Article Data

  • Views 729
  • Dowloads 125

Original Research

Open Access

3D image guided adaptive brachytherapy in patients with locally advanced cervical cancer: experience and clinical results from a minimum of six years of follow-up

  • Marit Sundset1,*,
  • Anne Dybdahl Wanderås2
  • Signe Danielsen2,3
  • Mirjam Delange Alsaker2
  • Bjørn Hagen1
  • Anne Beate Langeland Marthinsen2,3

1Department of Obstetrics and Gynecology, Section of Gynecological Oncology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway

2Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway

3Department of Physics, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway

DOI: 10.31083/j.ejgo.2021.01.2189 Vol.42,Issue 1,February 2021 pp.73-80

Submitted: 07 July 2020 Accepted: 31 August 2020

Published: 15 February 2021

*Corresponding Author(s): Marit Sundset E-mail: Marit.Sundset@stolav.no

Abstract

In 2005, individualized 3D image guided brachytherapy was implemented for cervical cancer patients, in accordance with the (GYN) GEC ESTRO recommendation, at St. Olavs Hospital, Trondheim, Norway. This study reports the clinical results of sixty-five consecutive patients treated from 2005 to 2010. The patients were treated with curative intent using external beam radiotherapy, brachytherapy and cisplatin. Results of this treatment are presented, including Kaplan-Meier estimates for overall survival (OS) and cancer specific survival (CSS), as well as biological effective dose normalized to equivalent 2 Gy fractions to tumor, defined as high-risk clinical target volume (CTVH⁢R), and to organs at risk (OARs, here bladder and rectum). Morbidity was prospectively assessed and scored in accordance with the CTCAE 3.0. 92% of the patients achieved treatment response. Local control (LC) remained in all but one patient during follow-up. Five-year OS and CSS were 71% and 80%, respectively. The mean minimum dose to CTVHR for all patients was 80.2 ± 7.3 Gy; 16% and 23% of the patients developed bladder and GI symptoms respectively. 14% of all symptoms were categorized as serious (CTCAE score 3). A dose-effect relationship was observed for adverse effects of the bladder, and the findings support the more recently recommended lower total dose limit for this OAR.


Keywords

Cervical cancer; Radiotherapy; Brachytherapy; Follow-up


Cite and Share

Marit Sundset,Anne Dybdahl Wanderås,Signe Danielsen,Mirjam Delange Alsaker,Bjørn Hagen,Anne Beate Langeland Marthinsen. 3D image guided adaptive brachytherapy in patients with locally advanced cervical cancer: experience and clinical results from a minimum of six years of follow-up. European Journal of Gynaecological Oncology. 2021. 42(1);73-80.

References

[1] Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: individual patient data meta-analysis. Cochrane Database of Systematic Reviews. 2010; 2010: CD008285.

[2] Gerbaulet A, Pötter R, Haie-Meder C. Cervix cancer. In: Gerbaulet A, Pötter R, Mazeron JJ, Meertens H, Van Limbergen E.(eds.) The GEC ESTRO handbook of brachytherapy (pp. 301-363). Brussels: ESTRO. 2002.

[3] Grover S, Harkenrider MM, Cho LP, Erickson B, Small C, Small W, et al. Image guided cervical brachytherapy: 2014 survey of the American brachytherapy society. International Journal of Radiation Oncology Biology Physics. 2016; 94: 598-604.

[4] Dimopoulos JCA, Petrow P, Tanderup K, Petric P, Berger D, Kirisits C, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiotherapy and Oncology. 2012; 103: 113-122.

[5] Haie-Meder C, Pötter R, Van Limbergen E, Briot E, De Braban-dere M, Dimopoulos J, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiotherapy and Oncology. 2005; 74: 235-245.

[6] Hellebust TP, Kirisits C, Berger D, Pérez-Calatayud J, De Brabandere M, De Leeuw A, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radio-therapy and Oncology. 2010; 96: 153-160.

