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Long-term results of 3-D brachytherapy treatment in locally advanced cervical cancer

Year 2019, Volume: 41 Issue: 3, 599 - 604, 30.09.2019
https://doi.org/10.7197/cmj.vi.622642

Abstract

In many advanced studies, image-guided 3D brachytherapy (BT) treatment has
been shown to improve survival and reduce treatment-related toxicity in locally
advanced cervical cancer. In this study, long-term treatment results, risky
organ doses and toxicity results of patients who were admitted to our clinic
with the diagnosis of cervical cancer and treated with 3D brachytherapy were
examined.



Between 2012 and 2015, 152 inoperable cervical cancers were admitted, and
long-term (> 12 months) follow-up of our clinic107 cases of inoperable
cervical cancer was included in the study. After pelvic radiotherapy, pelvic
MRI was performed, and target volumes were determined on CT. Volumes defined by
the GEC-ESTRO guideline were, Gross tumor volume (GTV); residual tumor volume
after external RT, High-risk clinical tumor volume (HRCTV); entire cervix and
residual lesion, Intermediate-risk clinical tumor volume (IRCTV) low-risk
volume and rectum, sigmoid and bladder contouring as risky organs,
respectively. 3D brachytherapy treatment was performed with the microselectron
device of 192 high-dose-rate (HDR) Ir 192 source.



The median age was 53 years, and the median follow-up was 45 months. All
patients were diagnosed by biopsy, and 81.9% of these patients were diagnosed
as squamous cell carcinoma. According to the stages;IB1 was 2 (2%), II was 65
(61%), III was 31 (29%), and IV was 9 (8%). 96% of the patients received
cisplatin-based chemotherapy with pelvic 3 D RT. When 3D RT doses of all
patients were examined; Median HRCTV was calculated as 90% 6 Gy, EQD2 value
84.7 Gy, IRCTV 95% 3.03 Gy. When we look at risky organ doses; The median
rectum 2cc 2.4Gy, EQD2 58.4Gy value, median bladder 2cc 3.52Gy, EQD2 value was
68.8 Gy, median sigmoid 2cc 2.60 Gy, EQD2 value was found to be 60.3 Gy. During
the follow-up period, 4 patients had local recurrence, 11 patients had both
local and distant metastasis, and 21 patients had only distant metastasis. The
overall survival rate of 3 and 5 years was 78.1% and 72.2%. The 3 and 5-year
local control rates were 87.4% and 77.3%, respectively. The survival rates of 3
and 5 years without distant metastasis were 66.5% and 61.2%. Rectovaginal
fistula developed in 5 patients as late side effects and tumor progression was
found in three of these patients.



In the treatment of locally advanced cervical cancer 3D BRT, the volumes
defined by the GEC-ESTRO guidance are individual. Thanks to the development of
imaging techniques during the treatment of these volumes, the survival rates
have increased compared to the previous series, and a shallow rate of GIS and
GUS side effects are observed.

Supporting Institution

yok

Project Number

yok

Thanks

This study has been presented in the 1. International Cancer Days (1st ICD) in Sivas Cumhuriyet University.

