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1.
J Natl Compr Canc Netw ; 22(2): 117-135, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38503056

RESUMO

Vulvar cancer is annually diagnosed in an estimated 6,470 individuals and the vast majority are histologically squamous cell carcinomas. Vulvar cancer accounts for 5% to 8% of gynecologic malignancies. Known risk factors for vulvar cancer include increasing age, infection with human papillomavirus, cigarette smoking, inflammatory conditions affecting the vulva, and immunodeficiency. Most vulvar neoplasias are diagnosed at early stages. Rarer histologies exist and include melanoma, extramammary Paget's disease, Bartholin gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma, and sarcoma. This manuscript discusses recommendations outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treatments, surveillance, systemic therapy options, and gynecologic survivorship.


Assuntos
Neoplasias Vulvares , Feminino , Humanos , Adenocarcinoma/patologia , Neoplasias dos Genitais Femininos , Doença de Paget Extramamária/diagnóstico , Doença de Paget Extramamária/etiologia , Doença de Paget Extramamária/terapia , Neoplasias Cutâneas , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/etiologia
2.
J Natl Compr Canc Netw ; 21(12): 1224-1233, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-38081139

RESUMO

The NCCN Guidelines for Cervical Cancer provide recommendations for all aspects of management for cervical cancer, including the diagnostic workup, staging, pathology, and treatment. The guidelines also include details on histopathologic classification of cervical cancer regarding diagnostic features, molecular profiles, and clinical outcomes. The treatment landscape of advanced cervical cancer is evolving constantly. These NCCN Guidelines Insights provide a summary of recent updates regarding the systemic therapy recommendations for recurrent or metastatic disease.


Assuntos
Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Neoplasias do Colo do Útero/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
4.
Gynecol Oncol ; 158(2): 244-253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32563593

RESUMO

OBJECTIVE: To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. METHODS: An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. RESULTS: Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. CONCLUSIONS: The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/virologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Radioterapia (Especialidade)/métodos , Radioterapia (Especialidade)/normas , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2
5.
Gynecol Oncol ; 158(2): 460-466, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32475772

RESUMO

OBJECTIVE: Uterine carcinosarcomas (UCS) represent a rare but aggressive subset of endometrial cancers, comprising <5% of uterine malignancies. To date, limited prospective trials exist from which evidence-based management of this rare malignancy can be developed. METHODS: The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines developed by a multidisciplinary expert panel for management of women with UCS. An extensive analysis of current medical literature from peer-reviewed journals was performed. A well-established methodology (modified Delphi) was used to rate the appropriate use of imaging and treatment procedures for the management of UCS. These guidelines are intended for the use of all practitioners who desire information about the management of UCS. RESULTS: The majority of patients with UCS will present with advanced extra uterine disease, with 10% presenting with metastatic disease. They have worse survival outcomes when compared to uterine high-grade endometrioid adenocarcinomas. The primary treatment for non-metastatic UCS is complete surgical staging with total hysterectomy, salpingo-oophorectomy and lymph node staging. Patients with UCS appear to benefit from adjuvant multimodality therapy to reduce the chance of tumor recurrence with the potential to improve overall survival. CONCLUSION: Women diagnosed with uterine UCS should undergo complete surgical staging. Adjuvant multimodality therapies should be considered in the treatment of both early- and advanced stage patients. Long-term surveillance is indicated as many of these women may recur. Prospective clinical studies of women with UCS are necessary for optimal management.


Assuntos
Carcinossarcoma/diagnóstico , Carcinossarcoma/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Quimioterapia Adjuvante , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
J Natl Compr Canc Netw ; 18(6): 660-666, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502976

RESUMO

The NCCN Guidelines for Cervical Cancer provide recommendations for diagnostic workup, staging, and treatment of patients with the disease. These NCCN Guidelines Insights focus on recent updates to the guidelines, including changes to first- and second-line systemic therapy recommendations for patients with recurrent or metastatic disease, and emerging evidence on a new histopathologic classification system for HPV-related endocervical adenocarcinoma.


Assuntos
Neoplasias do Colo do Útero , Feminino , Guias como Assunto , Humanos
7.
J Natl Compr Canc Netw ; 17(1): 64-84, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30659131

RESUMO

Cervical cancer is a malignant epithelial tumor that forms in the uterine cervix. Most cases of cervical cancer are preventable through human papilloma virus (HPV) vaccination, routine screening, and treatment of precancerous lesions. However, due to inadequate screening protocols in many regions of the world, cervical cancer remains the fourth-most common cancer in women globally. The complete NCCN Guidelines for Cervical Cancer provide recommendations for the diagnosis, evaluation, and treatment of cervical cancer. This manuscript discusses guiding principles for the workup, staging, and treatment of early stage and locally advanced cervical cancer, as well as evidence for these recommendations. For recommendations regarding treatment of recurrent or metastatic disease, please see the full guidelines on NCCN.org.


