Kenji Yoshida1, Noha Jastaniyah2, Alina Sturdza3, Jacob Lindegaard4, Barbara Segedin5, Umesh Mahantshetty6, Bhavana Rai7, Ina Jürgenliemk-Schulz8, Christine Haie-Meder9, Ryohei Sasaki10, Richard Pötter11. 1. Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; Kobe University Graduate School of Medicine, Kobe, Japan. 2. Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 3. Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria. Electronic address: alina.sturdza@akhwien.at. 4. Aarhus University Hospital, Aarhus, Denmark. 5. Institute of Oncology Ljubljana, Ljubljana, Slovenia. 6. Tata Memorial Hospital, Mumbai, India. 7. Post Graduate Institute of Medical Education and Research, Chandigarh, India. 8. University Medical Center, Utrecht, The Netherlands. 9. Institut Gustave Roussy, Paris, France. 10. Kobe University Graduate School of Medicine, Kobe, Japan. 11. Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria.
Abstract
PURPOSE: To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy. METHODS AND MATERIALS: Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters. RESULTS: A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm(3)). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm(3) vs 33.3 cm(3), P=.005). The mean high-risk clinical target volume D90 was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P<.001). CONCLUSION: Infiltrative tumors are more advanced at presentation and respond less favorably to chemo-radiotherapy when compared with expansive tumors that are more or less equivalent in size. The use of image-guided adaptive brachytherapy allows achieving reasonably high doses in both groups.
PURPOSE: To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy. METHODS AND MATERIALS: Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters. RESULTS: A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm(3)). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm(3) vs 33.3 cm(3), P=.005). The mean high-risk clinical target volume D90 was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P<.001). CONCLUSION: Infiltrative tumors are more advanced at presentation and respond less favorably to chemo-radiotherapy when compared with expansive tumors that are more or less equivalent in size. The use of image-guided adaptive brachytherapy allows achieving reasonably high doses in both groups.
Authors: Jason D Wright; Koji Matsuo; Yongmei Huang; Ana I Tergas; June Y Hou; Fady Khoury-Collado; Caryn M St Clair; Cande V Ananth; Alfred I Neugut; Dawn L Hershman Journal: Obstet Gynecol Date: 2019-07 Impact factor: 7.661
Authors: Mario Federico; Carmen Rosa Hernandez-Socorro; Ivone Ribeiro; Jesus Gonzalez Martin; Maria Dolores Rey-Baltar Oramas; Marta Lloret Saez-Bravo; Pedro Carlos Lara Jimenez Journal: Radiat Oncol Date: 2019-10-04 Impact factor: 3.481