Vaginal cancer treated with curative radiotherapy with or without concomitant chemotherapy: oncologic outcomes and prognostic factors

2021 ◽  
pp. 030089162110563
Author(s):  
Eva Meixner ◽  
Nathalie Arians ◽  
Nina Bougatf ◽  
Line Hoeltgen ◽  
Laila König ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Local Control ◽  
External Beam Radiotherapy ◽  
Concurrent Chemotherapy ◽  
Cox Proportional Hazards ◽  
Vaginal Cancer ◽  
Oncologic Outcomes ◽  
High Dose ◽  
Concomitant Chemotherapy ◽  
Curative Radiotherapy

Background: Vaginal cancer is a rare disease for which prospective randomized trials do not exist. We aimed to assess survival outcomes, patterns of recurrence, prognostic factors, and toxicity in the curative treatment using image-guided radiotherapy (RT). Methods: In this retrospective review, we identified 53 patients who were treated at a single center with external beam radiotherapy and brachytherapy with or without concomitant chemotherapy from 2000 to 2021. Results: With a median follow-up of 64.5 months, the Kaplan-Meier 2-, 5-, and 7-year overall survival (OS) was found to be 74.8%, 62.8%, and 58.9%, respectively. Local and distant control were 67.8%, 65.0%, and 65.0% and 74.4%, 62.6%, and 62.6% at 2, 5, and 7 years, respectively. In univariate Cox proportional hazards ratio analysis, OS was significantly correlated to FIGO stage (hazard ratio [HR] 1.78, p = 0.042), postoperative RT (HR 0.41, p = 0.044), and concomitant chemotherapy (HR 0.31, p = 0.009). Local control rates were superior when an equivalent dose in 2-Gy fractions (EQD2) of ⩾65 Gy was delivered (HR 0.216, p = 0.028) and with the use of concurrent chemotherapy (HR 0.248, p = 0.011). Not surprisingly, local control was inferior for patients with a higher TNM stage (HR 3.303, p = 0.027). Minimal toxicity was observed with no patients having documentation of high-grade toxicity (CTCAE grade 3+). Conclusion: In treatment of vaginal cancer, high-dose RT in combination with brachytherapy is well tolerated and results in effective local control rates, which significantly improve with an EQD2(α/β=10) ⩾65 Gy. Multivariate analyses revealed concomitant chemotherapy was a positive prognostic factor for overall and progression-free survival.

scholarly journals In-room computed tomography–based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study

2016 ◽  
Vol 58 (4) ◽  
pp. 543-551 ◽  
Author(s):  
Tatsuya Ohno ◽  
Shin-Ei Noda ◽  
Noriyuki Okonogi ◽  
Kazutoshi Murata ◽  
Kei Shibuya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Local Control ◽  
External Beam Radiotherapy ◽  
Clinical Stage ◽  
Stage Ii ◽  
High Dose ◽  
Significant Difference ◽  
Grade 3

Abstract Herein, we investigate the long-term clinical outcomes for cervical cancer patients treated with in-room computed tomography–based brachytherapy. Eighty patients with Stage IB1–IVA cervical cancer, who had undergone treatment with combined 3D high-dose rate brachytherapy and conformal radiotherapy between October 2008 and May 2011, were retrospectively analyzed. External beam radiotherapy (50 Gy) with central shielding after 20–40 Gy was performed for each patient. Cisplatin-based chemotherapy was administered concurrently to advanced-stage patients aged ≤75 years. Brachytherapy was delivered in four fractions of 6 Gy per week. In-room computed tomography imaging with applicator insertion was performed for treatment planning. Information from physical examinations at diagnosis, and brachytherapy and magnetic resonance imaging at diagnosis and just before the first brachytherapy session, were referred to for contouring of the high-risk clinical target volume. The median follow-up duration was 60 months. The 5-year local control, pelvic progression-free survival and overall survival rates were 94%, 90% and 86%, respectively. No significant differences in 5-year local control rates were observed between Stage I, Stage II and Stage III–IVA patients. Conversely, a significant difference in the 5-year overall survival rate was observed between Stage II and III–IVA patients (97% vs 72%; P = 0.006). One patient developed Grade 3 late bladder toxicity. No other Grade 3 or higher late toxicities were reported in the rectum or bladder. In conclusion, excellent local control rates were achieved with minimal late toxicities in the rectum or bladder, irrespective of clinical stage.