References

  • [1] Monk BJ., Tewari KS., Koh W-J. (2007).Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions. J Clin Oncol, 25,2952–65
  • [2] Chemoradiotherapy for Cervical Cancer Meta-analysis [1] Collaboration (CCCMAC).(2010). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: Individual patient data meta-analysis . Cochrane Database Syst Rev .CD 008285
  • [3] Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E, Jurgenliemk-Schulz I, Petric P, Hoskin P, Dorr W, et al. (2016). Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol,120(3),441–6.
  • [4] Mazeron R, Fokdal LU, Kirchheiner K, Georg P, Jastaniyah N, Šegedin B, Mahantshetty U, Hoskin P, Jürgenliemk-Schulz I, Kirisits C, et al.(2016). Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: results from the prospective multicenter EMBRACE study. Radiother Oncol,120,412–9.
  • [5] Kirchheiner K, Nout RA, Lindegaard JC, Haie-Meder C, Mahantshetty U, Segedin B, Jurgenliemk-Schulz IM, Hoskin PJ, Rai B, Dorr W, et al. (2016). Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study. Radiother Oncol,118,160–6.
  • [6] Haie-Meder C, Pötter R, van Limbergen E De Brabandere M , Dimopoulos J , et al. (2005). Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV . Radiother Oncol, 74 , 235 – 45 .
  • [7] Pötter R, Haie-Meder C, van Limbergen E et al Brabandere M , Dimopoulos J , et al . (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology . Radiother Oncol ,78 , 67 – 77 .
  • [8] J , De Brabandere M , De Leeuw A, et a l.(2010) . Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: Considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radiother Oncol, 96 ,153 – 60 . [9] Dimopoulos JCA , P etrow P , Tanderup K , P etric P , B erger D [11] , Kirisits C , et al. (2012) . Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol, 103 ,113 – 22 . [10] Rijkmans EC , Nout RA, Rutten IHHM , Ketelaars M, Neelis KJ , L aman M S , e t al. (2014) . Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy. Gynecol Oncol, 135, 231 – 8 .
  • [11] L, Pedersen EM , et al .(2011). Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept. Radiother Oncol,100 ,473 – 9. [12] Haie-Meder C, Chargari C, Rey A , Dumas I , Morice [18] P , Magn é N.(2009) DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI based low dose rate brachytherapy followed by surgery. Radiother Oncol ,93 ,316 – 21
  • [13] Dimopoulos JC, Lang S, Kirisits C et al (2009) Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys ,75,56–63
  • [14] Pötter R, Dimopoulos J, Georg P, Lang S, Waldhäusl C, WachterGerstner N, Weitmann H, Reinthaller A, Knocke TH, Wachter S, Kirisits C. (2007) Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol, 83,148–155
  • [15] Petra G, Stefan L, Johannes Detal. (2011).Dose–volume histogram parameters and late side effects in magnetic resonance image–guided adaptive cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys ,79(2),356–62
  • [16] Lindegaard JC, Tanderup KD, Nielsen SK, Haack S, Gelineck J.(2008). MRI-guided 3D optimization significantly improves DVH parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phy,71(3), 756–64
  • [17] Sturdza A, Pötter R, Fokdal LU, Haie-Meder C, Tan LT, Mazeron R, Petric P, Šegedin B, Jurgenliemk-Schulz IM, Nomden C, Gillham C, McArdle O, van Limbergen E, Janssen H, Hoskin P, LoweG,TharavichitkulE, VillafrancaE, MahantshettyU, GeorgP, Kirchheiner K, Kirisits C, Tanderup K, Lindegaard JC. (2016). Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol, 120,428–433
  • [18] Vishwanathan AN, Erickson B, Gaffney DK et al (2014) Comparison and consensus guidelines for delineation of clinical target volume fr CT- and MR- based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys ,90,320–328.
  • [19] Nomden C N , d e Leeuw A AC , R oesink JM , Tersteeg R JHA [14] , Moerland MA, Witteveen PO, et al.(2013).Clinical outcome and dosimetric parameters of chemo-radiation including MRI guided adaptive brachytherapy with tandem-ovoid applicators for cervical cancer patients: A single institution experience. Radiother Oncol,107 , 69 – 74 .
Year 2019, Volume: 41 Issue: 3, 599 - 604, 30.09.2019
https://doi.org/10.7197/cmj.vi.622642

