re-Irradiation with Stereotactic Body Radiotherapy Have a Role? A Systematic Review

Pontoriero,

Critelli,

Bosurgi

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Re-irradiation of patients with previously irradiated gynecological tumors represents one of the hot topics of modern oncology. It is generally performed using Brachytherapy (alone or after external beam radiation therapy (EBRT) re-treatment) or Stereotactic Body Radiotherapy (SBRT). Literature provides few data concerning SBRT re-irradiation (re-RT). Here we provided a statistical and comparative analysis of the studies to make a general assessment of the efficacy and reliability of SBRT, considering the potential benefits achievable in terms of local control, overall survival and toxicity. Methods: A computerized literature search was performed in 3 electronic databases (MEDLINE, EMBASE, and Cochrane) from 1996 to 2020. Only studies analysing outcomes of re-irradiated (re-I) patients were taken into consideration. Quality assessment score and risk of bias were assessed for each article. Random-effects models were used due to great subjectivity given the lack of related control groups in the non-comparative studies and a tendency towards high heterogeneity (examined by the Cochran Q chi-square test and the I 2 statistic). To determine the pooled 2-year Overall Survival (OS) and 2-year Local Control (LC) and ≥Grade 3 (G3) treatment-related toxicities, an established meta-analysis technique over single and multi-arm studies was performed. Results: Of 21 articles focusing on the role of SBRT in recurrent gynaecological cancers, were identified. Only 7 articles, published between 2009 and 2020, with outcomes limited to re-I patients and specific radiotherapy techniques were included. The selected studies counted a total of 196 patients, 157 of whom were previously irradiated. With a median follow up time of 14.5 months, using SBRT re-I technique, the pooled 2-year OS of 52.7% (95% confidence interval (CI): 0.372 to 0.651) and 2-year LC of 75.7% (95% CI: 0.614 to 0.852) were observed. SBRT re-irradiation technique does not affect toxicities with pooled ≥G3 late toxicities being 8.7% (95% CI: -0.0944 to 0.267). Conclusions: According to our review, SBRT re-irradiation technique seems to be feasible and safe, when brachytherapy re-RT technique is not available. Further studies are warranted to standardize the best radiation therapy in recurrent gynaecological cancer.

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Stereotactic radiotherapy in recurrent gynecological cancer: A case series

Cited by 20 publications

References 22 publications

Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy

Survival and Control Prognosticators of Recurrent Gynecological Malignancies of the Pelvis and Para-aortic Region Treated with Stereotactic Body Radiation Therapy

Oral Gastrografin Facilitates Delineation of Intestinal Tracts in CT-Based Brachytherapy for Uterine Cervical Cancer

Recurrent Gynecological Tumors in Previously Irradiated Patients. Does Re-Irradiation with Stereotactic Body Radiotherapy Have a Role? A Systematic Review

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