Dataset Information

Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: A single institution experience.

ABSTRACT:

Purpose

The aim of this study is to evaluate the efficacy and toxicity of image-guided high-dose rate (HDR) interstitial brachytherapy (ISBT) for the reirradiation of cervical cancer within a previously irradiated area.

Methods and materials

Twenty-three consecutive patients with cervical cancer were reirradiated with curative intent using brachytherapy (BT) with or without external beam irradiation. The median biologically equivalent dose in 2-Gy fractions (EQD2) for reirradiation was 64.0 Gy (range: 31.3-95.1 Gy), and the median cumulative EQD2 (for primary treatment and reirradiation) was 152.4 Gy (range: 97.8-200.9 Gy). The average clinical target volume was 82.9 cm³ (range: 26.9-208.3 cm³), and the median treatment-free interval (TFI) was 13 months (range: 3-93 months).

Results

The median follow-up time was 19 months (range: 2-59 months). The complete response rate after reirradiation was 56.5%. The 1-, 2- 3-, and 4-year post-relapse survival (PRS) rates were 65.2%, 43.5%, 33.8%, and 27.1%, respectively. The median reirradiation EQD2 D2cc of rectum and bladder was 39.5 Gy (range = 14.6-96.2 Gy) and 52.1 Gy (range = 29.1-114.2 Gy). The median cumulative EQD2 D2cc of rectum and bladder was 115.0 Gy (range = 84.4-189.3 Gy) and 130.5 Gy (range = 95.5-173.5 Gy). During follow-up, nine (39.1%) patients had experienced grade 3 or 4 late toxicities. Grade ≥3 rectal toxicity occurred in three patients (13.0%). Grade ≥3 urinary toxicity occurred in five patients (21.7%). One patient (4.3%) had both grade ≥3 urinary and rectal toxicity. Tumor volume, TFI, tumor invasion organ number, and local control were significant prognostic factors adversely affecting OS.

Conclusions

For recurrent cervical cancer after radiotherapy, reirradiation of HDR-ISBT is feasible, even if the local tumor invasion is large, with a good chance of survival and acceptable side effects.

SUBMITTER: Ren X

PROVIDER: S-EPMC9344972 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: A single institution experience.

Ren Xiaojun X Fu Yingli Y Liu Zhongshan Z Lin Xia X Qiu Ling L Li Yunfeng Y Li Hanyang H Bai Yuqi Y Wang Tiejun T

Frontiers in oncology 20220719

<h4>Purpose</h4>The aim of this study is to evaluate the efficacy and toxicity of image-guided high-dose rate (HDR) interstitial brachytherapy (ISBT) for the reirradiation of cervical cancer within a previously irradiated area.<h4>Methods and materials</h4>Twenty-three consecutive patients with cervical cancer were reirradiated with curative intent using brachytherapy (BT) with or without external beam irradiation. The median biologically equivalent dose in 2-Gy fractions (EQD2) for reirradiatio ...[more]

PMID: 35928866

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Project description:OBJECTIVE:To compare the accuracy of different methods for image registration in image-guided adaptive brachytherapy (IGABT) for cervical cancer. METHODS:The last treatment planning CT images (CT1) and the first treatment planning CT images (CT2) were acquired from 15 patients with cervical cancer and registered with different match image qualities (retained/removed catheter source in images) and different match regions [target only (S Group)/ interested organ structure (M Group)/body (L Group)] in Velocity3.2 software. The dice similarity coefficient (DSC) between the clinical target volumes (CTV) of the CT1 and CT2 images (CTVCT1 and CTVCT2, respectively) and between the organs-at-risk (OAR) of the two imaging datasets (OARCT1 and OARCT2, respectively) were used to evaluate the image registration accuracy. RESULTS:The auto-segmentation volume of the catheter source using Velocity software based on the CT threshold was the closest to the actual volume within the CT value range of 1700-1800 HU. In the retained group, the DSC for the OARs of was better than or equal to that of the removed group, and the DSC value of the rectum was significantly improved (P < 0.05). For comparison of different match regions, the high-risk target volume (HRCTV) and the low-risk target volume (IRCTV) had the best precision for registration of the target area, which was significantly greater than that of M group and L group (P < 0.05). The M group had better registration accuracy of the target area and the best accuracy for the OARs. The DSC values of the bladder and rectum were significantly better than those of the other two groups (P < 0.05). CONCLUSIONS:The CT value range of 1700-1800 HU is optimal for automatic image segmentation using Velocity software. Automatic segmentation and shielding the volume of the catheter source can improve the image quality. We recommend the use of interested organ structures regions for image registration in image-guided adaptive brachytherapy for cervical cancer.

Project description:BackgroundTo assess the intra-fractional dosimetric variations of image-guided brachytherapy of cervical cancer.MethodsA total of 38 fractions (9 patients) undergoing brachytherapy for cervical cancer underwent a CT scanning for treatment planning (planning CT) and a Cone-beam CT (CBCT) scanning immediately prior to delivery (pre-delivery CBCT). The variations of volumes as well as the dosimetric impact from treatment planning to delivery (intra-application) were evaluated. The dose volume histogram parameters including volume, D90 of high-risk clinical target volume (HRCTV) and D2cc of organs at risk (OARs) were recorded.ResultsThe relative differences (mean ± 1SD) of the volume and D90 HRCTV across the two scans were - 2.0 ± 3.3% and - 1.2 ± 4.5%, respectively. The variations of D2cc for bladder, rectum, sigmoid and small intestine are - 0.6 ± 17.1%, 9.3 ± 14.6%, 7.2% ± 20.5% and 1.5 ± 12.6%, respectively. Most of them are statistically nonsignificant except the D2cc for rectum, which showed a significant increase (P = 0.001). Using 5% and 10% uncertainty of physical dose for HRCTV at a 6 Gy × 5 high-dose-rate schedule, the possibility of total equivalent doses in 2 Gy fractions (EQD2) lower than 85 Gy is close to 0% and 3%, respectively. Performing similar simulation at 15% and 20% uncertainty of a 4 Gy physical dose for OARs, the possibility of total EQD2 dose exceeding 75 Gy is about 70%. Less than 1% of the total EQD2 of OARs would exceed 80 Gy.ConclusionsAverage intra-fractional dosimetric variation of HRCTV was small in an interval of less than 1 h, and the possibility of total EQD2 exceeding 85 Gy is higher than 97%. The intra-fractional dosimetric variations of OARs might result in an overdose for OARs in a single fraction or the whole treatment. It is necessary to detect unfavorable anatomical changes by re-imaging and take interventions to minimize applied doses and reduce the risk of complications.

Project description:BackgroundAdvanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS.MethodsBetween 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5?cm in longitudinal direction and 1.0?cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5?mm was added to receive the planning target volume. The full total dose of 50?Gy in 2?Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology.ResultsThirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5?months cumulative OS, local PFS and systemic PFS at 2?years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates.ConclusionsIMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.

Dataset Information

Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: A single institution experience.

Purpose

Methods and materials

Results

Conclusions

Publications

Image-guided interstitial brachytherapy for recurrent cervical cancer after radiotherapy: A single institution experience.

Similar Datasets

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