Andres Huertas1, Isabelle Dumas2, Alexandre Escande3, Eleonor Rivin Del Campo4, Tony Felefly4, Charles-Henri Canova4, Anne Tailleur4, Sebastien Gouy5, Enrica Bentivegna5, Philippe Morice5, Christine Haie-Meder4, Cyrus Chargari6, Renaud Mazeron7. 1. Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; Department of Radiation Oncology, Hôpital Européen Georges Pompidou, Paris, France. 2. Department of Medical Physics, Gustave Roussy, University of Paris Saclay, Villejuif, France. 3. Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; Department of Radiation Oncology, Centre Oscar Lambret, Lille, France. 4. Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France. 5. Department of Surgery, Gustave Roussy, University of Paris Saclay, Villejuif, France. 6. Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; Molecular Radiotherapy-UMR 1030, Gustave Roussy, Villejuif, France; French Armed Biomedical Research Institute, Bretigny sur Orge, France; Val-de-Grâce French Military Health Academy, Paris, France. Electronic address: cyrus.chargari@gustaveroussy.fr. 7. Department of Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France; Molecular Radiotherapy-UMR 1030, Gustave Roussy, Villejuif, France.
Abstract
PURPOSE: Primary vaginal cancer is a rare disease for which treatment has been modeled based on cervical cancer. We report our experience in the use of image-guided adaptive brachytherapy (IGABT) in this indication. METHODS AND MATERIALS: Patients treated for vaginal cancer with a combination of external beam radiation therapy and IGABT were identified through electronic search. The Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology recommendations for cervical cancer have been extrapolated with the definition of two clinical target volumes (CTVs) corresponding to the residual disease after external beam radiation therapy (CTVBT), assessed from clinical and imaging findings, and the so-called CTVi, comprising the CTVBT with directional margins and at least the initial disease at diagnosis. RESULTS: Twenty-seven patients were identified. MRI was used for brachytherapy guidance in 82% of the cases. An interstitial component was used in 59% of the cases. The D90 CTVBT and D90 CTVi were 73.1 ± 12.8 Gy and 66.6 ± 6.7 Gy, respectively. After a median followup of 40.1 months, nine recurrences in 8 patients were observed of which four were local. Local relapses occurred within the CTVBT. Three-year local control and disease-free rates were 82% and 65%, respectively. At 2 years, the Grade 2-4 gastrointestinal or urinary morbidity accrual rate was 9%. Twelve patients experienced late sexual morbidity, including three patients with Grade 3 stenosis. CONCLUSION: IGABT is feasible in vaginal cancer with promising outcomes. Harmonizing the definition of CTVs is required to allow comparisons between experiences and to perform multicenter studies.
PURPOSE:Primary vaginal cancer is a rare disease for which treatment has been modeled based on cervical cancer. We report our experience in the use of image-guided adaptive brachytherapy (IGABT) in this indication. METHODS AND MATERIALS: Patients treated for vaginal cancer with a combination of external beam radiation therapy and IGABT were identified through electronic search. The Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology recommendations for cervical cancer have been extrapolated with the definition of two clinical target volumes (CTVs) corresponding to the residual disease after external beam radiation therapy (CTVBT), assessed from clinical and imaging findings, and the so-called CTVi, comprising the CTVBT with directional margins and at least the initial disease at diagnosis. RESULTS: Twenty-seven patients were identified. MRI was used for brachytherapy guidance in 82% of the cases. An interstitial component was used in 59% of the cases. The D90 CTVBT and D90 CTVi were 73.1 ± 12.8 Gy and 66.6 ± 6.7 Gy, respectively. After a median followup of 40.1 months, nine recurrences in 8 patients were observed of which four were local. Local relapses occurred within the CTVBT. Three-year local control and disease-free rates were 82% and 65%, respectively. At 2 years, the Grade 2-4 gastrointestinal or urinary morbidity accrual rate was 9%. Twelve patients experienced late sexual morbidity, including three patients with Grade 3 stenosis. CONCLUSION: IGABT is feasible in vaginal cancer with promising outcomes. Harmonizing the definition of CTVs is required to allow comparisons between experiences and to perform multicenter studies.