Clinical Outcomes of MR-Guided versus CT-Guided High-Dose-Rate (HDR) Interstitial Brachytherapy for Vaginal Recurrence of Endometrial Cancer (original) (raw)
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Gynecologic Oncology, 1997
Purpose. To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachyther-Cancer of the uterus remains the most common gynecoapy (HDRB) and external beam radiotherapy (EBRT) for patients logical malignancy in the 1990s with an estimated 34,000 found to have isolated vaginal recurrences from early-stage endocases in 1996 in the United States [1]. The cornerstone of metrial adenocarcinoma following total abdominal hysterectomy treatment for early-stage endometrial carcinoma (i.e., FIGO and bisalpingo-oophorectomy (TAH BSO).
The Lancet, 2010
Methods In this open-label, non-inferiority, randomised trial undertaken in 19 Dutch radiation oncology centres, 427 patients with stage I or IIA endometrial carcinoma with features of high-intermediate risk were randomly assigned by a computer-generated, biased coin minimisation procedure to pelvic EBRT (46 Gy in 23 fractions; n=214) or VBT (21 Gy high-dose rate in three fractions, or 30 Gy low-dose rate; n=213). All investigators were masked to the assignment of treatment group. The primary endpoint was vaginal recurrence. The predefi ned noninferiority margin was an absolute diff erence of 6% in vaginal recurrence. Analysis was by intention to treat, with competing risk methods. The study is registered, number ISRCTN16228756. Findings At median follow-up of 45 months (range 18-78), three vaginal recurrences had been diagnosed after VBT and four after EBRT. Estimated 5-year rates of vaginal recurrence were 1·8% (95% CI 0·6-5·9) for VBT and 1·6% (0·5-4·9) for EBRT (hazard ratio [HR] 0·78, 95% CI 0·17-3·49; p=0·74). 5-year rates of locoregional relapse (vaginal or pelvic recurrence, or both) were 5·1% (2·8-9·6) for VBT and 2·1% (0·8-5·8) for EBRT (HR 2·08, 0·71-6·09; p=0·17). 1·5% (0·5-4·5) versus 0·5% (0·1-3·4) of patients presented with isolated pelvic recurrence (HR 3·10, 0·32-29·9; p=0·30), and rates of distant metastases were similar (8·3% [5·1-13·4] vs 5·7% [3·3-9·9]; HR 1·32, 0·63-2·74; p=0·46). We recorded no diff erences in overall (84·8% [95% CI 79·3-90·3] vs 79·6% [71·2-88·0]; HR 1·17, 0·69-1·98; p=0·57) or disease-free survival (82·7% [76·9-88·6] vs 78·1% [69·7-86·5]; HR 1·09, 0·66-1·78; p=0·74). Rates of acute grade 1-2 gastrointestinal toxicity were signifi cantly lower in the VBT group than in the EBRT group at completion of radiotherapy (12·6% [27/215] vs 53·8% [112/208]).
Journal of Contemporary Brachytherapy, 2017
Purpose: This study was designed to retrospectively analyze outcomes of high-dose-rate (HDR) brachytherapy, with or without external beam radiotherapy (EBRT), in patients with vaginal recurrence of endometrial carcinoma, and to identify factors prognostic of patient outcomes. Material and methods: The medical records of all patients who underwent HDR brachytherapy for initial recurrence in the vagina of endometrial cancer after definitive surgery between 1992 and 2014 were retrospectively reviewed. All patients underwent either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT) with or without EBRT. Late toxicity was graded using the EORTC (LENT/SOMA) scale, revised in 1995. Results: Thirty-seven patients were identified. The median follow-up time was 48 months (range: 6-225 months). Of these 37 patients, 23 underwent ICBT, 14 underwent ISBT, and 26 underwent EBRT. Tumor size at first examination of initial relapse was significantly larger in the ISBT than in the ICBT group. The 4-year respective overall survival (OS), local control (LC), and progression-free survival (PFS) rates in the entire cohort were 81.0%, 77.9%, and 56.8%, respectively. The interval between diagnosis of first recurrence and radiotherapy (< 3 months, ≥ 3 months) was a significant predictor of LC and PFS. OS and LC rates did not differ significantly in the ICBT and ISBT groups. Two patients experienced grade 2 rectal bleeding, and four experienced grade 2 hematuria. No grade 3 or higher late complications were observed. Conclusions: Salvage HDR brachytherapy is an optimal for treating vaginal recurrence of endometrial carcinoma with acceptable morbidity. Early radiotherapy, including brachytherapy, should be considered for women who experience vaginal recurrence of endometrial cancer.
