Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

Kemmerer, Eric; Hernández, Enrique; Ferriss, J. Stuart; Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong; Micaily, Bizhan

doi:10.1016/j.ijrobp.2012.02.058

Cited by 36 publications

(31 citation statements)

References 17 publications

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“…The authors found an overall 10-year LRR rate of 1 %. 19 Although relatively high proportion of patients (4.9 %) had positive margins, only two of these patients developed a LRR and none of these patients received PMRT. The authors concluded that mastectomy provides excellent locoregional control for DCIS and that routine use of PMRT is not justified.…”

Section: Discussionmentioning

confidence: 92%

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Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?

et al. 2013

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Background The impact of close margins in patients with ductal carcinoma-in situ (DCIS) treated with mastectomy is unclear; however, this finding may lead to a recommendation for postmastectomy radiotherapy (PMRT). We sought to determine the incidence and consequences of close margins in patients with DCIS treated with mastectomy. Methods The records of 810 patients with DCIS treated with mastectomy from 1996 through 2009 were reviewed. Clinical and pathologic factors were analyzed with respect to final margin status. Median follow-up was 6.3 years. Results Overall, 94 patients (11.7 %) had close margins (positive, n = 5; negative but ≤1 mm, n = 54; 1.1–2.9 mm, n = 35). Independent risk factors for close margins included multicentricity, pathologic lesion size ≥1.5 cm, and necrosis, but not age, use of skin-sparing mastectomy, or immediate reconstruction (p >0.05). Seven patients received PMRT, and none had a locoregional recurrence (LRR). Among the remaining 803 patients, the 10-year LRR rate was 1 % (5.0 % for margins ≤1 mm, 3.6 % for margins 1.1–2.9 mm, and 0.7 % for margins ≥3 mm [p <0.001]). The 10-year rate of contralateral breast cancer was 6.4 %. On multivariate analysis, close margins was the only independent predictor of LRR (p = 0.005). Conclusions Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised.

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Section: Discussionmentioning

confidence: 92%

“…The authors concluded that mastectomy provides excellent locoregional control for DCIS and that routine use of PMRT is not justified. 19 …”

Section: Discussionmentioning

confidence: 99%

Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?

et al. 2013

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“…Early detection is associated with better survival probabilities, where the 5 and 10-year survival rates for women diagnosed with stage 0 or I breast cancer range between 90% and 100% (Owen et al , 2013; Ries and Esner, 2013). The two cornerstones of early detection are awareness of the disease, and both opportunistic and population-based screening.…”

mentioning

confidence: 99%

Spectrum of very early breast cancer in a setting without organised screening

Bhoo-Pathy¹,

Subramaniam

Taib

et al. 2014

Br J Cancer

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Background:Within a setting without organised breast cancer screening, the characteristics and survival of very early breast cancer were determined.Methods:All 4930 women diagnosed with breast cancer in University Malaya Medical Center, Malaysia from 1993 to 2011 were included. Factors associated with very early presentation (stage I) at diagnosis were identified. Tumour characteristics, management patterns, and survival of very early breast cancer were described, and where appropriate, compared with other settings.Results:Proportion of women presenting with stage I breast cancer significantly increased from 15.2% to 25.2% over two decades. Factors associated with very early presentation were Chinese ethnicity, positive family history of breast cancer, and recent period of diagnosis. Within stage I breast cancers, median tumour size at presentation was 1.5 cm. A majority of stage I breast cancer patients received mastectomy, which was associated with older age, Chinese ethnicity, postmenopausal status, and larger tumours. Chemotherapy was administered in 36% of patients. Five-year age-adjusted relative survival for women with stage I breast cancer was 99.1% (95% CI: 97.6–99.6%).Conclusions:The proportion of women presenting with very early breast cancer in this setting without organised screening is increasing. These women seem to survive just as well as their counterparts from affluent settings.

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“…Furthermore, it should be noted that interfraction variation of the uterus was evaluated in a small number of patients in this study, and additional research is warranted to assess the significance of organ motion for patients with medically inoperable endometrial cancer. We do not recommend that SBRT be pursued for all patients with medically inoperable endometrial cancer, since HDR brachytherapy is generally considered to be safe and effective [4,9], but rather only in those individuals who are considered to be at unacceptably high risk of complications from anesthesia, such as the group described by Kemmerer and colleagues in their evaluation of SBRT as a boost strategy in lieu of brachytherapy [13]. We would recommend rigid immobilization for uterine SBRT, as well as consideration of repeat volumetric imaging during SBRT if the treatment delivery time is expected to be more than a few minutes.…”

Section: Discussionmentioning

confidence: 99%

“…Kemmerer et al explored the utility of EBRT with an SBRT boost for medically inoperable endometrial cancer and found the option to be safe and effective for the early stage patients in their cohort [13]. In the current study, we further develop the concept of SBRT for medically inoperable early stage endometrial cancer with the aim of providing a potential alternative to brachytherapy when it is considered medically necessary to avoid the risks of anesthesia, immobilization, and applicator placement.…”

Section: Introductionmentioning

confidence: 96%

Dosimetric feasibility of stereotactic body radiation therapy as an alternative to brachytherapy for definitive treatment of medically inoperable early stage endometrial cancer

et al. 2014

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PurposeThis study was designed to evaluate the dosimetric feasibility of definitive stereotactic body radiation therapy (SBRT) for the treatment of medically inoperable early stage endometrial cancer.MethodsCT simulation scans from 10 medically inoperable early stage endometrial cancer patients previously treated with high dose-rate (HDR) intracavitary brachytherapy were used to generate Helical Tomotherapy (HT) plans using the IMRT mode with clinical target volumes (CTVs) that included the uterus plus cervix. A prescription dose of 34 Gy in 4 fractions was used. The SBRT dosimetry was compared to the 10 prior intracavitary brachytherapy plans normalized to a standard dose. Organs at risk (OARs) evaluated were the bladder, rectum, sigmoid, femoral heads, and other bowel, including both large and small bowel. The simulation CT and daily image guidance for 4 patients treated with this technique were evaluated to assess for interfraction variation in the uterine position and effects on dosimetry.ResultsCompared to intracavitary brachytherapy, HT SBRT produced significantly greater overall target coverage to the uterus, boost CTV, and PTV, with exception of the V150% of the uterus. HT SBRT significantly increased dose to the rectum, bowel, and femoral heads compared to intracavitary brachytherapy, though not outside of dose tolerance limits. Review of daily image guidance for patients treated with this technique demonstrated good reproducibility with a mean overlap index of 0.87 (range, 0.74 – 0.99).ConclusionsDefinitive SBRT for medically inoperable early stage endometrial cancer appears to be a feasible treatment option. Future studies are warranted to evaluate long-term clinical outcomes with this technique, compared to HDR intracavitary brachytherapy.

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Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

Cited by 36 publications

References 17 publications

Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?

Incidence and Consequence of Close Margins in Patients with Ductal Carcinoma-In Situ Treated with Mastectomy: Is Further Therapy Warranted?

Spectrum of very early breast cancer in a setting without organised screening

Dosimetric feasibility of stereotactic body radiation therapy as an alternative to brachytherapy for definitive treatment of medically inoperable early stage endometrial cancer

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