scholarly journals Image guided interstitial brachytherapy for locally advanced disease after external beam radiotherapy in a case of carcinoma cervix – our institutional experience

2016 ◽  
Author(s):  
S. Tandon ◽  
S. Mitra ◽  
M. K. Sharma ◽  
U. Saxena ◽  
P. Ahlawat ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
External Beam Radiotherapy ◽  
Descriptive Analysis ◽  
Locally Advanced ◽  
Early Response ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Image Guided ◽  
The Mean

Purpose/Objective: Cervical cancer is the third most common cancer in women worldwide. Definitive chemoradiation is the accepted standard of care for patients especially for locally advanced cervical cancers. Intracavitary brachytherapy (ICBT) is an important part of definitive radiotherapy shown to improve overall survival. Interstitial brachytherapy (ISBT) is generally reserved for patients either with extensive pelvic and/or vaginal residual disease after external beam radiotherapy (EBRT) or with anatomy not allowing ICBT with standard applicators in an attempt to improve local control. We have conducted an observational study for patients who underwent image guided HDR-ISBT at our institute. Materials and Methods: Seven patients; diagnosed as a case of carcinoma cervix; were selected from the period of 2012 to 2015 who received EBRT by IMRT and for whom ICBT couldn’t be done for various reasons. These patients were then taken up for Martinez Universal Perineal Interstitial Template (MUPIT) image based ISBT. A descriptive analysis was done for doses received by HRCTV, bladder, rectum and sigmoid colon. At the end of treatment, early response at 3 months along with overall survival (OS) and disease free survival (DFS) was also calculated. Results: All the patients recruited were locally advanced with 3 patients in IIB, 1 patient in IIIA and 3 patients belonging to IIIB. The mean dose received by 95% high risk CTV (HRCTV) by IMRT was 49.75 Gy. Out of 7 patients, 3 were taken up for ISBT due to anatomical restriction whereas remaining 4 patients were included because of lack of dose coverage by ICBT. The mean doses received by 90% of HRCTV, 2 cc bladder, 2 cc rectum and 2 cc sigmoid colon were 20.58 Gy, 2.73 Gy, 3.19 Gy and 2.82 Gy respectively. The early response at 3 months was 57.14%. The DFS at one year and OS at 3 year were 53.6% and 53.3% respectively. Conclusions: Our descriptive analysis of seven patients being treated by image based ISBT have revealed that locally advanced cervical cancer patients for whom ICBT is unsuitable can achieve equitable LRC and OS with a combination of EBRT by IMRT and image based HDR-ISBT.

A PROSPECTIVE RANDOMIZED STUDY TO COMPARE THE CONCURRENT CHEMO-RADIATION VERSUS HYPO-FRACTIONATED CHEMO-RADIATION IN LOCALLY ADVANCED CERVICAL CANCER.

2021 ◽  
pp. 40-42
Author(s):  
Arpan Jana ◽  
Pabitra Das ◽  
Poulami Gupta ◽  
Phalguni Gupta
Keyword(s):  
Cervical Cancer ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Advanced Carcinoma

Background: Concurrent chemo-radiation is the standard treatment worldwide for locally advanced squamous Cell carcinoma cervix. However, conventional chemo-radiotherapy is also associated with unacceptable local and systemic failure rates for locally advanced disease. Biologically squamous cell carcinoma of head- neck cancer and cervical cancer behaves quite similarly in response to radiotherapy. So, it can be expected that, altered fractionation can increase the local control in case of squamous cell carcinoma cervix than conventional radiotherapy. There is no randomised control trial for carcinoma cervix till date, which compares conventional chemo-radiation with hypo-fractionated chemo-radiation. Aims And Objectives: The present study was planned to compare local disease control and acute toxicity of conventional chemo-radiation with hypo-fractionated chemo-radiation in locally advanced carcinoma cervix. Materials And Methods: In Conventional Chemo-radiation Arm A patients (n=30) received external beam radiotherapy 50 Gy in 25 fractions in 5 weeks accompanied by weekly intravenous Cisplatin 40mg/m2 followed by intracavitary brachytherapy 7 Gy per fraction once in a week for 3 weeks. The second group of hypo-fractionated Arm B received external beam radiotherapy 45 Gy in 20 fractions in 4 weeks accompanied by weekly intravenous Cisplatin 40mg/m2 followed by intracavitary brachytherapy 9 Gy per fraction once in a week for 2 weeks. Results: Grade II diarrhea were seen more in Arm B 17 (56.66%) compare to Arm A 12(40%) and grade III diarrhea was seen 4 (3.33%) in Arm B and 2(6.66%) in Arm A. At 2 months and 6 months after completion of treatment Complete response were 25 (83.4%) in Arm A compare to 22 (73.3%) in Arm B and 20 (74.1%) in Arm A and 18 (72%) in Arm B respectively. Conclusion: Hypo-fractioned radiotherapy may be used as an alternate protocol for treatment of locally advanced carcinoma cervix with acceptable toxicities.

scholarly journals Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy

2017 ◽  
Vol 27 (4) ◽  
pp. 768-775 ◽  
Author(s):  
Zhong-Shan Liu ◽  
Jie Guo ◽  
Yang-Zhi Zhao ◽  
Xia Lin ◽  
Bing-Ya Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Dose ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
3 Dimensional ◽  
Locally Advanced Cervical Cancer ◽  
The Mean

ObjectiveWe present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.Materials/MethodsInterstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT.ResultsThe mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications.ConclusionsThe IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.