Assuntos
Oncologia/normas , Infecções por Papillomavirus/terapia , Neoplasias do Colo do Útero/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia/métodos , Braquiterapia/normas , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Colo do Útero/virologia , Quimiorradioterapia Adjuvante/normas , Feminino , Preservação da Fertilidade/métodos , Preservação da Fertilidade/normas , Humanos , Histerectomia/normas , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Oncologia/métodos , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/normas , Teste de Papanicolaou/normas , Papillomaviridae/isolamento & purificação , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Sociedades Médicas/normas , Estados Unidos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
8.
J Natl Compr Canc Netw ; 17(11): 1374-1391, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31693991

RESUMO

Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.


Assuntos
Doença Trofoblástica Gestacional , Feminino , Humanos , Gravidez , Oncologia
9.
J Appl Clin Med Phys ; 20(7): 58-67, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31183967

RESUMO

PURPOSE: To investigate the plan quality and doses to the heart, contralateral breast (CB), ipsilateral lung (IL), and contralateral lung (CL) in tangential breast treatments using the Halcyon linac with megavoltage setup fields. METHODS: Radiotherapy treatment plans with tangential beams from 25 breast cancer patients previously treated on a C-arm linac were replanned for Halcyon. Thirteen corresponded to right-sided breasts and 12 to left-sided breasts, all with a dose prescription of 50 Gy in 25 fractions. Plans were created with the following setup imaging techniques: low-dose (LD) MVCBCT, high-quality (HQ) MVCBCT, LD-MV and HQ-MV pairs and the imaging dose was included in the plans. Plan quality metric values for the lumpectomy cavity, whole-breast and doses to the organs at risk (OARs) were measured and compared with those from the original plans. RESULTS: No significant differences in plan quality were observed between the original and Halcyon plans. An increase in the mean dose (Mean) for all the organs was observed for the Halcyon plans. For right-sided plans, the accumulated Mean over the 25 fractions in the C-arm plans was 0.4 ± 0.3, 0.2 ± 0.2, 5.4 ± 1.3, and 0.1 ± 0.1 Gy for the heart, CB, IL, and CL, respectively, while values in the MVCBCT-LD Halcyon plans were 1.2 ± 0.2, 0.6 ± 0.1, 6.5 ± 1.4, and 0.4 ± 0.1 Gy, respectively. For left-sided treatments, Mean in the original plans was 0.9 ± 0.2, 0.1 ± 0.0, 4.2 ± 1.2, and 0.0 ± 0.0 Gy, while for the MVCBCT-LD Halcyon plans values were 1.9 ± 0.2, 0.6 ± 0.2, 5.1 ± 1.2, and 0.5 ± 0.2 Gy, respectively. CONCLUSIONS: Plan quality for breast treatments using Halcyon is similar to the quality for a 6 MV, C-arm plan. For treatments using megavoltage setup fields, the dose contribution to OARs from the imaging fields can be equal or higher than the dose from treatment fields.


Assuntos
Neoplasias da Mama/radioterapia , Coração/efeitos da radiação , Pulmão/efeitos da radiação , Mastectomia Segmentar/métodos , Órgãos em Risco/efeitos da radiação , Aceleradores de Partículas/instrumentação , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Prognóstico , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos
10.
J Natl Compr Canc Netw ; 16(2): 170-199, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29439178

RESUMO

Endometrial carcinoma is a malignant epithelial tumor that forms in the inner lining, or endometrium, of the uterus. Endometrial carcinoma is the most common gynecologic malignancy. Approximately two-thirds of endometrial carcinoma cases are diagnosed with disease confined to the uterus. The complete NCCN Guidelines for Uterine Neoplasms provide recommendations for the diagnosis, evaluation, and treatment of endometrial cancer and uterine sarcoma. This manuscript discusses guiding principles for the diagnosis, staging, and treatment of early-stage endometrial carcinoma as well as evidence for these recommendations.


