scholarly journals Clinical results of image-guided interstitial brachytherapy with or without external beam radiotherapy for postsurgical vaginal recurrence of cervical and endometrial cancers

2021 ◽  
Author(s):  
Ayae Kanemoto ◽  
Tadashi Sugita ◽  
Fumio Ayukawa ◽  
Kotaro Takahashi ◽  
Ayano Horiuchi ◽  
...  
Keyword(s):  
Local Control ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Interstitial Brachytherapy ◽  
High Dose ◽  
External Beam ◽  
Free Survival ◽  
Image Guided ◽  
Endometrial Cancers ◽  
Vaginal Recurrence

Abstract Purpose This study aimed to evaluate the clinical outcome and efficacy of image-guided interstitial brachytherapy (ISBT) for postsurgical vaginal recurrence of cervical and endometrial cancers. Materials and methods The study included 11 patients who received CT-based image-guided high-dose-rate ISBT with or without external beam radiotherapy (EBRT). Local control, progression-free survival, and treatment-related toxicities were evaluated retrospectively. Results Of the 11 patients, 4 underwent ISBT with EBRT and the other 7 ISBT alone; two of the latter patients received previous pelvic radiotherapy. After a median follow-up of 43.9 months (range 3.9–92.7 months), the 2-year local control rate was 100%. The median equivalent doses in 2 Gy fractions received by at least 90% of the clinical target volume for ISBT with versus without EBRT were 82.2 Gy (range 60.4–84.2 Gy) versus 69.0 Gy (range 50.8–98.2 Gy). The 2-year progression-free survival rates after ISBT with versus without EBRT were 75% versus 80%, and the difference was not significant (p = 0.74). Grade 3 late toxicities occurred in two patients. Conclusion Our radiotherapy strategy using image-guided ISBT, either with or without EBRT, for postsurgical vaginal recurrence showed effective treatment outcomes.

Impact of postoperative intravaginal brachytherapy on survival for patients with intermediate-risk cervical cancer at National Cancer Institute (NCI), Egypt

2018 ◽  
Vol 17 (3) ◽  
pp. 332-336
Author(s):  
Mohamed Mahmoud ◽  
Shaimaa Abdelgeleel ◽  
Ahmed M. Mahmoud
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
National Cancer Institute ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Disease Stage ◽  
Postoperative Treatment ◽  
External Beam ◽  
Intermediate Risk ◽  
Free Survival

AbstractBackgroundCervical cancer is considered to be the fourth most frequent cancer among women. Postoperative treatment is indicated depending up on surgical findings and disease stage.ObjectiveThe objective of this study was to assess the long-term postoperative outcomes of cervical cancer patients with intermediate risk factors who have received pelvic external beam radiotherapy with or without vaginal brachytherapy, and treatment-related toxicities.Patients and methodsIn this retrospective study, the records were collected for all patients with cervical cancer who received postoperative radiotherapy at the National Cancer Institute between the years 2008 and 2013. The end points of the study were local control, progression-free survival, overall survival (OS) and delayed complications.ResultsOut of 248 patients, the median age of patients who did not receive brachytherapy was 53 years and the median age of patients who received brachytherapy was 52 years. A statistically significant difference was found in OS, progression-free survival and recurrence-free survival for those who received brachytherapy, with a p value<0·001, 0·01 and 0·004, respectively.ConclusionThe addition of brachytherapy to postoperative external beam radiotherapy improves OS, progression-free survival and local control for patients with intermediate-risk cervical cancer.

Concurrent 5-Fluorouracil, Mitomycin C and Radiation, with or without Brachytherapy, in Recurrent Endometrial Cancer: A Scoring System to Predict Clinical Response and Outcome

2005 ◽  
Vol 91 (3) ◽  
pp. 215-220 ◽  
Author(s):  
Daniela Smaniotto ◽  
Giuseppe D'Agostino ◽  
Stefano Luzi ◽  
Vincenzo Valentini ◽  
Gabriella Macchia ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Mitomycin C ◽  
Local Control ◽  
Progression Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Recurrent Endometrial Cancer ◽  
Grade 3

