Tumor Shrinkage During Chemoradiation in Locally Advanced Cervical Cancer Patients: Prognostic Significance, and Impact for Image-Guided Adaptive Brachytherapy

Schernberg, Antoine; Bockel, S.; Annède, Pierre; Fumagalli, I.; Escande, Alexandre; Mignot, Fabien; Kissel, M.; Morice, Philippe; Bentivegna, Enrica; Gouy, Sébastien; Deutsch, Éric; Haie-Méder, Christine; Chargari, Cyrus

doi:10.1016/j.ijrobp.2018.06.014

Cited by 63 publications

(33 citation statements)

References 25 publications

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“…Furthermore, available data indicate that FIGO > stage IB2 and (paraaortic) lymph node involvement before treatment is associated with higher chance of lymph node and distant relapse [5,13]. Recent literature from Schernberg et al, demonstrates significantly higher progression free survival and distant relapse free survival in patients that showed a GTV reduction > 90% during EBRT in a cohort of 255 patients treated with CRT and IGABT [38]. They also found significantly worse local, regional and distant outcomes when GTV and CTV HR were > 7.5 cm 3 and > 25 cm 3 respectively at the time of brachytherapy.…”

Section: Tablementioning

confidence: 99%

“…Therefore, the question is; could poor local response predict poor regional response to the same treatment that might ask for intensifying treatment? Schernberg et al showed a relation between tumour reduction during EBRT and required dose to the D 90% of the CTV HR for LC, however, they emphasised that more research is needed to identify those patients that would need dose escalation or dose deescalation [38]. As IGABT has improved 5 year LC to > 90% for most patients [13], the EMBRACE II study [39] focuses on identifying risk factors for lymph node recurrences.…”

Section: Tablementioning

confidence: 99%

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Cervical cancer apparent diffusion coefficient values during external beam radiotherapy

Boer

Mandija

Werensteijn-Honingh

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Apparent diffusion coefficient (ADC) reflects micro-enviromental changes and therefore might be useful in predicting recurrence prior to brachytherapy. The purpose of this study is to evaluate change in ADC of the primary tumour and pathologic lymph nodes during treatment and to correlate this with clinical outcome. Material and methods: Twenty patients were included who received chemoradiation for locally advanced cervical cancer between July 2016 and November 2017. All patients underwent magnetic resonance imaging (MRI) prior to treatment, and three MRIs in weeks 1/2, 3 and 4 of treatment, including T2 and diffusion weighted imaging (b-values 0, 200, 800 s/mm 2) for determining an ADC-map. Primary tumour was delineated on T2 and ADC-map and pathologic lymph nodes were delineated only on ADC-map. Results: At time of analysis median follow-up was 15 (range 7-22) months. From MRI one to four, primary tumour on ADC-map showed a significant signal increase of 0.94 (range 0.74-1.46) × 10 −3 mm 2 /s to 1.13 (0.98-1.49) × 10 −3 mm 2 /s (p < 0.001). When tumour was delineated on T2, ADC-value signal increase (in tumour according to T2) was similar. All 46 delineated pathologic lymph nodes showed an ADC-value increase on average from 0.79 (range 0.33-1.12) × 10 −3 mm 2 /s to 1.14 (0.59-1.75) × 10 −3 mm 2 /s (p < 0.001). The mean tumour/suspected lymph node volumes decreased respectively 51/40%. Four patients developed relapse (one local and three nodal), without clear relation with ΔADC. However, the median volume decrease of the primary tumour was substantially lower in the failing patients compared to the group without relapse (19 vs. 57%). Conclusions: ADC values can be acquired using T2-based tumour delineations unless there are substantial shifts between ADC-mapping and T2 acquisition. It remains plausible that ΔADC is a predictor for response to EBRT. However, the correlation in this study was not statistically significant.