International Journal of Radiation Oncology*Biology*Physics, 2012
Materials/Methods: The charts of patients with pathologic stage III endometrial cancer treated in our institution from June 1997 to June 2007 were reviewed. All patients underwent comprehensive surgical staging, including nodal assessment, followed by adjuvant treatment with chemotherapy alone (CT), radiation therapy alone (RT), or both (CRT). The radiation therapy included pelvic external beam radiation, whole abdominal radiation, vaginal brachytherapy, or a combination. Overall and disease-free survival (OS and DFS) were calculated from the date of surgery using a Kaplan-Meier method. The rates of loco-regional recurrence (LRR) and distant recurrence (DR) as sites of first failure were also calculated. Results: We identified 46 patients with pathologic stage III endometrial cancer who received adjuvant treatment. The median age at diagnosis was 61.4 years (range: 44-88 years). Most patients had stage III-C disease (85%). The histologic types included endometrioid adenocarcinoma (59%), papillary serous/clear cell (35%), and other carcinomas (6%). Adjuvant treatment was 13% (nZ6) CT, 37% (nZ17) RT, and 50% (nZ23) CRT. Of these patients, 45% (nZ21) received pelvic radiation therapy (PRT) and 55% (nZ25) received no pelvic radiation therapy (NPRT). Most NPRT patients received chemotherapy AE vaginal brachytherapy. The median follow-up for all patients was 41.5 months (range: 1.7-149 months). The rates of 3-year OS, 3-year DFS, LRR, and DR for each patient group are shown in the table below. There were no statistically significant differences between the CT, RT, and CRT groups. However, there was a trend towards improved 3-year DFS (pZ0.07) in the RT group. The PRT group on univariate analysis had a significant improvement in 3-year DFS (pZ0.009) and reduction in LRR (pZ0.04) as well as a trend towards improved 3-year OS (pZ0.06) compared to the NPRT group. On multivariate analysis, only depth of invasion was predictive of LRR and DFS.
Gynecologic Oncology, 2005
Objective. Postoperative management of early stage adenocarcinoma of the endometrium remains controversial. The use of pelvic radiation therapy as shown by the Gynecologic Oncology Group (GOG)-99 trial improves the event free interval at the cost of increased toxicity. We reviewed and compared our results treating early stage endometrial adenocarcinoma using hypofractionated high dose rate (HDR) vaginal brachytherapy (VB) alone with the results of the GOG-99.
