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 Сombined radiotherapy for cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine - immediate trial results of Azerbaijan national center of oncology

2017 ◽  
Vol 98 (6) ◽  
pp. 884-889
Author(s):  
J A Aliyev ◽  
I H Isayev ◽  
K S Akbarov ◽  
E H Guliyev ◽  
N R Aliyeva ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Group 2

Aim. Study of immediate results of chemoradiotherapy of locally advanced cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine. Methods. The article analyzes diagnostic and treatment results of 128 patients with IIA-IIIB stage cervical cancer. The age of patients varied between 31 and 76 years. External beam radiotherapy was performed with 1.8 Gy fraction up to a total dose of 45 Gy, high dose rate brachytherapy consisted of four 7.0 Gy fractions. Patients from group 1 received weekly infusions of cisplatin (40 mg/m2) and from group 2 - polyradiosensitization with cisplatin (40 mg/m2) and gemcitabine (75 mg/m2). Results. Chemoradiotherapy with the use of polyradiosensitization compared to standard chemoradiotherapy allowed significant improving of immediate results of treatment of patients with locally advanced cervical cancer, which was particularly prominent in such unfavorable cases as cervical adenocarcinoma and IIIB stage of the disease. Early toxicity of the treatment was higher in group 2 but effectively resolved with symptomatic supportive treatment and did not lead to interruptions in radiotherapy. Conclusion. Combination of conformal external beam radiotherapy, high dose rate intracavitary brachytherapy and concurrent polychemotherapy with cisplatin and gemcitabine is feasible and reasonably safe; chemoradiotherapy with the use of polyradiosensitization improves immediate results of the treatment of cervical cancer with acceptable level of toxicity.

scholarly journals Cervical Cancer in the Commonwealth: Collective Action

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 153s-153s ◽  
Author(s):  
E. Zubizarreta ◽  
M. Lodge ◽  
M. Abdel-Wahab ◽  
A. Polo
Keyword(s):  
Cervical Cancer ◽  
Collective Action ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
High Dose ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Member States ◽  
Capital Costs ◽  
Locally Advanced Cervical Cancer

Background and context: Fifty-three countries are members of the Commonwealth. These countries span Africa, Asia, the Americas, Europe and the Pacific and are diverse - they are among the world's largest, smallest, richest and poorest countries. Thirty-one of these members are classified as small states - countries with a population size of 1.5 million people or less and larger member states that share similar characteristics with them. The Commonwealth Secretariat is planning to tackle the problem of cervical cancer in their low and middle member states (LMIC) through the project “Cervical Cancer in the Commonwealth: Collective Action”. There are 209,100 cervical cancer cases diagnosed per year in the Commonwealth, and in 167,300 cases radiotherapy treatment is indicated. Aim: To analyze the problem of cervical cancer in low and middle-income countries of the Commonwealth and to propose the first step for a collective action. Strategy/Tactics: The treatment of locally advanced cervical cancer includes radiotherapy (teletherapy and brachytherapy) plus concomitant chemotherapy. Cervical cancer has a high rate of curability if brachytherapy is added to teletherapy. We identified radiotherapy departments in Commonwealth LMIC with teletherapy but no brachytherapy and proposed the upgrade of these services to include brachytherapy as a first step. Program/Policy process: The evidence-based treatment of locally advanced cervical cancer is a combination of external beam radiotherapy with chemotherapy and brachytherapy. Brachytherapy has played a major role during many decades in the treatment of gynecologic cancer with good clinical results. EBRT combined with BT leads to superior survival for patients with cervix cancer as compared with EBRT alone, and additionally, MR image-guided BT further improves local control and survival. Countries with no access to BT may only offer palliative treatment to women diagnosed with locally advanced cervical cancer. Any curative attempt for these patients should include brachytherapy. The addition of brachytherapy to external beam radiotherapy in the treatment of cervical cancer is associated with a 12% increase in the 4-y overall survival rates and 13% increase in cause-specify survival. Brachytherapy can save at least 12% more cervical cancer lives than radiotherapy alone. These differences would be much bigger in LMIC because of the limited technology used for external beam radiotherapy. Outcomes: Each high dose rate (HDR) brachytherapy afterloader can treat up to 666 patients per year, of which 466 (70%) could be potentially cured. The capital costs for installing an HDR afterloader is around US$ 1 million, including equipment and building, the annual operating costs are US$ 473,000, and the costs of brachytherapy are US$ 710 per patient. In the lifetime of an HDR afterloader (10 years), 4660 patients could be cured per afterloader installed. What was learned: Brachytherapy saves lives!

Individually customised parametrial boost for locally advanced cervical cancer: is 2D planned external beam radiotherapy useful?

2019 ◽  
Vol 19 (3) ◽  
pp. 248-253
Author(s):  
Aparna Gangopadhyay ◽  
Subrata Saha
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Intracavitary Brachytherapy ◽  
External Beam ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Pelvic Wall ◽  
Significant Difference ◽  
Median Period

AbstractAim:Pelvic wall control and toxicity was retrospectively assessed in patients who received individually customised parametrial boost (PMB) for locally advanced cervical cancer with 2D planned external beam radiotherapy. Outcomes of a dose-escalated combined boost were also evaluated.Materials and methods:Toxicity and pelvic wall recurrence was evaluated over a median period of 24 months between two groups who received different pelvic wall doses. One group was randomised to receive either intracavitary brachytherapy (ICRT) with an external beam PMB using a customised midline shield, or a dose-escalated combined boost with interstitial brachytherapy (ISBT) and PMB. The comparator group received no PMB.Results:At 24 months, pelvic wall recurrence occurred in 2/112 and 40/130 with and without PMB, respectively (p < 0·000001). No significant difference in toxicity was noted between boost versus no-boost groups (p = 0·56). Combined ISBT/PMB dose escalation showed no significant difference in pelvic wall recurrence compared with PMB alone (p = 0·49).Findings:Individually customised 2D PMBs with 3D image-based ICRT was safe and improved pelvic wall control in locally advanced cervix cancer. Dose-escalated combined boosts offered no significant benefit over standard boost doses.

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