Curative Radiotherapy using Different Radiation Techniques for Isolated Lung Metastasis from Colorectal Cancer

2013 ◽  
Vol 99 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Sunyoung Lee ◽  
Dae Yong Kim ◽  
Sun Young Kim ◽  
Woong Sub Koom ◽  
Sun Young Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Treatment Response ◽  
Surgical Resection ◽  
Lung Metastasis ◽  
Local Control ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Curative Radiotherapy ◽  
Isolated Lung

Aims and background Surgical resection remains the mainstay for the treatment of colorectal lung metastasis, but a group of patients who are medically inoperable or unsuitable for surgery are treated with radiotherapy. The purpose of this multi-institutional study was to evaluate the clinical outcome and investigate the prognostic factors affecting local control and survival in this subset of patients. Methods We retrospectively analyzed 30 patients with 43 lesions who underwent curative radiotherapy for isolated lung metastasis from colorectal cancer at nine institutions from 2003 and 2008. A total dose of 42–75 Gy at the peripheral planning target volume was administered in 3–35 fractions. The median biologically equivalent dose was 84 Gy (range, 58.5–180). Results Treatment response was complete in 10 (33.3%), partial in 13 (43.3%), stable in six (20.0%), and progressive in one patient (3.3%). The median follow-up period for all patients was 29.0 months (range, 5.0–93.8). Kaplan-Meier local control at 5 years was 44%. The median survival was 46.2 months, and the 5-year overall survival was 47%. Twenty-three patients (77%) experienced treatment failure, most of which were intrapulmonary failure. The intrapulmonary relapse-free survival and overall relapse-free survival at 5 years were 22% and 19%, respectively. Treatment response and pre-radiotherapy carcinoembryonic antigen level were significant prognostic factors for local control and survival. Grade 3–5 toxicity occurred in 7 patients. Three patients had grade 5 toxicity, including radiation pneumonitis, a tracheoesophageal fistula, and hemoptysis. Conclusions Curative radiotherapy for isolated lung metastasis from colorectal cancer in patients who are medially inoperable or unsuitable for surgery results in long-term survival, comparable to surgical resection. Curative radiotherapy could be an effective and noninvasive alternative if dose-limiting toxicity is carefully considered, particularly in patients with bilateral or central lesions.

scholarly journals Stereotactic ablative radiotherapy (SABR) for recurrent and previously irradiated head and neck cancers

BJR|Open ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 20190051
Author(s):  
Anil Kumar Anand ◽  
Bharat Dua ◽  
Anil Kumar Bansal ◽  
Heigrujam Malhotra Singh ◽  
Amit Verma ◽  
...  
Keyword(s):  
Head And Neck ◽  
Local Control ◽  
Proportional Hazards ◽  
Poor Response ◽  
Class Ii ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Stereotactic Ablative Radiotherapy ◽  
High Dose ◽  
Grade 3

