Radiation therapy for elderly patients with uterine cervical cancer: feasibility of curative treatment

2019 ◽  
Vol 29 (3) ◽  
pp. 622-629 ◽  
Author(s):  
Masaharu Hata
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Elderly Patients ◽  
Adult Population ◽  
Locally Advanced ◽  
Uterine Cervical Cancer ◽  
External Beam Radiation ◽  
Curative Treatment ◽  
Carbon Ions ◽  
Beam Radiation

As the average lifespan lengthens worldwide, and the older adult population increases, the number of elderly patients with uterine cervical cancer is increasing. Because intensive and invasive treatments, including surgery, are frequently unacceptable in elderly patients, cancer treatments for these patients must be carefully considered. Elderly patients have undergone radiation therapy as less-invasive curative treatment, and it has been shown to be safe and effective for local control of cervical cancer in this population, even among patients aged ≥80 years treated with curative radiation doses. Although concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer, it is unclear whether the addition of chemotherapy to radiation therapy prolongs survival in elderly patients. Elderly patients treated with curative radiation therapy for cervical cancer might develop more therapy-related gastrointestinal and hematological toxicities and insufficiency fractures compared with younger patients. However, advanced techniques of radiation therapy (eg, intensity-modulated radiation therapy and volumetric modulated arc therapy with photons, charged-particle radiation therapy with protons and carbon ions in external-beam radiation therapy, and image-guided adaptive brachytherapy) can minimize radiation-induced toxicities and thus make curative treatment safer and more effective for elderly patients with uterine cervical cancer.

scholarly journals PROTECT: Prospective Phase-II-Trial Evaluating Adaptive Proton Therapy for Cervical Cancer to Reduce the Impact on Morbidity and the Immune System

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5179
Author(s):  
Anouk Corbeau ◽  
Remi A. Nout ◽  
Jan Willem M. Mens ◽  
Nanda Horeweg ◽  
Jérémy Godart ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Phase Ii ◽  
Proton Therapy ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Intensity Modulated ◽  
The Impact

External beam radiation therapy (EBRT) with concurrent chemotherapy followed by brachytherapy is a very effective treatment for locally advanced cervical cancer (LACC). However, treatment-related toxicity is common and reduces the patient’s quality of life (QoL) and ability to complete treatment or undergo adjuvant therapies. Intensity modulated proton therapy (IMPT) enables a significant dose reduction in organs at risk (OAR), when compared to that of standard intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). However, clinical studies evaluating whether IMPT consequently reduces side effects for LACC are lacking. The PROTECT trial is a nonrandomized prospective multicenter phase-II-trial comparing clinical outcomes after IMPT or IMRT/VMAT in LACC. Thirty women aged >18 years with a histological diagnosis of LACC will be included in either the IMPT or IMRT/VMAT group. Treatment includes EBRT (45 Gy in 25 fractions of 1.8 Gy), concurrent five weekly cisplatin (40 mg/m2), and 3D image (MRI)-guided adaptive brachytherapy. The primary endpoint is pelvic bones Dmean and mean bowel V15Gy. Secondary endpoints include dosimetric parameters, oncological outcomes, health-related QoL, immune response, safety, and tolerability. This study provides the first data on the potential of IMPT to reduce OAR dose in clinical practice and improve toxicity and QoL for patients with LACC.

Brachytherapy for Locally Advanced Cervix Cancer (Methodological Aspects)

2019 ◽  
Vol 64 (5) ◽  
pp. 76-80
Author(s):  
О. Кравец ◽  
O. Kravets ◽  
А. Дубинина ◽  
A. Dubinina ◽  
Е. Тарачкова ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Tumor Volume ◽  
Maximum Dose ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Beam Radiation ◽  
Locally Advanced Cervical Cancer

Purpose: To increase local control of cervical tumors by developing and introducing into practice the optimization of dose distribution in the primary tumor during concomitant chemoradiation (CRT) and image-guided adaptive brachytherapy (IGABT) i.e. summing up the maximum dose to the tumor volume of HR-CTV> 85 Gy in the shortest possible period of time by the optimal fractionation regime, without increasing the tolerable doses to the organs of risk (bladder, rectum, sigmoid). Material and methods: Data of the study was the of clinical observations of patients with locally advanced cervical cancer proven stage IIb–IIIb according to FIGO, treated with curative radiation therapy. After pelvic +/- para-aortic external-beam radiation therapy (2 Gy × 50 Gy with Cisplatin 40 mg/m2 weekly), they received high-dose rate intracavitary brachytherapy or in combination with interstitial component following GEC-ESTRO recommendations. Results: We managed to achieve maximum dose to the tumor volume of HR-CTV> 85 Gy without increasing the load on the risk organs. The Clinical Contouring at the time of primary diagnosis of cervical cancer and before brachytherapy session based on clinical and diagnostic data using MRI helps to optimize the brachytherapy process, develop patient management tactics and a clear sequence of actions in a complex program of brachytherapy. Conclusion: The presented clinical cases indicate the prospects of using an individual approach in planning the brachytherapy of patients with locally advanced cervical cancer.

