Five-year results for image-guided brachytherapy (IGBT) for cervical carcinoma: a report from single institute of Thailand

2016 ◽  
Vol 16 (1) ◽  
pp. 38-45
Author(s):  
Ekkasit Tharavichitkul ◽  
Somvilai Chakrabandhu ◽  
Pitchayaponne Klunklin ◽  
Wimrak Onchan ◽  
Bongkot Jia-Mahasap ◽  
...  
Keyword(s):  
Cervical Carcinoma ◽  
Local Control ◽  
Clinical Target Volume ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Target Volume ◽  
Long Term Results ◽  
Image Guided ◽  
Grade 3

AbstractAimTo report of long-term results and toxicity profiles using image-guided brachytherapy (IGBT) combined with whole pelvic radiation therapy (WPRT) for cervical carcinoma.Materials and MethodsIn total, 52 patients with locally advanced cervical carcinoma were enrolled into the study. WPRT was used to treat the clinical target volume (CTV) with a dose of 45–50·4 Gy in 23–28 fractions. IGBT using computed tomography was performed at the dose of 6·5–7 Gy×4 fractions to the minimum dose covering 90% of target volume (D90) of high-risk clinical target volume (HR-CTV).ResultsThe mean cumulative dose in equivalent doses of 2 Gy for the D90 of HR-CTV, dose at 2% at refereed volume (D2cc) of bladder, D2cc of rectum and D2cc of sigmoid colon were 92·4, 87·9, 69·6, and 72 Gy, respectively. At the median follow-up time of 61 months, the 5-year local control, disease-free survival, and overall survival rates were 96·2, 75 and 84·6% respectively. Two patients (3·8%) developed grade 3–4 gastrointestinal and two patients (3·8%) developed grade 3–4 genitourinal toxicities.ConclusionThe combination of WPRT plus IGBT showed very promising long-term results with excellent local control and toxicity profiles.

scholarly journals Computed tomography–based image-guided brachytherapy for cervical cancer: correlations between dose–volume parameters and clinical outcomes

2017 ◽  
Vol 59 (1) ◽  
pp. 67-76 ◽  
Author(s):  
Takeaki Kusada ◽  
Takafumi Toita ◽  
Takuro Ariga ◽  
Hitoshi Maemoto ◽  
Seiji Hashimoto ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Local Control ◽  
Organs At Risk ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Image Guided ◽  
Future Challenges ◽  
Grade 3

AbstractThis study evaluated the oncologic outcomes and complications of cervical cancer patients in terms of CT-based image-guided brachytherapy (IGBT) parameters. Of 68 cervical cancer patients treated with definitive radiotherapy/concurrent chemoradiotherapy, most received whole-pelvis external beam RT (EBRT) of 40 Gy in 20 fractions, pelvic EBRT with central shield of 10 Gy in 5 fractions, and CT-based IGBT of 18 Gy in 3 fractions prescribed to point A. Cumulative EBRT and IGBT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). The median follow-up was 31 (3–52) months. The 2-year overall survival, local control, pelvic control, and disease-free survival rates of the 68 patients were 92%, 83%, 82% and 73%, respectively. The HR-CTV D90, length from the tandem axis to left/right margin of the HR-CTV (T-LR), and HR-CTV volume were significant IGBT parameters for predicting local/pelvic control. Patients who received an HR-CTV D90 of >60 Gy, compared with ≤60 Gy, had significantly better local/pelvic control. Furthermore, 70 Gy was a marginally significant HR-CTV D90 cut-off affecting local control. T-LR was an independent IGBT parameter predicting local/pelvic control on multivariate analysis. Three patients developed Grade 3 or higher treatment-related complications. The D2cm3 of organs at risk were not significant predictors of complications. Future challenges for further improving outcomes include additional interstitial needles for irregularly shaped HR-CTVs, and moderate dose escalation, especially for patients with poor tumor responses.

Preoperative Concomitant Radiochemotherapy with A 5-Fluorouracil plus Folinic Acid Bolus in the Combined Treatment of Locally Advanced Extraperitoneal Rectal Cancer: A Long-Term Analysis on 27 Patients

2003 ◽  
Vol 89 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Antonella Ciabattoni ◽  
Antonio Cavallaro ◽  
Angelo Eugenio Potenza ◽  
Rosa Colli ◽  
Francesca Maurizi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Folinic Acid ◽  
Local Control ◽  
Locally Advanced ◽  
Target Volume ◽  
Preoperative Chemoradiation ◽  
Intravenous Bolus ◽  
Resectable Rectal Cancer