scholarly journals Comparison of Response to the Concurrent Low Dose Daily Cisplatin Vs Weekly Cisplatin Vs Three Weekly Cisplatin with External Beam Radiotherapy in Carcinoma Cervix Patients of Stage IIB, IIIA & IIIB: A Prospective Study from Single Institution

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Amol Ubale ◽  
Shruti Chandra ◽  
S N Prasad ◽  
P K Singh
Keyword(s):  
Cervical Cancer ◽  
Low Dose ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Beam Radiation ◽  
Significant Difference ◽  
Weekly Cisplatin

Introduction: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. External beam radiation therapy along with intra cavitary insertion has long been the treatment of choice for locally advanced (IIB-IVA) cervical cancer, but long-term successes are limited in terms of pelvic recurrence or distant metastasis. Outcome of low dose daily versus weekly versus three weekly Cisplatin concurrent with External beam radiotherapy in locally advanced cervical carcinoma was compared in this study. Methods: A prospective cross sectional study was carried out in J K cancer institute, Kanpur. Total 60 patients of cervical cancer were randomized into 3 arms. Arm I, Arm II and Arm III received External beam radiotherapy concurrent with either daily (8mg/m2), weekly (40 mg/m2) or three weekly (100 mg/m2) Cisplatin respectively. External beam radiotherapy was given with a dose of 50 Gy / 25 # / 5 week / 2 field or 4 field. Patients were evaluated weekly during treatment and afterwards up to 1year. Results: Most of the patients were from fourth and fifth decade, low socioeconomic strata and illiterate. Majority of the cases belong to squamous cell carcinoma (96.6%) and stage III B (55%). Objective response in arm I was 80.0%, in arm II was 75.0% and in arm III was 60.0% respectively. Statistically significant difference was noted between arm III and Arm I (80%Vs60% p<0.05). Results were better in arm I as compare to arm II but not statistically significant. (80%Vs75% P>0.05) Conclusions: This study showed that response was better in ARM I as compared to ARM III and best results was seen with Cisplatin concurrent daily with radiation. Keywords: Cisplatin, concurrent chemotherapy, daily, weekly, three weekly, carcinoma cervix

Intensity modulated radiation therapy boost in locally-advanced cervical cancer in the absence of brachytherapy

2020 ◽  
Vol 30 (5) ◽  
pp. 607-612 ◽  
Author(s):  
Roberta Lazzari ◽  
Giulia Riva ◽  
Matteo Augugliaro ◽  
Andrea Vavassori ◽  
Samantha Dicuonzo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Lymph Nodes ◽  
Local Control ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
External Beam ◽  
Tumor Persistence

ObjectiveStandard treatment in locally-advanced cervical cancer is external beam radiotherapy concomitant with platinum-based chemotherapy, followed by brachytherapy. The goal of our study was to determine whether an intensity modulated radiation therapy (IMRT) boost is feasible in patients unfit for brachytherapy.MethodsWe retrospectively analyzed data of 25 patients unfit for brachytherapy with median age 55 years (range, 30–82) with locally-advanced/metastatic cervical cancer who underwent external beam radiotherapy to pelvis ±para-aortic lymph nodes and sequential IMRT boost between July 2014 and December 2017. Total dose of 45–50.4 Gy in 25–28 fractions (1.8 Gy/fraction) was administered to the cervix, uterus, parametria, ovaries, vaginal tissues (based on vaginal extension), involved lymph nodes, or relevant draining lymph-nodal groups. Para-aortic nodes were included if involved at radiological staging or if common iliac nodes were positive. The IMRT boost included all residual tumor after external beam radiotherapy identified on MRI. The Kaplan–Meier method was used to calculate 2 years' overall survival, 2 years' progression-free survival, and 2 years' local control. Overall survival- and progression-free survival were calculated considering the starting of radiotherapy or neo-adjuvant chemotherapy if prescribed, while local control was calculated from the end of radiotherapy.ResultsMedian radiation dose to pelvis ±para-aortic lymph nodes was 50.4 Gy (45–50.4), boost treatment was homogeneously performed to a total dose of 25 Gy in five fractions every other day.After a median follow-up of 26 months (range, 4–77), tumor persistence at cervix at 6 months from the end of radiotherapy or local recurrence occurred in five women (20%), eight (32%) experienced a further distant progression (two of them had also tumor persistence). Two-year local control and overall survival rates for all stages were 78% and 67%, respectively. According to Common Terminology Criteria for Adverse Events v.4 scoring criteria, 10 patients experienced gastrointestinal and/or genitourinary grade G1-2 acute toxicity. G2 rectal late toxicity requiring laser-coagulation was registered in two patients, there were no gastrointestinal and/or genitourinary acute or late toxicities≥G3.ConclusionThe combination of external beam radiotherapy and brachytherapy remains the standard of care, however our preliminary data show the feasibility of IMRT boost in terms of toxicity with promising results in terms of local control and overall survival.

Brachytherapy or external beam radiotherapy as a boost in locally advanced cervical cancer: a Gynaecology Study Group in the Italian Association of Radiation and Clinical Oncology (AIRO) review

2021 ◽  
pp. ijgc-2020-002310
Author(s):  
Maura Campitelli ◽  
Roberta Lazzari ◽  
Federica Piccolo ◽  
Patrizia Ferrazza ◽  
Anna Rita Marsella ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Tech ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Image Guided

This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.

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