Assuntos
Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Feminino , Humanos , Neoplasias Uterinas/etiologia
11.
J Natl Compr Canc Netw ; 15(1): 92-120, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28040721

RESUMO

Vulvar cancer is a rare gynecologic malignancy. Ninety percent of vulvar cancers are predominantly squamous cell carcinomas (SCCs), which can arise through human papilloma virus (HPV)-dependent and HPV-independent pathways. The NCCN Vulvar Cancer panel is an interdisciplinary group of representatives from NCCN Member Institutions consisting of specialists in gynecological oncology, medical oncology, radiation oncology, and pathology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vulvar Cancer provide an evidence- and consensus-based approach for the management of patients with vulvar SCC. This manuscript discusses the recommendations outlined in the NCCN Guidelines for diagnosis, staging, treatment, and follow-up.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Recidiva Local de Neoplasia/diagnóstico , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/terapia , Antineoplásicos/uso terapêutico , Biópsia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia , Feminino , Humanos , Oncologia/normas , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Radioterapia Adjuvante , Fatores de Risco , Taxa de Sobrevida , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologia
12.
Oncology (Williston Park) ; 30(9): 816-22, 2016 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27633412

RESUMO

These consensus guidelines on adjuvant radiotherapy for early-stage endometrial cancer were developed from an expert panel convened by the American College of Radiology. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method; and Grading of Recommendations Assessment, Development, and Evaluation, or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. After a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia/normas , Neoplasias do Endométrio/terapia , Oncologia/normas , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Braquiterapia/efeitos adversos , Braquiterapia/mortalidade , Quimioterapia Adjuvante/normas , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Medicina Baseada em Evidências/normas , Feminino , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Excisão de Linfonodo/normas , Gradação de Tumores , Estadiamento de Neoplasias , Doses de Radiação , Radioterapia (Especialidade)/normas , Radioterapia Adjuvante/normas , Fatores de Risco , Terapia de Salvação/normas , Oncologia Cirúrgica/normas , Resultado do Tratamento
13.
J Natl Compr Canc Netw ; 13(11): 1321-31, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26553763

RESUMO

The NCCN Guidelines for Uterine Neoplasms provide interdisciplinary recommendations for treating endometrial carcinoma and uterine sarcomas. These NCCN Guidelines Insights summarize the NCCN Uterine Neoplasms Panel's 2016 discussions and major guideline updates for treating uterine sarcomas. During this most recent update, the panel updated the mesenchymal tumor classification to correspond with recent updates to the WHO tumor classification system. Additionally, the panel revised its systemic therapy recommendations to reflect new data and collective clinical experience. These NCCN Guidelines Insights elaborate on the rationale behind these recent changes.


Assuntos
Sarcoma/diagnóstico , Sarcoma/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Feminino , Humanos , Gradação de Tumores , Prognóstico , Sarcoma/etiologia , Sarcoma/mortalidade , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/mortalidade
14.
J Natl Compr Canc Netw ; 13(4): 395-404; quiz 404, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25870376

RESUMO

The NCCN Guidelines for Cervical Cancer provide interdisciplinary recommendations for treating cervical cancer. These NCCN Guidelines Insights summarize the NCCN Cervical Cancer Panel's discussion and major guideline updates from 2014 and 2015. The recommended systemic therapy options for recurrent and metastatic cervical cancer were amended upon panel review of new survival data and the FDA's approval of bevacizumab for treating late-stage cervical cancer. This article outlines relevant data and provides insight into panel decisions regarding various combination regimens. Additionally, a new section was added to provide additional guidance on key principles of evaluation and surgical staging in cervical cancer. This article highlights 2 areas of active investigation and debate from this new section: sentinel lymph node mapping and fertility-sparing treatment approaches.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Guias de Prática Clínica como Assunto , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Feminino , Preservação da Fertilidade , Humanos , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/cirurgia
15.
Oncology (Williston Park) ; 29(11): 867-72, 874-5, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26568534

RESUMO

These American College of Radiology consensus guidelines were formed from an expert panel on the appropriate use of adjuvant therapy in vulvar cancer after primary treatment with surgery. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel reviewed the pertinent literature in vulvar cancer and voted on three variants to establish appropriate use of imaging, adjuvant radiation, including dose, fields, and technique, as well as adjuvant chemotherapy. This report will aid clinicians in selecting appropriate patients for adjuvant treatment and will provide guidelines for the optimal delivery of adjuvant radiation therapy and chemotherapy.