Aims and background Many studies of preoperative chemoradiation in resectable rectal cancer have focused on downstaging and sphincter-saving procedures. The aim of this study was to evaluate long-term outcome in resectable rectal cancer treated with preoperative chemoradiation and surgery by only one surgical team irrespective of the tumor downstaging. Material and methods From 1992 to 2001, in a cooperative study between the Institute of Semeiotica Chirurgica and the Division of Radiotherapy of the Catholic University of the Sacred Heart, 27 patients with locally advanced rectal cancer were treated with preoperative chemoradiation, followed by surgery after 4-6 weeks, and, just for 6 of them, by adjuvant chemotherapy. Seventeen patients were staged T3 N1 (63%), 4 patients T3N0 (15%), 4 patients T3N2 (15%) and 2 T4N2 (7.5%). Twenty-three patients (85.1%) had signs of nodal involvement at combined imaging. Radiation therapy was delivered to the posterior pelvis at a dose of 45 Gy to the tumor (clinical target volume) and the whole pelvis (planning target volume). Fractionation was conventional: 1.8 Gy/day, 5 fractions a week. Radiotherapy was started on Monday for all patients and was delivered with a linear accelerator. Concomitant chemotherapy consisted of 5-fluorouracil (350 mg/m2/day, as an intravenous bolus on days 1-5 and 29-33 of radiotherapy) and folinic acid (L-isomer) (10 mg/m2 as an intravenous bolus on days 1-5 and 29-33). This chemotherapy was generally administered about 1 hr before radiotherapy. Data were analyzed on July 2002; median follow-up was 59 months (range, 20-116 months). No patient was lost during the follow-up. Results All patients completed the treatment. Grade >3 acute toxicity occurred in 11% of the patients and late toxicity was 15%. A pathologic complete response was recorded in 22% of patients; sphincter-preserving surgery was feasible in 44%. Seven patients died: 2 of them perioperatively, 1 patient died with local recurrence, and 1 died with distant metastases; 3 patients died during the follow-up for other causes. Five-year local control was 95% and overall survival was 84%. Conclusions Our study, although limited in number, demonstrated good results in local control and disease-free survival with a limited toxicity.

The influence of hospital and surgeon volume on survival and local control in rectal cancer: Long-term results of the CAO/ARO/AIO-94 trial.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 738-738
Author(s):  
Thilo Sprenger ◽  
Tim Beissbarth ◽  
Rolf Sauer ◽  
Emmanouil Fokas ◽  
Werner Hohenberger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Local Recurrence ◽  
Local Control ◽  
Locally Advanced ◽  
High Volume ◽  
Surgeon Volume ◽  
Long Term Results ◽  
Rectal Cancers

738 Background: The association of hospital and surgeon volume with the outcome of rectal cancer patients is under debate. In this study the long-term influence of the hospital as well as the surgeon volume on overall survival and local recurrence were investigated. Methods: In a post-hoc analysis of the randomized phase III CAO/ARO/AIO-94 trial after a follow-up of more than 10 years, 799 patients with locally advanced rectal cancers were evaluated. Survival and local recurrence rates were stratified by the hospital recruitment volume (≤20 vs. 21-90 vs. > 90 patients) and by the surgeon volume (≤10 vs. 11-50 vs. > 50 procedures). Results: Patients treated in „high-volume“ hospitals had a longer overall survival than those treated in hospitals with medium or low treatment volume (p = 0.03). The surgeon volume was significantly associated with decreased local recurrences (p = 0.01) but had no influence on overall survival. The effect of neoadjuvant chemoradiation on local control was the strongest in patients being operated by medium-volume surgeons. Conclusions: Patients with locally advanced rectal cancers might benefit from treatment in in specialized high-volume hospitals. In particular, the surgeon volume had significant influence on local control.

scholarly journals Image-Guided Adaptive Brachytherapy (IGABT) for Primary Vaginal Cancer: Results of the International Multicenter RetroEMBRAVE Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1459
Author(s):  
Henrike Westerveld ◽  
Maximilian P. Schmid ◽  
Remi A. Nout ◽  
Cyrus Chargari ◽  
Bradley R. Pieters ◽  
...  
Keyword(s):  
Local Control ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Target Volume ◽  
Vaginal Cancer ◽  
Free Survival ◽  
Image Guided ◽  
Included Patient ◽  
Late Morbidity ◽  
Disease Free

Purpose: This study assessed outcomes following the nowadays standing treatment for primary vaginal cancer with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT) in a multicenter patient cohort. Methods: Patients treated with computer tomography (CT)–MRI-assisted-based IGABT were included. Retrospective data collection included patient, tumor and treatment characteristics. Late morbidity was assessed by using the CTCAE 3.0 scale. Results: Five European centers included 148 consecutive patients, with a median age of 63 years. At a median follow-up of 29 months (IQR 25–57), two- and five-year local control were 86% and 83%; disease-free survival (DFS) was 73% and 66%, and overall survival (OS) was 79% and 68%, respectively. Crude incidences of ≥ grade-three urogenital, gastro-intestinal and vaginal morbidity was 8%, 3% and 8%, respectively. Lymph node metastasis was an independent prognostic factor for disease-free survival (DFS). Univariate analysis showed improved local control in patients with T2–T4 tumors if >80 Gy EQD2α/β10 was delivered to the clinical target volume (CTV) at the time of brachytherapy. Conclusions: In this large retrospective multicenter study, IGABT for primary vaginal cancer resulted in a high local control with acceptable morbidity. These results compared favorably with two-dimensional (2D) radiograph-based brachytherapy and illustrate that IGABT plays an important role in the treatment of vaginal cancer.

