Christopher L Tinkle1, Vivian Weinberg1, Lee-May Chen2, Ramey Littell3, J Adam M Cunha1, Rajni A Sethi1, John K Chan4, I-Chow Hsu5. 1. Department of Radiation Oncology, University of California, San Francisco, California. 2. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California. 3. Gynecologic Oncology, The Permanente Medical Group, San Francisco, California. 4. Gynecologic Oncology, California Pacific Medical Center, San Francisco, California. 5. Department of Radiation Oncology, University of California, San Francisco, California. Electronic address: ichow.hsu@ucsf.edu.
Abstract
PURPOSE: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. METHODS AND MATERIALS: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. RESULTS: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. CONCLUSIONS: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall survival continues to be limited by the high rates of distant metastasis.
PURPOSE: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. METHODS AND MATERIALS: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. RESULTS: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. CONCLUSIONS: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall survival continues to be limited by the high rates of distant metastasis.
Authors: Richard Pötter; Kari Tanderup; Christian Kirisits; Astrid de Leeuw; Kathrin Kirchheiner; Remi Nout; Li Tee Tan; Christine Haie-Meder; Umesh Mahantshetty; Barbara Segedin; Peter Hoskin; Kjersti Bruheim; Bhavana Rai; Fleur Huang; Erik Van Limbergen; Max Schmid; Nicole Nesvacil; Alina Sturdza; Lars Fokdal; Nina Boje Kibsgaard Jensen; Dietmar Georg; Marianne Assenholt; Yvette Seppenwoolde; Christel Nomden; Israel Fortin; Supriya Chopra; Uulke van der Heide; Tamara Rumpold; Jacob Christian Lindegaard; Ina Jürgenliemk-Schulz Journal: Clin Transl Radiat Oncol Date: 2018-01-11
Authors: L T Tan; K Tanderup; A Nappa; P Petric; I M Jürgenliemk-Schulz; M Serban; J V Swamidas; M Palmu; S L Duke; U Mahantshetty; N Nesvacil; R C Pötter; R A Nout Journal: Clin Transl Radiat Oncol Date: 2021-06-15