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Section: Tablementioning

confidence: 99%

Section: Tablementioning

confidence: 99%

Cervical cancer apparent diffusion coefficient values during external beam radiotherapy

Boer

Mandija

Werensteijn-Honingh

et al. 2019

Physics and Imaging in Radiation Oncology

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“…In cervical cancer, tumor volume regression at MRI during chemoradiotherapy has greater prognostic value than either pre-or post-treatment tumor volumes [26]. Volume shrinkage < 90% at the time of brachytherapy has been associated with poor outcome [19]. There are no studies evaluating volume regression by MRI in vaginal recurrence of EC treated with salvage RT.…”

Section: Discussionmentioning

confidence: 99%

“…Despite increasing utilization of MRI in vaginal recurrence of EC, there are currently no studies describing the different MRI features of these tumors. Furthermore, tumor volumes on MRI and volume shrinkage during RT-known predictors of outcome in cervical cancer-have not been evaluated in vaginal recurrence of EC [19].…”

Section: Introductionmentioning

confidence: 99%

Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy

et al. 2020

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Purpose To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Methods Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2-and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher's exact test, respectively. Results Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1-0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1-0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1-99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Conclusion Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.

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“…Recent data from the EMBRACE study show that this situation is not infrequent: 16% of patients have a distal parametrial residue after radiochemotherapy [ 9 ]. Furthermore, retrospective data suggest that tumors with poor volumetric response after EBRT (< 90%) require higher doses to be eradicated, as compared to tumors with good shrinkage [ 10 ].…”

Section: Purposementioning

confidence: 99%

Venezia applicator with oblique needles improves clinical target volume coverage in distal parametrial tumor residue compared to parallel needles only

Kissel¹,

Fournier-Bidoz²,

Henry³

et al. 2021

jcb

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Purpose: Residual distal parametrial involvement after radiochemotherapy is a true challenge for brachytherapists since the width and asymmetry of high-risk clinical target volume (HR-CTV) are difficult to cover properly with a standard implant.Material and methods: Dosimetric plans of five patients treated with Venezia advanced gynecological applicator at our institution were reviewed. For each patient, we compared the original plan with a new plan where oblique needles were removed and re-optimized manually. Optimization process was halted when EQD2 10 D 90 HR-CTV reached 90 Gy, when one hard constraint to organs at risk (OARs) was reached according to the EMBRACE II protocol, or when dose-rate of one of OARs exceeded 0.6 Gy/h.Results: Tumors were large; median HR-CTV volume was 64 cc and median distance between tandem and outer contour of HR-CTV was 40 mm. For the five patients, HR-CTV EQD2 10 D 90 was superior in the plan using oblique needles, with a median difference of 6.5 Gy (range, 1.7-8.5 Gy). Median D 90 HR-CTV and intermediate-risk CTV (IR-CTV) were significantly increased with oblique needles: 85.9 Gy (range, 83.2-90.3 Gy) vs. 81.5 Gy (range, 77.4-84 Gy), and 68.7 Gy (range, 66.3-72.3 Gy) vs. 67 Gy (range, 64.3-69.1 Gy), p = 0.006 for both. There were no significant differences in the dose to OARs. Plans with only parallel needles had less favorable dose distribution, with cold spots on the outer parametria and higher vaginal activation to compensate parametrial coverage in its inferior part.Conclusions: Venezia TM applicator permits reproducible application to increase CTV coverage in patients with distal parametrial tumor residue during brachytherapy, while maintaining acceptable dose to OARs.

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Tumor Shrinkage During Chemoradiation in Locally Advanced Cervical Cancer Patients: Prognostic Significance, and Impact for Image-Guided Adaptive Brachytherapy

Cited by 63 publications

References 25 publications

Cervical cancer apparent diffusion coefficient values during external beam radiotherapy

Cervical cancer apparent diffusion coefficient values during external beam radiotherapy

Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy

Venezia applicator with oblique needles improves clinical target volume coverage in distal parametrial tumor residue compared to parallel needles only

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