scholarly journals The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients After Radical Hysterectomy and External Beam Radiation Therapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Ying-Lu Lai ◽  
Ye-Ning Jin ◽  
Xi Wang ◽  
Wei-Xiang Qi ◽  
Rong Cai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Stromal Invasion ◽  
Vaginal Cuff ◽  
Beam Radiation ◽  
Case Selection ◽  
Brachytherapy Boost ◽  
Bulky Mass

ObjectiveTo explore the suitable cases for vaginal cuff brachytherapy (VCB) combined with external beam radiation therapy (EBRT) in the postoperative treatment of cervical cancer.MethodsWe retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 patients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12–18 Gy/2–3 Fx VCB. Survival analyses were performed using Kaplan–Meier method, and Cox model was used to analyze prognostic factors.ResultsThe median follow-up was 52 months (9–136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients (27.10%) had local or distant recurrences, 29 (13.55%) in pelvis, six (2.80%) with metastases to para-aortic, 19 (8.88%) with distant metastases (including inguinal lymph nodes) and four (1.87%) with both local and distant recurrences. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P = 0.77, P = 0.99, respectively. Neither it decreased the local relapse in the pelvis or vaginal cuff, P = 0.56, P = 0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4 cm) as well as 1) with deep stromal invasion (>50% stromal invasion), P = 0.012 or 2) received low EBRT dose (≤45 Gy), P = 0.033, and in patients with deep stromal invasion as well as received low EBRT dose (P = 0.018).ConclusionsWe first proposed the case selection model for postoperative EBRT plus VCB. Brachytherapy boost were considered in the setting of postoperative radiotherapy if the patients had at least two out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.

scholarly journals The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients after Radical Hysterectomy and External Beam Radiation Therapy

2021 ◽  
Author(s):  
Ying-Lu LAI ◽  
Ye-Ning JIN ◽  
Xi WANG ◽  
Wei-Xiang QI ◽  
Rong CAI ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Stromal Invasion ◽  
Vaginal Cuff ◽  
Beam Radiation ◽  
Case Selection ◽  
Brachytherapy Boost ◽  
Bulky Mass

Abstract ObjectiveTo Explore the suitable cases for vaginal cuff brachytherapy(VCB) combined with external beam radiation therapy(EBRT) in the postoperative treatment of cervical cancer. MethodsWe retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 patients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12-18Gy/2-3Fx VCB. Survival analyses were performed using Kaplan-Meier method, and Cox model was used to analyze prognostic factors. ResultsThe median follow-up was 52 months (9-136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients had local or distant recurrences, 29 in pelvic, 8 with metastases to para-aortic or inguinal lymph nodes, 17 with distant metastases and 4 with both local and distant recurrences. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P=0.77, P=0.99, respectively. Neither it decreased the local relapse in the pelvis or vaginal cuff, P=0.56, P=0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4cm) as well as 1) with deep stromal invasion (>50% stromal invasion), P=0.012 or 2) received low EBRT dose (≤ 45Gy), P=0.033, and in patients with deep stromal invasion as well as received low EBRT dose (P=0.018). ConclusionsWe first proposed the case selection model for postoperative EBRT plus VCB. Brachytherapy boost were considered in the setting of postoperative radiotherapy if the patients had at least 2 out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.

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.

Disparities in the Use of Adjuvant External Beam Radiation Therapy in Node-positive Cervical Cancer Patients Following Hysterectomy

2020 ◽  
Vol 43 (1) ◽  
pp. 43-46
Author(s):  
Dimitrios Nasioudis ◽  
Kelsey Musselman ◽  
Sushmita Gordhandas ◽  
Eloise Chapman-Davis ◽  
Melissa K. Frey ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Node Positive

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.

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