Assuntos
Neoplasias Vulvares/radioterapia , Idoso , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto , Dosagem Radioterapêutica , Radioterapia Adjuvante , Biópsia de Linfonodo Sentinela , Neoplasias Vulvares/patologia
16.
Semin Radiat Oncol ; 34(4): 474-476, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39271283

RESUMO

Data demonstrates that hypofractionation is increasingly utilized based on evidence-based guidelines. The outdated Medicare fee-for-service approach penalizes radiation oncology (RO) practices from adopting hypofractionation, even as many patients benefit. To address the flawed fee-for-service payment system, which rewards volume over value, ASTRO introduced the Radiation Oncology Case Rate (ROCR) Value-Based Payment Program. ROCR shifts payment for RO services from fee-for-service to payment per patient or per episode. To address disparities, ROCR provides an evidence-based approach through the Health Equity Achievement in Radiation Therapy (HEART) initiative, providing transportation assistance payment for the underserved. Additionally, ROCR allows practices sufficient capital to maintain existing equipment and invest in new technology. This increases patient access to technological advancements allowing for more efficient, targeted, and personalized care with improved patient outcomes at a lower overall cost.


Assuntos
Planos de Pagamento por Serviço Prestado , Medicare , Radioterapia (Especialidade) , Radioterapia (Especialidade)/economia , Humanos , Estados Unidos , Planos de Pagamento por Serviço Prestado/economia , Medicare/economia , Neoplasias/radioterapia , Neoplasias/economia , Hipofracionamento da Dose de Radiação , Mecanismo de Reembolso
17.
Med Phys ; 51(7): 4591-4606, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38814165

RESUMO

BACKGROUND: 3D neural network dose predictions are useful for automating brachytherapy (BT) treatment planning for cervical cancer. Cervical BT can be delivered with numerous applicators, which necessitates developing models that generalize to multiple applicator types. The variability and scarcity of data for any given applicator type poses challenges for deep learning. PURPOSE: The goal of this work was to compare three methods of neural network training-a single model trained on all applicator data, fine-tuning the combined model to each applicator, and individual (IDV) applicator models-to determine the optimal method for dose prediction. METHODS: Models were produced for four applicator types-tandem-and-ovoid (T&O), T&O with 1-7 needles (T&ON), tandem-and-ring (T&R) and T&R with 1-4 needles (T&RN). First, the combined model was trained on 859 treatment plans from 266 cervical cancer patients treated from 2010 onwards. The train/validation/test split was 70%/16%/14%, with approximately 49%/10%/19%/22% T&O/T&ON/T&R/T&RN in each dataset. Inputs included four channels for anatomical masks (high-risk clinical target volume [HRCTV], bladder, rectum, and sigmoid), a mask indicating dwell position locations, and applicator channels for each applicator component. Applicator channels were created by mapping the 3D dose for a single dwell position to each dwell position and summing over each applicator component with uniform dwell time weighting. A 3D Cascade U-Net, which consists of two U-Nets in sequence, and mean squared error loss function were used. The combined model was then fine-tuned to produce four applicator-specific models by freezing the first U-Net and encoding layers of the second and resuming training on applicator-specific data. Finally, four IDV models were trained using only data from each applicator type. Performance of these three model types was compared using the following metrics for the test set: mean error (ME, representing model bias) and mean absolute error (MAE) over all dose voxels and ME of clinical metrics (HRCTV D90% and D2cc of bladder, rectum, and sigmoid), averaged over all patients. A positive ME indicates the clinical dose was higher than predicted. 3D global gamma analysis with the prescription dose as reference value was performed. Dice similarity coefficients (DSC) were computed for each isodose volume. RESULTS: Fine-tuned and combined models showed better performance than IDV applicator training. Fine-tuning resulted in modest improvements in about half the metrics, compared to the combined model, while the remainder were mostly unchanged. Fine-tuned MAE = 3.98%/2.69%/5.36%/3.80% for T&O/T&R/T&ON/T&RN, and ME over all voxels = -0.08%/-0.89%/-0.59%/1.42%. ME D2cc were bladder = -0.77%/1.00%/-0.66%/-1.53%, rectum = 1.11%/-0.22%/-0.29%/-3.37%, sigmoid = -0.47%/-0.06%/-2.37%/-1.40%, and ME D90 = 2.6%/-4.4%/4.8%/0.0%. Gamma pass rates (3%/3 mm) were 86%/91%/83%/89%. Mean DSCs were 0.92%/0.92%/0.88%/0.91% for isodoses ≤ 150% of prescription. CONCLUSIONS: 3D BT dose was accurately predicted for all applicator types, as indicated by the low MAE and MEs, high gamma scores and high DSCs. Training on all treatment data overcomes challenges with data scarcity in each applicator type, resulting in superior performance than can be achieved by training on IDV applicators alone. This could presumably be explained by the fact that the larger, more diverse dataset allows the neural network to learn underlying trends and characteristics in dose that are common to all treatment applicators. Accurate, applicator-specific dose predictions could enable automated, knowledge-based planning for any cervical brachytherapy treatment.