Aims and background This prospective, phase II study aimed to test the efficacy of concurrent 5-fluorouracil, mitomycin C and radiation, with or without brachytherapy, on the clinical outcome of a series of recurrent endometrial cancer patients and to determine the prognostic impact of a subset of factors. Methods Thirty patients with locally recurrent, nonmetastatic endometrial cancer received external beam radiation (4-week split course: 23.4 + 23.4 Gy) plus two courses of concomitant chemotherapy (5-fluorouracil, 96-h continous infusion, days 1-4; 1 g/m2/day; mitomycin C, 10 mg/m2, bolus iv, day 1). Nineteen patients (63.3%) underwent endocavitary, low-dose brachytherapy boost (20-25 Gy); eight patients (26.7%) received external beam radiation boost (14-20 Gy). Results Eleven complete responses (36.7%), 11 partial responses (36.7%), 6 disease stabilizations (20.0%) and 2 progressions (6.6%) were observed. After a median follow-up of 27 months (range, 1-108), overall actuarial 3-year survival, progression-free survival and local progression-free survival were 46.8%, 35.2% and 41.2%, respectively. Two patients (6.7%) experienced hematological grade 3 toxicity. Two patients (6.7%) had grade 3 intestinal toxicity. Severe late toxicity was infrequent, only 3 patients showing severe vaginal stenosis (10.0%). A clinical score of 0 to 1 was assigned to each patient on the basis of the absence (score = 0) or presence (score = 1) of any of the following prognostic factors: time between surgery and recurrence shorter than 12 months, pelvic wall site of recurrence, positive lymph nodes, hemoglobin <11 g/dL. With this device, it was clear that patients with a low score had a significantly better outcome (clinical remission: 77.2% of patients with a score <2 vs 25.0% of patients with a score ≥2, P = 0.009), better local control of the disease (50.2% vs. 0 at 3 years, P = 0.014,) and better overall survival (65.8% vs 0 at 3 years, P = 0.003). Conclusions Our data suggest that this combined modality therapy was relatively well tolerated and resulted in reasonable local control and survival. The scoring system proved to be helpful in identifying patients with the best chance of benefiting from the treatment.

scholarly journals Low and high-dose-rate brachytherapy in combination with external beam radiotherapy for high risk prostate cancer

2021 ◽  
Vol 17 (2) ◽  
pp. 72-82
Author(s):  
V. A. Solodkiy ◽  
A. Yu. Pavlov ◽  
A. D. Tsibulskii ◽  
G. A. Panshin ◽  
A. G. Dzidzaria ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Biochemical Failure ◽  
High Dose ◽  
External Beam ◽  
Free Survival ◽  
Group 4

Background. Prostate cancer (PCa) in the Russian Federation takes the leading place in the prevalence of cancer among the male population.Objective: to investigate the effect of increasing a single focal dose in high-dose-rate brachytherapy (HDR-BT) in combination with external beam radiotherapy on biochemical failure-free survival and local control in patients with high-risk PCa. Materials and methods. The study included 350 men with PCa in the group of high and extremely high risk of progression. All patients included in the study were divided into 4 groups. Groups 1, 2 and 3 included 276 patients who received HDR-BT with a 192Ir source with a single dose per fraction: 10 Gy (n = 83), 12 Gy (n = 46) and 15 Gy (n = 147). Group 4 included 74 patients who received low-dose-rate brachytherapy with 125I sources up to a total focal dose of 110 Gy. At the 2 stage, external beam radiotherapy was a conventional fractionation (single dose of 2 Gy, total - 44-46 Gy).Results. Of 350 patients over a 5-year follow-up period, PCa recurrence was noted in 65 (18.6 %). The 3- and 5-year biochemical failure-free survival rates in the general cohort of patients were 87.4 and 81.4 %. 5-year biochemical failure-free survival was significantly higher in group 3 relative to group 4 and amounted to 89.8 and 74.2 % (p = 0.03). Increasing the dose for HDR-BT from 10 to 12 Gy per fraction significantly reduced the frequency of local relapses from 15.7 % (in group 1) to 2.2 % (in group 2) (p = 0.0001) while maintaining the level of genitourinary and gastrointestinal toxicity. Conclusion. The use of a combination of brachytherapy and external beam radiotherapy in patients with high risk PCa is highly effective in achieving local control of the tumor. The optimal fractionation regime for HDR-BT remains a matter of debate. The use of 15 Gy per fraction for HDR-BT in combination with external beam radiotherapy is the most optimal fractionation regimen in patients with high-risk PCa.

