Pawel T Dyk1, Susan Richardson2, Shahed N Badiyan1, Julie K Schwarz3, Jacqueline Esthappan1, Jose L Garcia-Ramirez1, Perry W Grigsby4. 1. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO. 2. Swedish Cancer Institute, Seattle, WA. 3. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO; Alvin J. Siteman Cancer Center, St. Louis, MO. 4. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO; Alvin J. Siteman Cancer Center, St. Louis, MO; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO. Electronic address: pgrigsby@wustl.edu.
Abstract
PURPOSE: To evaluate outpatient-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) in the treatment of gynecologic malignancies. METHODS AND MATERIALS: Between December 2006 and July 2012, 50 patients were treated with twice-daily outpatient-based HDR iridium-192 ISBT at our institution. Thirty-two patients had vaginal cancers, 13 vulvar, 3 urethral, and 2 cervical cancers. The most common histologies were squamous cell carcinoma (58%) and endometrioid adenocarcinoma (26%). Twenty-six patients were treated with definitive radiation therapy with or without platinum-based chemotherapy, 16 were treated for recurrent disease, 5 were treated in the postoperative setting, and 3 were treated palliatively. Forty patients received external beam radiation therapy before ISBT. RESULTS: Median followup was 13.7 months. Median interstitial dose was 18 Gy in 2.25 Gy twice-daily fractions prescribed to the implant volume. Median external beam dose was 50.4 Gy in 1.8 Gy daily fractions prescribed to the primary disease site. Eight patients (16%) were seen in the emergency room or were admitted to the hospital during treatment. Six patients (17%) experienced significant complications after treatment (3 ulcerations at the primary site, 1 vaginal necrosis, 1 vaginal abscess, and 1 patient with urinary obstruction). Larger volume encompassing 100% of the prescribed dose was correlated with significant complications on multivariate analysis (p = 0.039). Actuarial local control at 1 year was 72%, with univariate analysis demonstrating worse local control for nonendometrioid adenocarcinoma compared with squamous cell carcinoma (20% vs. 84%, p = 0.044). CONCLUSIONS: Outpatient-based HDR ISBT is feasible and safe, with toxicity and local control rates consistent with historical outcomes.
PURPOSE: To evaluate outpatient-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) in the treatment of gynecologic malignancies. METHODS AND MATERIALS: Between December 2006 and July 2012, 50 patients were treated with twice-daily outpatient-based HDR iridium-192 ISBT at our institution. Thirty-two patients had vaginal cancers, 13 vulvar, 3 urethral, and 2 cervical cancers. The most common histologies were squamous cell carcinoma (58%) and endometrioid adenocarcinoma (26%). Twenty-six patients were treated with definitive radiation therapy with or without platinum-based chemotherapy, 16 were treated for recurrent disease, 5 were treated in the postoperative setting, and 3 were treated palliatively. Forty patients received external beam radiation therapy before ISBT. RESULTS: Median followup was 13.7 months. Median interstitial dose was 18 Gy in 2.25 Gy twice-daily fractions prescribed to the implant volume. Median external beam dose was 50.4 Gy in 1.8 Gy daily fractions prescribed to the primary disease site. Eight patients (16%) were seen in the emergency room or were admitted to the hospital during treatment. Six patients (17%) experienced significant complications after treatment (3 ulcerations at the primary site, 1 vaginal necrosis, 1 vaginal abscess, and 1 patient with urinary obstruction). Larger volume encompassing 100% of the prescribed dose was correlated with significant complications on multivariate analysis (p = 0.039). Actuarial local control at 1 year was 72%, with univariate analysis demonstrating worse local control for nonendometrioid adenocarcinoma compared with squamous cell carcinoma (20% vs. 84%, p = 0.044). CONCLUSIONS:Outpatient-based HDR ISBT is feasible and safe, with toxicity and local control rates consistent with historical outcomes.
Authors: Yuan James Rao; Anupama Chundury; Julie K Schwarz; Comron Hassanzadeh; Todd DeWees; Daniel Mullen; Matthew A Powell; David G Mutch; Perry W Grigsby Journal: Adv Radiat Oncol Date: 2017-02-28