High-dose-rate interstitial brachytherapy for gynecologic malignancies
Brachytherapy, 2006
The study aimed to assess the outcome of locally advanced cervical and vaginal cancer treated with high-dose-rate interstitial brachytherapy (HDRB).Between 1998 and 2004, 16 previously unirradiated patients with locally advanced cervical and vaginal cancer not suitable for intracavitary brachytherapy because of distorted anatomy or extensive vaginal disease were treated with HDRB in combination with external beam radiotherapy. All patients received whole pelvis external beam radiation therapy (EBRT) followed by interstitial implantation. The median whole pelvis external beam dose was 45 Gy (range, 39.6–50.4 Gy) with 11 patients receiving parametrial boost to a median dose of 9 Gy. Twelve (75%) of these patients received chemotherapy concurrent with external beam. All patients received a single HDRB procedure using a modified Syed–Neblett template. A CT scan was performed postimplant for needle placement verification and treatment planning purpose. Dose was prescribed to the tumor volume based on the radiographic and clinical examination. All patients received 18.75 Gy in five fractions delivered twice daily. The median followup was 25 months (6–69 months).Median cumulative biologic effective dose (EBRT + HDRB) to tumor volume was 78.9 Gy10 with the range of 72.5–85.2 Gy10. Median cumulative biologic effective dose for the rectum and bladder were 99.4 Gy3 (range, 79.6–107.8 Gy3) and 96.4 Gy3 (range, 78.3–105.3 Gy3), respectively. Complete response was achieved in 13 (81%) patients with 3 patients having persistent disease. Five of these 13 patients developed recurrence at a median time of 14 months (distant in 4 and local and distant in 1). The 5-year actuarial local control and cause-specific survival were 75% and 64%, respectively. In subset analysis, 5-year actuarial local control was 63% for cervical cancer patients and 100% for vaginal cancer patients. No patient had acute Grade 3 or 4 morbidity. Grade 3 or 4 delayed morbidity resulting from treatment occurred in 1 patient with 5-year actuarial rate of 7%. Three patients had late Grade 2 rectal morbidity and 1 patient had Grade 2 small bowel morbidity.Our series suggests that single interstitial implantation procedure with five fractions of 3.75 Gy each to target volume is an effective and safe fractionation schedule. The integration of imaging modality helps in decreasing dose to the critical organs. Additional patients and followup are ongoing to determine the long-term efficacy of this approach.
Brachytherapy, 2015
OBJECTIVE: To evaluate recurrence patterns and overall survival in patients treated with adjuvant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. METHODS/MATERIALS: The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. RESULTS: Median patient age was 59 years (range, 42e87 years). All tumors were of endometrioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival ( p 5 0.510) or freedom from vaginal ( p 5 0.840), distant ( p 5 0.133), or any recurrence ( p 5 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or recurrences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. CONCLUSIONS: VB alone results in excellent local control for patients with Stage II endometrial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy. Ó
Radical radiotherapy with high-dose-rate brachytherapy for uterine cervix cancer long-term results
Australasian Radiology, 2007
The aim of this is to report the results of radical radiotherapy in carcinoma of the cervix treated by high-dose rate (HDR) intracavitary brachytherapy and external beam radiotherapy (XRT) at a single centre in Singapore. This is a retrospective analysis of 106 consecutive cases with histologically proven cervical cancer, treated by HDR brachytherapy and XRT at the Mount Elizabeth Hospital from 1990 to 1993. External beam radiotherapy to the pelvis was delivered with 6 MV photons, to 45-50.4 Gy in 1.8 Gy fractions. High-dose-rate brachytherapy comprised two to three applications of an intrauterine tandem with paired ovoids, to a median dose of 18 Gy to point 'A', carried out during XRT. All 106 patients completed treatment. Their ages ranged from 32 to 80 years (median 57 years). Most patients presented with stage II or III disease (44 and 37%, respectively) and with squamous cell carcinoma (91%). Median follow-up time was 59 months (range 2-169 months). The 5-year relapse-free survival rate across all stages was 71%. The corresponding overall survival rate was 69%. Local control was achieved in 86 patients (81%); six patients had residual disease (6%), and 14 patients had local recurrence (13%). Fourteen patients developed metastatic disease (13%). On univariate analysis, tumour stage, haemoglobin level, number of brachytherapy treatments and overall treatment time were found to be prognostic factors for overall survival. Late complications were mild (Radiation Therapy Oncology Group score 1-2), except for one patient with grade 4 rectal toxicity. The complication rates were 8, 14 and 45%, respectively, for the rectum, bladder and vagina (stenosis). The use of two to three fractions of HDR intracavitary brachytherapy in addition to pelvic XRT achieves good outcomes.