scholarly journals The Incorporation of Immunotherapy and Targeted Therapy Into Chemoradiation for Cervical Cancer: A Focused Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Otasowie Odiase ◽  
Lindsay Noah-Vermillion ◽  
Brittany A. Simone ◽  
Paul D. Aridgides
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Targeted Therapy ◽  
Targeted Therapies ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Recurrent Cervical Cancer ◽  
Platinum Based Chemotherapy ◽  
Wide Range

In 2011 the Food and Drug Administration (FDA) approved anti-vascular endothelial growth factor (VEGF) therapy, bevacizumab, for intractable melanoma. Within the year, immunotherapy modulators inhibiting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) were approved in addition to programmed death-ligand 1 (PD-L1) antibodies in 2012. Since then, research showing the effectiveness of targeted therapies in a wide range of solid tumors has prompted studies incorporating their inclusion as part of upfront management as well as refractory or relapsed disease. For treatment of cervical cancer, which arises from known virus-driven oncogenic pathways, the incorporation of targeted therapy is a particularly attractive prospect. The current standard of care for locally advanced cervical cancer includes concurrent platinum-based chemotherapy with radiation therapy (CRT) including external beam radiation therapy (EBRT) and brachytherapy. Building upon encouraging results from trials testing bevacizumab or immunotherapy in recurrent cervical cancer, these agents have begun to be incorporated into upfront CRT strategies for prospective study. This article will review background data establishing efficacy of angiogenesis inhibitors and immunotherapy in the treatment of cervical cancer as well as results of prospective studies combining targeted therapies with standard CRT with the aim of improving outcomes. In addition, the role of immunotherapy and radiation on the tumor microenvironment (TME) will be discussed.

Adjuvant Radiation for Gynecologic Cancers

2019 ◽  
Author(s):  
Joanne Jang
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Endometrial Cancer ◽  
Vulvar Cancer ◽  
Vaginal Cancer ◽  
External Beam Radiation ◽  
Adjuvant Radiation ◽  
Gynecologic Cancers ◽  
Beam Radiation ◽  
Postoperative Setting

Radiation therapy plays a significant role in the treatment of nearly all gynecologic cancers, including endometrial cancer, cervical cancer, vaginal cancer, and vulvar cancer. Radiotherapy can be given as the primary modality for curative treatment of gynecologic cancers, most often for cervical, vaginal, and vulvar cancers, but can also be used adjuvantly in the postoperative setting. Radiation can be delivered in the form of external beam radiation therapy or as gynecologic implants for brachytherapy, which is radiation that is delivered internally. This review highlights the data supporting radiation therapy for gynecologic cancers and explains the different methods of radiation delivery. This review contains 5 figures, and 4 tables, and 40 references.  Key Words: adjuvant treatment, brachytherapy, cervical cancer, endometrial cancer, IMRT, ovarian cancer, radiation therapy, vaginal cancer, vulvar cancer

External beam radiation and brachytherapy boost at different facilities is associated with increased treatment delays in cervical cancer

2020 ◽  
Vol 30 (10) ◽  
pp. 1505-1512
Author(s):  
Richard Li ◽  
Elizabeth Germino ◽  
Zachary D Horne ◽  
John A Vargo ◽  
Yi-Jen Chen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Treatment Delays ◽  
Exact Test ◽  
Cancer Management ◽  
Brachytherapy Boost

IntroductionDue to variation in facility expertise and capabilities, patients commonly complete external beam radiation therapy at one facility and brachytherapy boost at another. We evaluated the association of external beam radiation therapy and brachytherapy at the same facility versus different facilities with treatment delays and survival.MethodsPatients receiving definitive external beam radiation therapy and brachytherapy for non-metastatic cervical cancer from 2004 to 2015 were identified in the National Cancer Database. Treatment delays were classified based on published thresholds: a course of >56 days was considered delayed, >65 days moderately delayed, and >77 days severely delayed. Fisher’s exact test and logistic regression were used to evaluate the association of same facility versus different facilities with treatment delays and predictors of same facility versus different facility treatment.ResultsWe identified 23 911 patients meeting the inclusion criteria at a median follow-up of 39.7 months (IQR 21.0–72.6 months), with 17 391 patients (72.7%) receiving same facility treatment and 6520 patients (27.3%) receiving different facility treatment. Any treatment delay was found in 49.3% of same facility treatments versus 51.9% of different facility treatments (p<0.001); moderate or worse delays in 24.8% of same facility versus 29.4% of different facility treatments (p<0.001); severe treatment delays in 11.3% of same facility versus 15.5% of different facility treatments (p<0.001). Receipt of same facility versus different facility treatment was independently associated with treatment delays (OR 1.28, 95% CI 1.20 to 1.37; p<0.001). Both treatment delays, particularly moderate delays (HR 1.20, 95% CI 1.13 to 1.28; p<0.001) and severe delays (HR 1.32, 95% CI 1.24 to 1.41; p<0.001), and different facility treatments (HR 1.11, 95% CI 1.06 to 1.16; p<0.001) were associated with worse survival.ConclusionsDelivery of external beam radiation therapy and brachytherapy at different facilities was associated with treatment delays and worse survival. Our findings underscore the importance of care coordination in cervical cancer management.

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