Abstract

Project Number

yok

References

  • [1] Monk BJ., Tewari KS., Koh W-J. (2007).Multimodality therapy for locally advanced cervical carcinoma: state of the art and future directions. J Clin Oncol, 25,2952–65
  • [2] Chemoradiotherapy for Cervical Cancer Meta-analysis [1] Collaboration (CCCMAC).(2010). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: Individual patient data meta-analysis . Cochrane Database Syst Rev .CD 008285
  • [3] Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E, Jurgenliemk-Schulz I, Petric P, Hoskin P, Dorr W, et al. (2016). Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol,120(3),441–6.
  • [4] Mazeron R, Fokdal LU, Kirchheiner K, Georg P, Jastaniyah N, Šegedin B, Mahantshetty U, Hoskin P, Jürgenliemk-Schulz I, Kirisits C, et al.(2016). Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: results from the prospective multicenter EMBRACE study. Radiother Oncol,120,412–9.
  • [5] Kirchheiner K, Nout RA, Lindegaard JC, Haie-Meder C, Mahantshetty U, Segedin B, Jurgenliemk-Schulz IM, Hoskin PJ, Rai B, Dorr W, et al. (2016). Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study. Radiother Oncol,118,160–6.
  • [6] Haie-Meder C, Pötter R, van Limbergen E De Brabandere M , Dimopoulos J , et al. (2005). Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV . Radiother Oncol, 74 , 235 – 45 .
  • [7] Pötter R, Haie-Meder C, van Limbergen E et al Brabandere M , Dimopoulos J , et al . (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology . Radiother Oncol ,78 , 67 – 77 .
  • [8] J , De Brabandere M , De Leeuw A, et a l.(2010) . Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: Considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radiother Oncol, 96 ,153 – 60 . [9] Dimopoulos JCA , P etrow P , Tanderup K , P etric P , B erger D [11] , Kirisits C , et al. (2012) . Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol, 103 ,113 – 22 . [10] Rijkmans EC , Nout RA, Rutten IHHM , Ketelaars M, Neelis KJ , L aman M S , e t al. (2014) . Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy. Gynecol Oncol, 135, 231 – 8 .
  • [11] L, Pedersen EM , et al .(2011). Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept. Radiother Oncol,100 ,473 – 9. [12] Haie-Meder C, Chargari C, Rey A , Dumas I , Morice [18] P , Magn é N.(2009) DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI based low dose rate brachytherapy followed by surgery. Radiother Oncol ,93 ,316 – 21
  • [13] Dimopoulos JC, Lang S, Kirisits C et al (2009) Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys ,75,56–63
  • [14] Pötter R, Dimopoulos J, Georg P, Lang S, Waldhäusl C, WachterGerstner N, Weitmann H, Reinthaller A, Knocke TH, Wachter S, Kirisits C. (2007) Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol, 83,148–155
  • [15] Petra G, Stefan L, Johannes Detal. (2011).Dose–volume histogram parameters and late side effects in magnetic resonance image–guided adaptive cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys ,79(2),356–62
  • [16] Lindegaard JC, Tanderup KD, Nielsen SK, Haack S, Gelineck J.(2008). MRI-guided 3D optimization significantly improves DVH parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phy,71(3), 756–64
  • [17] Sturdza A, Pötter R, Fokdal LU, Haie-Meder C, Tan LT, Mazeron R, Petric P, Šegedin B, Jurgenliemk-Schulz IM, Nomden C, Gillham C, McArdle O, van Limbergen E, Janssen H, Hoskin P, LoweG,TharavichitkulE, VillafrancaE, MahantshettyU, GeorgP, Kirchheiner K, Kirisits C, Tanderup K, Lindegaard JC. (2016). Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol, 120,428–433
  • [18] Vishwanathan AN, Erickson B, Gaffney DK et al (2014) Comparison and consensus guidelines for delineation of clinical target volume fr CT- and MR- based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys ,90,320–328.
  • [19] Nomden C N , d e Leeuw A AC , R oesink JM , Tersteeg R JHA [14] , Moerland MA, Witteveen PO, et al.(2013).Clinical outcome and dosimetric parameters of chemo-radiation including MRI guided adaptive brachytherapy with tandem-ovoid applicators for cervical cancer patients: A single institution experience. Radiother Oncol,107 , 69 – 74 .
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Medical Science Research Articles
Authors

Özlem Yetmen Doğan 0000-0002-2733-0427

Makbule Eren 0000-0002-7105-7165

Project Number yok
Publication Date September 30, 2019
Acceptance Date September 26, 2019
Published in Issue Year 2019Volume: 41 Issue: 3

Cite

AMA Yetmen Doğan Ö, Eren M. Long-term results of 3-D brachytherapy treatment in locally advanced cervical cancer. CMJ. September 2019;41(3):599-604. doi:10.7197/cmj.vi.622642