Objective: To assess the response and toxicity of stereotactic ablative radiotherapy (SABR) in patients with recurrent head and neck cancer (HNC), who had previously received radiation for their primary tumor. Methods: Between 2014 and 2018, patients who received SABR to recurrent HNC within the previously irradiated region were retrospectively reviewed. Mean age was 60 years (range 30–78 Years). Histology was confirmed in all patients. MRI and /or CT-positron emission tomography were done to evaluate local extent and to rule out metastasis. Response was assessed as per RECIST/PERCIST Criteria. Cox proportional hazards regression and the Kaplan–Meier methods were used for statistical analysis. Results: 32 patients received SABR. RPA Class II, III patients were 20 and 12 respectively. 87% patients received a dose of ≥30 Gy/5 fractions. Median follow-up was 12 months. Estimated 1 year and 2 years local control was 64.2 and 32% and 1 year and 2 years overall survival was 67.5 and 39.5% respectively. Acute Grade 2 skin and Grade 3 mucosal toxicity was seen in 31.3 and 28% patients respectively. Late Grade 3 toxicity was seen in 9.3% patients. Conclusion: Re-irradiation with SABR yields high local control rates and is well tolerated. It compares favorably with other treatment modalities offered to patients with recurrent HNC. It is also suitable for patients of RPA Class II and III. There is need for novel systemic agents to further improve the survival. Advances in knowledge: Treatment of patients with recurrent HNC is challenging and is more difficult in previously radiated patient. More than 50% patients are unresectable. Other options of salvage treatment like re-irradiation and chemotherapy are associated with poor response rates and high incidence of acute and late toxicity (Gr ≥3 toxicity 50–70%). SABR is a novel technology to deliver high dose of radiation to recurrent tumor with high precision. It yields high local control rates with less toxicity compared to conventionally fractionated radiation.

Radiotherapeutic Factors in the Management of Cervical-basal Chordomas and Chondrosarcomas

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1252-1262 ◽  
Author(s):  
Georges Noël ◽  
Loïc Feuvret ◽  
Régis Ferrand ◽  
Gilbert Boisserie ◽  
Jean-Jacques Mazeron ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Cervical Spine ◽  
Local Control ◽  
Tumor Volume ◽  
High Energy ◽  
Cranial Base ◽  
High Dose ◽  
Female Ratio ◽  
Line P

Abstract OBJECTIVE: To define prognostic factors for local control and survival in 90 consecutive patients treated by fractionated photon and proton radiation for chordoma or chondrosarcoma of the cranial base and upper cervical spine. METHODS: Between December 1995 and December 2000, 90 patients (median age, 51.3 yr; range, 10–85 yr; male/female ratio, 3:2) were treated by a combination of high-energy photons and protons. Sixty-four patients had a chordoma, and 26 had a chondrosarcoma. The proton component was delivered by the 201-MeV proton beam of the Centre de Protonthérapie d'Orsay. The median total dose delivered to the gross tumor volume (GTV) was 67 cobalt Gray equivalents (range, 22–70 cobalt Gray equivalents). RESULTS: With a median follow-up of 34 months (range, 3–74 mo), treatment of 25 tumors failed locally. The 3-year local control rates were 69.2% (±6.0%) and 91.6% (±8.4%) for chordomas and chondrosarcomas, respectively. According to multivariate analysis, a small tumor volume excluded from the 95% isodose line (P = 0.032; relative risk [RR], 0.098; 95% confidence interval [CI], 0.01–0.81) and a controlled tumor (P = 0.049; RR, 0.19; 95% CI, 0.04–0.99) were independent favorable prognostic factors for overall survival. On multivariate analysis, a high minimum dose (P = 0.02; RR, 2.8; 95% CI, 1.2–6.6), a high tumor control probability (P = 0.02; RR, 3.8; 95% CI, 1.2–12.5), a high dose delivered to 95% of the GTV (P = 0.03; RR, 3.4; 95% CI, 1.15–10.2), a high GTV encompassed by the 90% isodose line (P = 0.01; RR, 3.29; 95% CI, 1.29–8.44), and a small GTV excluded from the 90% isodose line (P = 0.036; RR, 0.4; 95% CI, 0.1–0.9) were independent favorable prognostic factors for local control. CONCLUSION: In chordomas and chondrosarcomas of the cranial base and cervical spine treated by surgical resection and then by high-dose photon and proton irradiation, local control is mainly dependent on the quality of radiation, especially dose uniformity within the GTV. Special attention must be paid to minimize underdosed areas because of the close proximity of critical structures and to redefine and possibly escalate dose constraints to tumor targets in future studies in view of the low toxicity observed to date.

