scholarly journals Analysis of local control rate and toxicity of radiotherapy dose of cervical cancer.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 136-136
Author(s):  
Hanyi Zhang ◽  
Shun Lu ◽  
Chang Sun ◽  
Jin Yi Lang
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Univariate Analysis ◽  
Local Control Rate ◽  
External Beam Radiation ◽  
Youden Index ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Beam Radiation ◽  
Radiotherapy Dose

136 Background: The standard of care for treatment of advanced cervical cancer is the combination of external beam radiation therapy (EBRT) and intracavitary brachytherapy with cisplatin based concurrent chemotherapy. Radiotherapy plays a crucial role in treatment of cervical cancer. Recent GEC-ESTRO guidelines recommend that the dose to 90% (D90) of the high-risk clinical target volume (HRCTV) in cervical cancer be at least 85Gy with higher doses for poor response to radiotherapy. This study was aim to analyze our institution’s patients with locally advanced cervical cancer in regards to whether higher brachytherapy dose delivery lead to a better outcome, and to investigate the proper dose to balance the local control rate and toxicity. Methods: A total of 262 patients with local advanced cervical cancer treated at a single institution were retrospectively analyzed for the association between dosimetry and outcomes. Youden index was used to identify the optimal cut-off point of continuous tumor parameters and divide patients into subgroups. Significance of radiotherapy dose parameters on OS, PFS, LRFS and DMFS and toxicity was evaluated. Results: In the univariate analysis, for both HR-CTV and LR-CTV, the high dose group (EQD2 D90 >75Gy, LR-CTV>68Gy, respectively) have a better LRFS than low-dose groups (P<0.05). LR-CTV remains significance after adjusted for age and FIGO stage. Moreover, in the high-dose LR-CTV group, there is no association between dose of LR-CTV and LRFS was found, however, higher dose of HR-CTV significant associated with higher ratio of side effect was found. In addition, no association of dose of HR-CTV or LR-CTV and OS were found for all patients. Conclusions: Our results showed that dose of LR-CTV may be a useful prognostic factor of LRFS of patients with cervical cancer. Moreover, after D90 of LR-CTV reaches 68Gy, increasing dose did not show a better LRFS but lead to higher ratio of toxicity, supporting that LR-CTV at 68Gy might be a safety and efficacy dose of radiotherapy to the patients with cervical cancer. However, further improved in dose had no significant benefit on local control rate, and it might increase the risks of toxicity.

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.

Long-Term Results of a Phase II Trial of Concomitant Cisplatin-Paclitaxel Chemoradiation in Locally Advanced Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1162-1168 ◽  
Author(s):  
María Isabel Martínez-Fernández ◽  
Jairo Legaspi Folgueira ◽  
Germán Valtueña Peydró ◽  
Mauricio Cambeiro ◽  
Jaime Espinós ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
High Dose Rate ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Long Term Results ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation

ObjectivesThe aim of this study was to determine the long-term results of a 7-week schedule of external beam radiation therapy, high dose rate brachytherapy, and weekly cisplatin and paclitaxel in patients with locally advanced carcinoma of the cervix.MethodsThirty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVa cervical cancer were treated with 40 mg/m2 per week of intravenous cisplatin and 50 mg/m2 per week of intravenous paclitaxel combined with 45 Gy of pelvic external beam radiation therapy and 28 to 30 Gy of high dose rate brachytherapy.ResultsSixteen patients (43.2%) were able to complete the 6 scheduled cycles of chemotherapy. The median number of weekly chemotherapy cycles administered was 5. Thirty-six (16.2%) of 222 cycles of chemotherapy were not given because of toxicity. The mean dose intensity of cisplatin was 29.6 mg/m2 per week (95% confidence interval, 27.0–32.1); that of paclitaxel was 40.0 mg/m2 per week (95% confidence interval, 36.9–43.1). Thirty-four patients (91.8%) completed the planned radiation course in less than 7 weeks. Median radiation treatment length was 43 days. After a median follow-up of 6 years, 7 patients (18.9%) experienced severe (RTOG grade 3 or higher) late toxicity. No fatal events were observed. Ten patients have failed, 1 locally and 9 at distant sites. The 14-year locoregional control rate was 96.7%, and the 14-year freedom from systemic failure rate was 64.6%. Fourteen-year actuarial disease-free survival and overall survival rates were 44.8% and 50%, respectively.ConclusionsThis study demonstrates excellent very long-term results and tolerable toxicity although the target weekly dosage of cisplatin and paclitaxel needs to be adjusted in the majority of the patients.

Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis

2017 ◽  
Vol 27 (7) ◽  
pp. 1446-1454 ◽  
Author(s):  
Ozan Cem Guler ◽  
Sezin Yuce Sari ◽  
Sumerya Duru Birgi ◽  
Melis Gultekin ◽  
Ferah Yildiz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Local Control ◽  
External Beam Radiation ◽  
Significant Prognostic Factor ◽  
Definitive Chemoradiotherapy ◽  
Beam Radiation ◽  
Significant Difference

ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.

The Variability of Applicator Position among High Dose Rate Intracavitary Brachytherapy Applications in Cervical Cancer Patients Treated with Ring & Tandem Applicators

2007 ◽  
Vol 93 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Cuneyt Ebruli ◽  
Ayşe Nur Demiral ◽  
Riza Çetingöz ◽  
Ferhat Eyiler ◽  
Münir Kinay
Keyword(s):  
Cervical Cancer ◽  
Standard Deviation ◽  
Dose Rate ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
High Dose Rate ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

Objective To evaluate the interindividual and intraindividual applicator position variability in high dose rate ring and tandem intracavitary brachytherapy applications in locally advanced cervical cancer. Patients and Methods Eight patients with locally advanced cervical cancer formed the study population. They had been treated in Dokuz Eylül University Department of Radiation Oncology between the years 2000 and 2005 with high dose rate intracavitary brachytherapy using ring and tandem applicators. The 3-dimensional geometric variation of the applicator center in craniocaudal, mediolateral and anteroposterior directions was determined on the basis of bony reference points in 24 pairs of orthogonal films obtained in the conventional simulator. Then the following evaluations were performed: 1) the applicator position variability in all applications (interindividual variability), 2) the intraindividual applicator position variability relative to the first application, 3) the intraindividual applicator position variability relative to the average of three applications. Among the potential factors that might influence the reproducibility of ring and tandem applications, age, stage, the period between external radiotherapy and brachytherapy were evaluated by univariate analysis. Results Standard deviation of interindividual applicator variability was 3.83 mm in craniocaudal, 0.39 mm in mediolateral and 2.86 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the first application was 1.91 mm in craniocaudal, 0.4 mm in mediolateral, and 4.26 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the average of three applications was 0.95 mm in craniocaudal, 1.86 mm in mediolateral, and 1.24 mm in anteroposterior directions. According to univariate analysis, no factor influenced applicator position variability. Conclusions In order to extract definitive conclusions about factors that affect positional reproducibility of ring and tandem applicators, studies are needed that include larger numbers of patients.

MRI-based radiomics: promise for locally advanced cervical cancer treated with a tailored integrated therapeutic approach

2021 ◽  
pp. 030089162110142
Author(s):  
Concetta Laliscia ◽  
Angiolo Gadducci ◽  
Roberto Mattioni ◽  
Francesca Orlandi ◽  
Sabina Giusti ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Figo Stage ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Primary Tumor Site ◽  
Locally Advanced Cervical Cancer ◽  
Sequential Boost