1461: Local Control and Long Term Disease Free Survival Following Radical Prostatectomy for D1 Prostate Cancer In The PSA ERA

2004 ◽  
Vol 171 (4S) ◽  
pp. 385-385 ◽  
Author(s):  
Carl K. Gjertson ◽  
Kevin P. Asher ◽  
Joshua D. Sclar ◽  
Aaron E. Katz ◽  
Erik T. Goluboff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Local Control ◽  
Disease Free Survival ◽  
Free Survival ◽  
Disease Free

scholarly journals Carbon ion radiotherapy for prostate cancer with bladder invasion

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuhei Miyasaka ◽  
Hidemasa Kawamura ◽  
Hiro Sato ◽  
Nobuteru Kubo ◽  
Tatsuji Mizukami ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Locally Advanced ◽  
Therapeutic Benefit ◽  
Carbon Ion Radiotherapy ◽  
Safety And Efficacy ◽  
Carbon Ion ◽  
Grade 3 ◽  
Bladder Invasion

Abstract Background The optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain. At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. Hence, we evaluated CIRT for PC with bladder invasion in terms of the safety and efficacy. Methods Between March 2010 and December 2016, a total of 1337 patients with nonmetastatic PC received CIRT at a total dose of 57.6 Gy (RBE) in 16 fractions over 4 weeks. Among them, seven patients who had locally advanced PC with bladder invasion were identified. Long-term androgen-deprivation therapy (ADT) was also administered to these patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Event version 5.0. Results At the completion of our study, all the patients with cT4 PC were alive with a median follow-up period of 78 months. Grade 2 acute urinary disorders were observed in only one patient. Regarding late toxicities, only one patient developed grade 2 hematuria and urinary urgency. There was no grade 3 or worse toxicity, and gastrointestinal toxicity was not observed. Six (85.7%) patients had no recurrence or metastasis. One patient had biochemical and local failures 42 and 45 months after CIRT, respectively. However, the recurrent disease has been well controlled by salvage ADT. Conclusions Seven patients with locally advanced PC invading the bladder treated with CIRT were evaluated. Our findings seem to suggest positive safety and efficacy profiles for CIRT.

scholarly journals Synergies Radiotherapy-Immunotherapy in Head and Neck Cancers. A New Concept for Radiotherapy Target Volumes-“Immunological Dose Painting”

Medicina ◽  
2020 ◽  
Vol 57 (1) ◽  
pp. 6
Author(s):  
Camil Ciprian Mireştean ◽  
Anda Crişan ◽  
Călin Buzea ◽  
Roxana Irina Iancu ◽  
DragoşPetru Teodor Iancu
Keyword(s):  
Immune System ◽  
Synergistic Effect ◽  
Head And Neck ◽  
Multimodal Treatment ◽  
Clinical Target Volume ◽  
Locally Advanced ◽  
Target Volume ◽  
Head And Neck Cancers ◽  
Dose Painting ◽  
Target Volumes

The combination of immune checkpoint inhibitors and definitive radiotherapy is investigated for the multimodal treatment of cisplatin non-eligible locally advanced head and neck cancers (HNC). In the case of recurrent and metastatic HNC, immunotherapy has shown benefit over the EXTREME protocol, being already considered the standard treatment. One of the biggest challenges of multimodal treatment is to establish the optimal therapy sequence so that the synergistic effect is maximal. Thus, superior results were obtained for the administration of anti-CTLA4 immunotherapy followed by hypofractionated radiotherapy, but the anti-PD-L1 therapy demonstrates the maximum potential of radio-sensitization of the tumor in case of concurrent administration. The synergistic effect of radiotherapy–immunotherapy (RT–IT) has been demonstrated in clinical practice, with an overall response rate of about 18% for HNC. Given the demonstrated potential of radiotherapy to activate the immune system through already known mechanisms, it is necessary to identify biomarkers that direct the “nonresponders” of immunotherapy towards a synergistic RT–IT stimulation strategy. Stimulation of the immune system by irradiation can convert “nonresponder” to “responder”. With the development of modern techniques, re-irradiation is becoming an increasingly common option for patients who have previously been treated with higher doses of radiation. In this context, radiotherapy in combination with immunotherapy, both in the advanced local stage and in recurrent/metastatic of HNC radiotherapy, could evolve from the “first level” of knowledge (i.e., ballistic precision, dose conformity and homogeneity) to “level two” of “biological dose painting” (in which the concept of tumor heterogeneity and radio-resistance supports the need for doses escalation based on biological criteria), and finally to the “third level“ ofthe new concept of “immunological dose painting”. The peculiarity of this concept is that the radiotherapy target volumes and tumoricidal dose can be completely reevaluated, taking into account the immune-modulatory effect of irradiation. In this case, the tumor target volume can include even the tumor microenvironment or a partial volume of the primary tumor or metastasis, not all the gross and microscopic disease. Tumoricidal biologically equivalent dose (BED) may be completely different from the currently estimated values, radiotherapy treating the tumor in this case indirectly by boosting the immune response. Thus, the clinical target volume (CTV) can be replaced with a new immunological-clinical target volume (ICTV) for patients who benefit from the RT–IT association (Image 1).

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