Quality of life in patients of carcinoma cervix treated with chemoradiotherapy: A prospective study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16545-e16545
Author(s):  
Pavankumar Lachi ◽  
Monica Malik ◽  
Kesava Ramgopal Adavikolanu ◽  
Syedakram Kothwal ◽  
Deepajoseph M ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Total Dose ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Carcinoma Cervix ◽  
Duration Of Treatment

e16545 Background: The standard of care in locally advanced carcinoma cervix is concurrent chemoradiotherapy. The aim of the study is to prospectively assess quality of life (QoL) in patients of carcinoma cervix treated with chemoradiotherapy. Methods: Between June 2011 and June 2012, 20 patients of carcinoma cervix were included in the study. All patients received conformal external beam radiotherapy (EBRT) on Linear accelerator to a total dose of 50Gy, 2 Gy per fraction, 25 fractions to the pelvis and intracavitary brachytherapy by High dose rate brachytherapy, 7 Gy per fraction, 3 fractions to a total dose of 21 Gy. Patients received concurrent chemotherapy with Cisplatin 40 mg/m2 weekly for five weeks. QoL was assessed using EORTC QLQ-C30 and QLQ-C24 questionnaires at baseline and at six months following completion of treatment. The collected data was analyzed using standard statistical software package (SPSS version 20.0). Results: Median age of the patients in the study was 52years ( range 34 – 69 years), 13 (65%) patients were stage II and seven (35%) were stage III. Mean duration of treatment is 37 days (range 34- 70 days). Local control rate at six months was 95%. Compliance with completion of QoL scores was high. A statistically significant improvement (p = 0.001) was seen at six months post treatment in Global health score and in function scales like physical function, role function, emotional function, social function and cognitive function. There was a significant improvement in symptom scales of urologic and vaginal symptoms. The difference in sexual function at six months showed a trend towards significance (p = 0.052). Conclusions: Patients of carcinoma cervix have a significant improvement in quality of life following treatment with radiotherapy and chemotherapy.

Definitive Radiotherapy for Treatment of Primary Vaginal Cancer: Effectiveness and Prognostic Factors

2012 ◽  
Vol 22 (3) ◽  
pp. 521-527 ◽  
Author(s):  
Won Il Jang ◽  
Hong-Gyun Wu ◽  
Sung Whan Ha ◽  
Hak Jae Kim ◽  
Soon Beom Kang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Local Control ◽  
Disease Free Survival ◽  
Vaginal Cancer ◽  
Significant Prognostic Factor ◽  
Early Stage Disease ◽  
Free Survival ◽  
Definitive Radiotherapy ◽  
Gynecology And Obstetrics ◽  
Disease Free

ObjectiveThis study was performed to evaluate treatment outcomes and define prognostic factors for primary vaginal cancer treated with definitive radiotherapy.Materials and MethodsWe retrospectively analyzed 38 patients with primary vaginal cancer who received radiotherapy with curative intent between January 1981 and August 2008. Of these 38 patients, 6 were excluded from this analysis because of other uncontrolled malignancy (n = 1), uncommon histology (n = 4), or insufficient medical records (n = 1). Twenty-three patients (72%) presented with early-stage disease (International Federation of Gynecology and Obstetrics stages 0, I, or II). Eleven patients (34%) were treated with external beam radiotherapy (EBRT) alone and 21 patients (66%) with EBRT plus brachytherapy (BT). Low–dose rate cesium-137 was used with intracavitary technique for most of the patients who received BT. Five patients received chemotherapy. The median total dose in patients who received EBRT and EBRT+BT was 50.4 Gy (range, 39.6–70.4 Gy) and 78.9 Gy (range, 72.0–87.0 Gy), respectively.ResultsThe median duration of follow-up was 38 months. Five-year overall survival, cause-specific survival, disease-free survival, local control, and regional control rates for the analyzed patients were 75%, 88%, 58%, 62% and 90%, respectively. Thirteen patients had treatment failure as follows: local (n = 7), distant (n = 1), local plus regional (n = 1), local plus distant (n = 2), and local plus regional plus distant (n = 2). Primary tumor size was a significant prognostic factor for disease-free survival (P = 0.039).ConclusionsDefinitive radiotherapy is an effective treatment modality for primary vaginal cancer. Local failure was the major failure pattern, and achievement of local control is important for disease control and survival.

Sign in / Sign up

Export Citation Format

Share Document