Objective: To assess prognostic factors by analyzing clinical and radiomic data of patients with locally advanced cervical cancer (LACC) treated with definitive concurrent cisplatin-based chemoradiotherapy (CCRT) using magnetic resonance imaging (MRI). Methods: We analyzed radiomic features from MRI in 60 women with FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IVA cervical cancer who underwent definitive CCRT 45–50.4 Gy (in 25–28 fractions). Thirty-nine (65.0%) received EBRT sequential boost (4–20 Gy) on primary tumor site and 56 (93.3%) received high-dose-rate brachytherapy boost (6–28 Gy) (daily fractions of 5–7 Gy). Moreover, 71.7% of patients received dose-dense neoadjuvant chemotherapy for 6 cycles. The gross tumor volume was defined on T2-weighted sequences and 29 features were extracted from each MRI performed before and after CCRT, using dedicated software, and their prognostic value was correlated with clinical information. Results: In univariate analysis, age ⩾60 years and FIGO stage IB2–IIB had significantly better progression-free survival (PFS) ( p = 0.022 and p = 0.009, respectively). There was a trend for significance for worse overall survival (OS) in patients with positive nodes ( p = 0.062). In multivariate analysis, only age ⩾60 years and FIGO stage IB2–IIB reached significantly better PFS ( p = 0.020 and p = 0.053, respectively). In radiomic dataset, in multivariate analysis, pregray level p75 was significantly associated with PFS ( p = 0.047), pre-D3D value with OS ( p = 0.049), and preinformation measure of correlation value with local control ( p = 0.031). Conclusion: The combination of clinical and radiomics features can provide information to predict behavior and prognosis of LACC and to make more accurate treatment decisions.

CyberKnife Frameless Radiosurgery for the Treatment of Extracranial Benign Tumors

2005 ◽  
Vol 4 (5) ◽  
pp. 571-576 ◽  
Author(s):  
Ajay K. Bhatnagar ◽  
Peter C. Gerszten ◽  
Cihat Ozhasaglu ◽  
William J. Vogel ◽  
Shalom Kalnicki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Late Toxicity ◽  
Foramen Magnum ◽  
Local Control Rate ◽  
External Beam Radiation ◽  
Benign Tumors ◽  
Beam Radiation ◽  
Frameless Radiosurgery

Limited data exists for the use of radiosurgery for benign extracranial tumors. The purpose of this study was to evaluate the feasibility, toxicity, and local control of patients with benign extracranial lesions treated with the CyberKnife Frameless Radiosurgery System. From September 2001 thru January 2004, 59 benign tumors in 44 patients were treated using the CyberKnife a frameless image-guided radiosurgery system. Of these tumors, there were 21 neurofibromas, ten schwannomas, eight meningiomas, eight hemangioblastomas, seven paragangliomas, two hemangiopericytomas, one pseudotumor, one ependymoma, and one arteriovenous malformation (AVM). The anatomic locations of these tumors were spinal (25 cervical, four thoracic, 14 lumbar, and two sacral), neck (eight), orbital (three), brainstem (one), and foramen magnum (one). All patients were treated in a single fraction except three lesions were treated in a fractionated manner. The median treatment delivery time per fraction was 59 minutes (range 11–194). Twenty three lesions initially underwent surgical resection. Ten lesions received prior external beam radiation with a median dose 48 Gy (range 40–54 Gy), and one lesion received two prior CyberKnife treatments for a total dose of 32 Gy to the 80% isodose line. The median follow-up was eight months (range 1–25 months). Acute and late toxicity was graded using the National Cancer Institute Common Toxicity Criteria (CTC) scale. Symptomatic response was documented as “improved,” “stable,” or “progression”. The median tumor dose delivered was 16.0 Gy to the 80% isodose line (range 10–31 Gy). The median tumor volume was 4.3 cc (range 0.14–98.6 cc). The median spinal cord volume receiving more than 8 Gy was 0.035 cc (range 0–2.5 cc) and the median maximum spinal cord dose 11.5 Gy (range 0–19.8 Gy). There were no patients that suffered a significant (Grade 3, 4, or 5) acute toxicity. There was no observed late toxicity. 78% of patients experienced an improvement of their pre-treatment symptoms while only one patient experienced symptom progression. Of the 26 patients who underwent follow-up imaging, the local control rate was 96%. This study suggests that CyberKnife Radiosurgery is a safe and efficacious treatment modality for benign tumors, even for those patients with recurrent previously irradiated lesions.

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