[7] Pötter R, Haie-Meder C, Limbergen EV, Barillot I, Brabandere MD, Dimopoulos J, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiotherapy and Oncology. 2006; 78: 67-77.

[8] Lorenz E, Strickert T, Hagen B. Radiation therapy in cervical carcinoma: fifteen years experience in a Norwegian health region. European Journal of Gynaecological Oncology. 2009; 30: 20-24.

[9] Wanderås AD, Sundset M, Langdal I, Danielsen S, Frykholm G, Marthinsen ABL. Adaptive brachytherapy of cervical cancer, comparison of conventional point a and CT based individual treatment planning. Acta Oncologica. 2012; 51: 345-354.

[10] Pötter R, Tanderup K, Kirisits C, de Leeuw A, Kirchheiner K, Nout R, et al. The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clinical and Translational Radiation Oncology. 2018; 9: 48-60.

[11] Sturdza A, Pötter R, Fokdal LU, Haie-Meder C, Tan LT, Maze-ron R, et al. Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in RetroEM-BRACE, a multicenter cohort study. Radiotherapy and Oncology. 2016; 120: 428-433.

[12] Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E, et al. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiotherapy and Oncology. 2016; 120: 441-446.

[13] Georg P, Pötter R, Georg D, Lang S, Dimopoulos JCA, Sturdza AE, et al. Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy. International Journal of Radiation Oncology Biology Physics. 2012; 82: 653-657.

[14] Trifiletti DM, Tyler Watkins W, Duska L, Libby BB, Showalter TN. Severe gastrointestinal complications in the era of image-guided high-dose-rate intracavitary brachytherapy for cervical cancer. Clinical Therapeutics. 2015; 37: 49-60.

[15] Mazeron R, Fokdal LU, Kirchheiner K, Georg P, Jastaniyah N, Šegedin B, et al. Dose-volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: results from the prospective multicenter EMBRACE study. Radiotherapy and Oncology. 2016; 120: 412-419.

[16] Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A, et al. Use of normal tissue complication probability models in the clinic. International Journal of Radiation Oncology Biology Physics. 2010; 76: S10-S19.

[17] Ramlov A, Kroon PS, Jürgenliemk-Schulz IM, De Leeuw AAC, Gormsen LC, Fokdal LU, et al. Impact of radiation dose and standardized uptake value of (18) FDG PET on nodal control in locally advanced cervical cancer. Acta Oncologica. 2015; 54: 1567-1573.

[18] Kirchheiner K, Nout RA, Tanderup K, Lindegaard JC, Westerveld H, Haie-Meder C, et al. Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo) therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. International Journal of Radiation Oncology Biology Physics. 2014; 89: 88-95.

[19] Nomden CN, de Leeuw AAC, Moerland MA, Roesink JM, Tersteeg RJHA, Jürgenliemk-Schulz IM. Clinical use of the utrecht applicator for combined intracavitary/interstitial brachytherapy treatment in locally advanced cervical cancer. International Journal of Radiation Oncology Biology Physics. 2012; 82: 1424-1430.

[20] Pötter R, Georg P, Dimopoulos JCA, Grimm M, Berger D, Nesvacil N, et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiotherapy and Oncology. 2011; 100: 116- 123.

[21] Klopp AH, Yeung AR, Deshmukh S, Gil KM, Wenzel L, Westin SN, et al. Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG oncology-RTOG 1203. Jour-nal of Clinical Oncology. 2018; 36: 2538-2544.

[22] Viani GA, Viana BS, Martin JEC, Rossi BT, Zuliani G, Stefano EJ. Intensity-modulated radiotherapy reduces toxicity with similar biochemical control compared with 3-dimensional conformal radiotherapy for prostate cancer: a randomized clinical trial. Cancer. 2016; 122: 2004-2011.

[23] van de Schoot AJAJ, de Boer P, Visser J, Stalpers LJA, Rasch CRN, Bel A. Dosimetric advantages of a clinical daily adaptive plan selection strategy compared with a non-adaptive strategy in cervical cancer radiation therapy. Acta Oncologica. 2017; 56: 667-674.



Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top