Transabdominal Ultrasonography Based High Dose Rate Conformal Intracavitary Brachytherapy in Cervical Carcinoma

Nayak, Abhirup; Engineer, Reena; Mahantshetty, Umesh; Sastri, S.; Swamidas, Jamema; Shrivastava, Shyam Kishore; Sable, Nilesh

doi:10.1016/j.ijrobp.2017.06.1330

Cited by 4 publications

(3 citation statements)

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“…Because our dose prescription was to point A rather than HRCTV, it is likely that HRCTV, which was hitherto not defined in our patient population, would have received > 90 Gy in several complete responders. The 3-year local control of 94.1% and 85.1% in stages IB to IIB and III to IVA, respectively, is better than our previously reported historical cohort and comparable to our recently published experience of MRI-based BT and Retro-EMBRACE, 12 , 13 , 20 suggesting that the benefit of dose deposited with regard to tumor control is not completely dependent on the imaging used for target delineation.…”

Section: Discussionsupporting

confidence: 85%

Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

Mittal

Chopra

Pant

et al. 2018

JGO

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PurposeRecent guidelines recommend magnetic resonance imaging–based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with chemoradiation and point A–based brachytherapy (BT) using x-ray– or computed tomography–based planning.MethodsPatients treated between January 2014 and December 2015 were included. Patients underwent x-ray– or computed tomography–based BT planning with an aim to deliver equivalent doses in 2 Gy (EQD2) > 84 Gy10 to point A while minimizing maximum dose received by rectum or bladder to a point or 2 cc volume to < 75 Gy EQD2 and < 90 Gy EQD2, respectively. The impact of known prognostic factors was evaluated.ResultsA total of 339 patients were evaluated. Median age was 52 (32 to 81) years; 52% of patients had stage IB2 to IIB and 48% had stage III to IVA disease. There was 85% compliance with chemoradiation, and 87% of patients received four or more cycles. Median point A dose was 84 (64.8 to 89.7) Gy. The median rectal and bladder doses were 73.5 (69.6 to 78.4) Gy3 and 83 (73.2 to 90.0) Gy3, respectively. At a median follow-up of 28 (4 to 45) months, the 3-year local, disease-free, and overall survival for stage IB to IIB disease was 94.1%, 83.3%, and 82.7%, respectively. The corresponding rates for stage III to IVA were 85.1%, 60.7%, and 69.6%. Grade III to IV proctitis and cystitis were observed in 4.7% and 0% of patients, respectively.ConclusionThis audit demonstrates good 3-year outcomes that are comparable to published MRBT series. Conventional BT with selective use of interstitial needles and MRBT should continue as standard procedures until level-I evidence for MRBT becomes available.

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Section: Discussionsupporting

confidence: 85%

Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

Mittal

Chopra

Pant

et al. 2018

JGO

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“…With a median follow up of 49 months, the five-year local and pelvic control, DFS and OS were 93.3, 85, 71.7, and 71.7 per cent, respectively. Hence, USG may be an acceptable alternative to MRI brachytherapy 54 .…”

Section: Contribution To Brachytherapymentioning

confidence: 99%

Contribution of Tata Memorial Centre, India, to cervical cancer care

Kumar

Chopra

Gupta

2021

Indian Journal of Medical Research

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Cervical cancer continues to be a major public health concern in India and other low- and middle-income countries. Tata Memorial Centre, India, has been at the forefront in providing treatment, developing best practice guidelines for low-cost efficacious interventions, conducting practice-changing randomized trials and engaging in regional and international collaborations for education and research in cervical cancer. This review summarizes how cervical cancer research and clinical care has evolved over the past two decades at the Tata Memorial Centre, right from testing low-cost public health screening of cervical cancers to the incorporation of the latest technological advancements and providing high-quality evidence for therapeutic management of cervical cancer. The various ongoing strategies for improving survival, toxicity reduction, translational research studies, educational activities and teaching programmes initiated by the Tata Memorial Centre at both national and international levels are discussed.

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“…A few studies have reported the use of a TAUS-based plan and have shown a clinical benefit. 21,[25][26][27][28][29][30][31] At our Institute, transformation from 2D (point) to 3D (volume) began in 2008 with CT-based brachytherapy. Unfortunately, the total transformation could not be performed immediately due to our workloads and equipment.…”

Section: Introductionmentioning

confidence: 99%

Comparative dosimetry of brachytherapy treatment planning between a volume-based plan by CT and a point-based plan by TAUS in CT datasets for brachytherapy

et al. 2021

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Aim: To evaluate comparative dosimetry of brachytherapy treatment planning between a volume-based plan by computed tomography (CT) and a point-based plan by transabdominal ultrasound (TAUS) in CT datasets for brachytherapy. Materials and methods: From 2019 to 2021, 59 different datasets of CT images were collected from 38 patients treated by intracavitary brachytherapy with tandem ovoid or tandem ring applicators. At that time, TAUS was performed to prevent uterine perforation and to evaluate topography of the cervix during application. In volume-based planning by CT, the target dose was used to keep the dose at 90% of high-risk clinical target volume (HR-CTV), to give a dose of at least 7Gy, while in the point-based plan by TAUS, the target dose was used to keep the minimum dose to eight cervix reference points (measured by TAUS), to give a dose of at least 7Gy. The doses to targets and organs at risk were evaluated and compared between volume-based planning by CT and the point-based plan by TAUS. Results: Of 59 fractions, a tandem ovoid applicator was used in 48 fractions (81·3%). In the volume-based plan by CT, the mean doses to HR-CTV(D90), intermediate-risk clinical target volume (IR-CTV)(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 7·0, 3·9, 4·9, 2·9 and 3·3 Gy, respectively, while in the point-based plan by TAUS, the mean doses to HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 8·2, 4·6, 5·9, 3·4 and 3·9 Gy, respectively. The percentages of mean dose differences between TAUS and CT of HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 17·7, 19·5, 20·5, 19·5, 21·3 and 19·8%, respectively. With the target dose to the point-based plan by TAUS (7 Gy to the cervix reference points), this was close to D98 of HR-CTV with a mean percentage of difference of 0·6%. Findings: The point-based plan by TAUS showed higher values to targets and organs at risk than the volume-based plan by CT. With the point-based plan by TAUS, it was close to D98 of HR-CTV.

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Transabdominal Ultrasonography Based High Dose Rate Conformal Intracavitary Brachytherapy in Cervical Carcinoma

Cited by 4 publications

References 0 publications

Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

Contribution of Tata Memorial Centre, India, to cervical cancer care

Comparative dosimetry of brachytherapy treatment planning between a volume-based plan by CT and a point-based plan by TAUS in CT datasets for brachytherapy

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