Assuntos
Braquiterapia , Redes Neurais de Computação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Neoplasias do Colo do Útero , Braquiterapia/instrumentação , Braquiterapia/métodos , Humanos , Neoplasias do Colo do Útero/radioterapia , Feminino , Planejamento da Radioterapia Assistida por Computador/métodos , Doses de Radiação
18.
Int J Radiat Oncol Biol Phys ; 119(3): 878-883, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38151190

RESUMO

PURPOSE/OBJECTIVE(S): NIBB has potential advantages over other APBI techniques by delivering highly conformal radiation with minimal collateral dose to the heart and lung compared with external beam techniques, but unlike other brachytherapy techniques NIBB is non-invasive. Previous data has shown encouraging outcomes using a 10-fraction regimen. To improve efficiency, convenience, and cost, reduction in the fraction number is desirable. Final results of a prospective phase II trial are reported. MATERIALS/METHODS: NIBB APBI was delivered using 28.5Gy in 5 fractions daily over 1 week. Patient eligibility criteria required: invasive carcinoma ≤2.0 cm or DCIS ≤3.0 cm, ER positive (if invasive), lymph node negative, LVI absent, and lumpectomy with margins negative by 2mm. The primary endpoint was grade ≥ 2 subcutaneous fibrosis/induration <30%. Secondary endpoints included any late toxicity, cosmetic outcome, and local control. RESULTS: 40 patients were treated with a median follow-up of 59.7 months. The mean age was 67 years (50-89 years) and tumor size was 1.0cm (0.3-2.0cm). 80% had invasive carcinoma. The mean breast separation with compression was 6.7cm (3.5-8.9cm). The 5-year actuarial local control was 96.6% and overall survival was 96.9%. Grade 2 and 3 late toxicities were 15% and 0%, respectively. The rate of grade 2 subcutaneous fibrosis/induration was 2.5% (+/-2.5%) meeting the study's primary endpoint. The most common late toxicity of any grade was skin telangiectasia; 22.5% grade 1 and 15% grade 2. Only breast separation was associated with telangiectasia risk, p=0.002. Overall cosmetic outcome was excellent, good, and fair/poor in 75%, 25%, and 0%, respectively. CONCLUSIONS: NIBB APBI delivered in 5 fractions results in a low rate of late toxicity and a high rate of good/excellent cosmetic outcomes. Telangiectasia risk can be minimized by keeping breast separation ≤7.0cm. The local failure rate was appropriately low. Further investigation of this technique is warranted.


Assuntos
Braquiterapia , Neoplasias da Mama , Fracionamento da Dose de Radiação , Radioterapia Guiada por Imagem , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Braquiterapia/métodos , Braquiterapia/efeitos adversos , Idoso de 80 Anos ou mais , Neoplasias da Mama/radioterapia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Estudos Prospectivos , Radioterapia Guiada por Imagem/métodos , Fibrose , Carga Tumoral , Resultado do Tratamento
19.
J Am Coll Radiol ; 21(6S): S79-S99, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38823957

RESUMO

Asymptomatic adnexal masses are commonly encountered in daily radiology practice. Although the vast majority of these masses are benign, a small subset have a risk of malignancy, which require gynecologic oncology referral for best treatment outcomes. Ultrasound, using a combination of both transabdominal, transvaginal, and duplex Doppler technique can accurately characterize the majority of these lesions. MRI with and without contrast is a useful complementary modality that can help characterize indeterminate lesions and assess the risk of malignancy is those that are suspicious. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Doenças dos Anexos , Medicina Baseada em Evidências , Sociedades Médicas , Humanos , Doenças dos Anexos/diagnóstico por imagem , Feminino , Estados Unidos , Diagnóstico Diferencial
20.
Oncology (Williston Park) ; 27(11): 1166-73, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24575547

RESUMO

Due to its rarity, treatment guidelines for vaginal cancer are extrapolated from institutional reports and prospective studies of cervical and anal cancer. An expert panel was convened to reach consensus on the selection of imaging and therapeutic modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by the panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Four variants were developed to represent clinical scenarios in vaginal cancer management. Group members reached consensus on the appropriateness of the pretreatment evaluation and therapeutic interventions. This article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.


Assuntos
Neoplasias Vaginais/terapia , Braquiterapia , Quimiorradioterapia , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Vaginais/mortalidade , Neoplasias Vaginais/patologia
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