Cyrus Chargari1, Renaud Mazeron2, Alexandre Escande3, Pierre Maroun3, Isabelle Dumas3, Florent Martinetti3, Alain Tafo-Guemnie3, Eric Deutsch4, Philippe Morice5, Christine Haie-Meder3. 1. Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; Department of Surgery, Gustave Roussy, Villejuif, France. Electronic address: cyrus.chargari@gustaveroussy.fr. 2. Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France. 3. Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France. 4. INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; Radiotherapy Department, Gustave Roussy, Villejuif, France; Department of Surgery, Gustave Roussy, Villejuif, France. 5. Department of Surgery, Gustave Roussy, Villejuif, France; University Paris-Sud, SIRIC SOCRATES, Faculte de Médecine, Le Kremlin-Bicêtre, France.
Abstract
PURPOSE: Cervical cancer patients with a bulky high-risk clinical target volume (HR-CTV) get the largest benefit of dose escalation in terms of local control. However, the expected survival benefit could be lessened by a higher metastatic risk. We examined the patterns of relapse according to major prognostic factors: the HR-CTV volume and to the D90 HR-CTV. METHODS AND MATERIALS: The clinical records of patients treated with pulsed-dose-rate image-guided adaptive brachytherapy after concurrent pelvic chemoradiation were reviewed. All patients had an optimal workup before treatment comprising a 18-fluorodeoxyglucose positron emission tomography/computed tomography and a para-aortic lymph node dissection. Patients with initial extrapelvic disease were excluded. RESULTS: A total of 109 patients fulfilled inclusion criteria. Median followup was 39 months. An HR-CTV volume ≥40 cm(3) was associated with a poorer local failure-free survival. There was a strong inverse correlation between the HR-CTV volume and the D90 of the HR-CTV (correlation coefficient r = -0.696; p < 0.001) with increasing HR-CTV volume being associated with a decreasing D90 HR-CTV. A D90 HR-CTV <85 Gy and an HR-CTV volume ≥40 cm(3) were significant univariate factors for experiencing nonlocal failure (p = 0.002 and 0.035, respectively), even after exclusion of local relapses. CONCLUSION: A lower ability to reach the target D90 HR-CTV planning and an HR-CTV volume ≥ 40 cm(3) correlated with a high propensity of relapsing at distance, these factors being interrelated. Next step of treatment personalization should design strategies integrating this risk, which is now the main cause of failure.
PURPOSE:Cervical cancerpatients with a bulky high-risk clinical target volume (HR-CTV) get the largest benefit of dose escalation in terms of local control. However, the expected survival benefit could be lessened by a higher metastatic risk. We examined the patterns of relapse according to major prognostic factors: the HR-CTV volume and to the D90 HR-CTV. METHODS AND MATERIALS: The clinical records of patients treated with pulsed-dose-rate image-guided adaptive brachytherapy after concurrent pelvic chemoradiation were reviewed. All patients had an optimal workup before treatment comprising a 18-fluorodeoxyglucose positron emission tomography/computed tomography and a para-aortic lymph node dissection. Patients with initial extrapelvic disease were excluded. RESULTS: A total of 109 patients fulfilled inclusion criteria. Median followup was 39 months. An HR-CTV volume ≥40 cm(3) was associated with a poorer local failure-free survival. There was a strong inverse correlation between the HR-CTV volume and the D90 of the HR-CTV (correlation coefficient r = -0.696; p < 0.001) with increasing HR-CTV volume being associated with a decreasing D90 HR-CTV. A D90 HR-CTV <85 Gy and an HR-CTV volume ≥40 cm(3) were significant univariate factors for experiencing nonlocal failure (p = 0.002 and 0.035, respectively), even after exclusion of local relapses. CONCLUSION: A lower ability to reach the target D90 HR-CTV planning and an HR-CTV volume ≥ 40 cm(3) correlated with a high propensity of relapsing at distance, these factors being interrelated. Next step of treatment personalization should design strategies integrating this risk, which is now the main cause of failure.
Authors: Alexandre Escande; Christine Haie-Meder; Pierre Maroun; Sébastien Gouy; Renaud Mazeron; Thomas Leroy; Enrica Bentivegna; Philippe Morice; Eric Deutsch; Cyrus Chargari Journal: Oncotarget Date: 2016-11-15
Authors: Romain-David Seban; Charlotte Robert; Laurent Dercle; Randy Yeh; Ariane Dunant; Sylvain Reuze; Antoine Schernberg; Roger Sun; Fabien Mignot; Marie Terroir; Martin Schlumberger; Christine Haie-Meder; Cyrus Chargari; Eric Deutsch Journal: Oncoimmunology Date: 2019-03-06 Impact factor: 8.110