Comprehensive analysis of patient outcome after local recurrence of locally advanced cervical cancer treated with concomitant chemoradiation and image-guided adaptive brachytherapy.

Comprehensive analysis of patient outcome after local recurrence of locally advanced cervical cancer treated with concomitant chemoradiation and image-guided adaptive brachytherapy. Gynecol Oncol. 2020 Mar 13;: Authors: Mignot F, Gouy S, Schernberg A, Bockel S, Espenel S, Maulard A, Leary A, Genestie C, Annede P, Kissel M, Fumagalli I, Pautier P, Deutsch E, Haie-Meder C, Morice P, Chargari C Abstract INTRODUCTION: Since dose escalation allowed by image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), local relapses have become a rare event. Only scarce data are available on the outcome of patients experiencing a local relapse after IGABT. METHODS: Between 2004 and 2016, all consecutive patients treated at Gustave Roussy Institute for LACC and receiving concomitant chemoradiation and IGABT were analysed. Clinical and treatment-related prognostic factors for survival after local relapse were searched, in order to potentially identify patients requiring salvage treatment. RESULTS: Two hundred and fifty-nine patients were treated during this period. With a median follow-up of 4.1 years, 10.8% (n = 28) had a local relapse. Among these patients, 53.6% had synchronous lymph nodes or distant metastatic relapse and only 13 patients (5% of all patients) had isolated local relapse. After local relapse, median survival was 47 months and three patients were alive at last follow-up. Only three patients wit...
Source: Gynecologic Oncology - Category: Cancer & Oncology Authors: Tags: Gynecol Oncol Source Type: research

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This study aimed to evaluate the rectal volume and dose-volume histogram (DVH) relationship in high-dose-rate (HDR) brachytherapy in locally advanced cervical cancer. Material and methods: Planning computed tomography of 65 patients who underwent HDR brachytherapy boost as a component of definitive radiotherapy from March 2016 to February 2018 were reviewed. OARs and target volume were re-delineated by a single physician to decrease interobserver variation. Two sets of plan were generated; in the first set, the dose was prescribed to point A with Manchester system loading pattern, while in the second set, the dose was ...
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
Conclusions: There is a need to ensure consistency in vaginal points reporting. The impact of the dosimetric inter- and intra-observer variability should also be considered when dealing with dose tolerances and limits due to the potential dose gradient. PMID: 32395138 [PubMed]
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
Conclusions: Extended treatment planning time for brachytherapy due to the changes in topography of small pelvis can lead to different dose in high-risk organs than previously planned. It seems that the most significant changes are related to rectum. PMID: 32395135 [PubMed]
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
Authors: Gursel SB, Serarslan A, Meydan AD, Okumus N, Yasayacak T Abstract Purpose: The standard treatment for locally advanced stage cervical cancer is definitive radiotherapy, the quality of which affects both survival and side effects. Brachytherapy is a major component of definitive radiotherapy; it is administered using different techniques and applicators. The purpose of this study was to dosimetrically compare tandem ovoid (T-ovoid) and tandem ring (T-ring) brachytherapy treatments. Material and methods: Both applicator sets were applied to the same 20 patients, and treatment plans were made three-dimens...
Source: Journal of Contemporary Brachytherapy - Category: Cancer & Oncology Tags: J Contemp Brachytherapy Source Type: research
This study aimed to develop a volumetric independent dose calculation (vIDC) system for verification of the treatment plan in image-guided adaptive brachytherapy (IGABT) and to evaluate the feasibility of the vIDC in clinical practice with simulated cases.Methods: The vIDC is based on the formalism of TG-43. Four simulated cases of cervical cancer were selected to retrospectively evaluate the dose distributions in IGABT. Some reference point doses, such as points A and B and rectal points, were calculated by vIDC using absolute coordinate. The 3D dose volume was also calculated to acquire dose-volume histograms (DVHs) with...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
The objective of this study was to compare the ICRU 38 calculated rectal dose with in vivo dosimetry measured doses in cobalt-60 HDR brachytherapy for cervical cancer.MethodsA total of 48 brachytherapy insertions done on 15 patients treated from January to March 2017 at our institution were included in this prospective cross-sectional study.ResultsThe results demonstrated no significant difference between the computed ICRU rectal point dose and in vivo maximum measured rectal dose ((r) 0.6208,p 
Source: Journal of Radiation Oncology - Category: Cancer & Oncology Source Type: research
Brachytherapy with a remote after-loading system (RALS) plays an important role in the treatment of cervical cancer [1,2]. Recent developments in three-dimensional (3D) planning using computed tomography (CT) and magnetic resonance imaging (MRI) allow the assessment of 3D dose distributions in brachytherapy, and the widespread use of 3D-image guided brachytherapy (3D-IGBT), dose evaluation facilitates the use of dose volume histogram (DVH) in addition to the dose at “point A” approach. The Gynecologic Brachytherapy Working Group of the Groupe Européen de Curiethérapie and European Society for Radi...
Source: Physica Medica: European Journal of Medical Physics - Category: General Medicine Authors: Tags: Original paper Source Type: research
Abstract Imaging is involved in the management of uterine cervical cancer with several objectives: 1/to assess local and lymph node extension of the initial disease; 2/evaluate treatment response to conservative therapy; 3/detect recurrences. Pelvic MRI is the first-line examination in all these indications. It is the key element for delineation after image fusion when the indication of chemoradiation therapy is made. It is also essential for guiding the placement of applicators and optimising the dosimetry of brachytherapy. The diffusion-weighted acquisition is a sequence sensitive to the motion of water molecule...
Source: Cancer Radiotherapie - Category: Cancer & Oncology Authors: Tags: Cancer Radiother Source Type: research
ConclusionSomewhat difference could be seen between HR-CTVMR and HR-CTVCT.
Source: Japanese Journal of Radiology - Category: Radiology Source Type: research
According to international recommendations by GEC-ESTRO GYN working group [1], combined radiation therapy is the most effective treatment for locally advanced cervical cancer (LACC). Classical combined radiotherapy includes two sequential stages: external beam radiotherapy (EBRT) and brachytherapy (BT) [1]. EBRT is used for irradiation of the tumour itself and the lymph nodes to total dose values up to 50Gy. BT is used as a boost for irradiation of the tumour up to EQD2 doses as high as 90Gy. The golden standard of modern combined radiotherapy includes EBRT followed by image-guided adaptive BT.
Source: Physica Medica: European Journal of Medical Physics - Category: General Medicine Authors: Tags: Original paper Source Type: research
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