Clinical outcomes with high-dose image guided radiotherapy (IGRT) compared with non-IGRT for the treatment of clinically localized prostate cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 12-12
Author(s):  
Michael J. Zelefsky ◽  
Marisa Kollmeier ◽  
Brett Wayne Cox ◽  
Xin Pei ◽  
Margie Hunt
Keyword(s):  
Prostate Cancer ◽  
External Beam Radiotherapy ◽  
Localized Prostate Cancer ◽  
Tumor Control ◽  
High Dose ◽  
External Beam ◽  
Fiducial Markers ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Risk Patients

12 Background: To compare toxicity profiles and biochemical tumor control outcomes between patients treated with high-dose image-guided radiotherapy (IGRT) and high-dose intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer. Methods: 186 patients with prostate cancer were treated with IGRT to a dose of 86.4 Gy with daily correction of the target position based upon kilovoltage imaging of implanted prostatic fiducial markers. This group of patients was retrospectively compared with a similar cohort of 190 patients who were treated with IMRT to the same prescription dose without, implanted fiducial markers in place (non-IGRT). In both groups the margins used for the prostate were the same. The median follow-up time was 2.8 years (range, 2-4 years). Results: A significant reduction in late urinary toxicity was observed for IGRT patients compared with the non-IGRT patients. The 3-year likelihood of urinary toxicity for the IGRT and non-IGRT cohorts were 10.4% and 20.0%, respectively (p=0.02).Multivariate analysis identifying predictors for late urinary toxicity demonstrated that, in addition to the baseline IPSS, IGRT was associated with significantly less late urinary toxicity compared with non-IGRT. The incidence of late rectal toxicity was low for both treatment groups (1.0% and 1.6%, respectively; p = 0.81). No differences in prostate-specific antigen relapse–free survival outcomes were observed for low- and intermediate-risk patients when treated with IGRT and non-IGRT. For high-risk patients a significant improvement was observed at 3-years for patients treated with IGRT compared with non-IGRT. Conclusions: IGRT is associated with a reduction in late urinary toxicity and improvement in biochemical tumor control after definitive high-dose external beam radiotherapy compared with high-dose IMRT. These data suggest that, for definitive radiotherapy, the placement of fiducial markers and daily tracking of target positioning should be the preferred mode of external beam radiotherapy delivery for the treatment of prostate cancer.

Effect of transarterial chemoembolization plus external beam radiotherapy on survival of patients with hepatocellular carcinoma showing macroscopic vascular invasion compared with sorafenib: A randomized trial.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 210-210
Author(s):  
Sang MIN Yoon ◽  
So Jung Lee ◽  
Jong Hoon Kim ◽  
Ji Hoon Shin ◽  
Jihyun An ◽  
...  
Keyword(s):  
Disease Progression ◽  
Vascular Invasion ◽  
Response Rate ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
External Beam ◽  
Free Survival ◽  
Advanced Hcc ◽  
Sorafenib Group ◽  
Macroscopic Vascular Invasion

210 Background: Sorafenib is the sole treatment option for advanced stage hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) with unsatisfactory response rate and survival benefit. Combined transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results in these patients by observational studies. Here, we report the efficacy and safety of TACE plus RT compared to sorafenib in patients with advanced HCC and MVI. Methods: This study was a randomized, open-label trial at an academic tertiary care center. Between 2013 and 2016, 90 treatment-naive patients with liver-confined HCC showing MVI were randomly assigned to receive sorafenib (400 mg twice-daily; n = 45; sorafenib group) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE; n = 45; TACE+RT group). Primary endpoint was 12-week the progression-free survival (PFS) rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to Response Evaluation Criteria in Solid Tumors (version 1.1). Crossover of treatment was permitted after confirming disease progression. Results: All patients had portal vein invasion of HCC and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. At week 12, the PFS rate was significantly higher in the TACE+RT group than the sorafenib group (77.8% vs. 26.7%; P< 0.001). The TACE+RT group showed significantly higher radiologic response rate (33.3% vs. 2.2% at 24 weeks; P< 0.001), significantly longer median time to disease progression (30 weeks vs. 8 weeks; P< 0.001), and significantly longer overall survival (55 weeks vs. 43 weeks; P= 0.04), compared with the sorafenib group. No patients in the TACE+RT group discontinued treatment due to hepatic decompensation. Conclusions: In patients with advanced HCC showing MVI, first-line treatment with TACE+RT was well-tolerated and provided improved progression-free survival, objective response rate, time to disease progression, and overall survival, compared with sorafenib treatment. Clinical trial information: NCT01901692.

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