High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes.
Clin Transl Radiat Oncol
; 32: 15-23, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-34816022
ABSTRACT
PURPOSE:
Brachytherapy (BT) boost after radio-chemotherapy (RCT) is a standard of care in the management of locally advanced cervical cancer (LACC). As there is no consensus on high-dose-rate (HDR) BT fractionation schemes, our aim was to report the oncological outcome and toxicity profile of four different schemes using twice-a-day (BID) HDR-BT. PATIENTS ANDMETHODS:
This was an observational, retrospective, single institution study for patients with LACC receiving a HDR-BT boost. The latter was performed with a single implant and single imaging done on day 1. The different fractionation schemes were 7 Gy + 4x3.5 Gy (group 1); 7 Gy + 4x4.5 Gy (group 2); 3x7Gy (group 3) and 3x8Gy (group 4). Local (LFS), nodal (NFS) and metastatic (MFS) recurrence-free survival as well as progression-free survival (PFS) and overall survival (OS) were analyzed. Acute (≤6 months) and late toxicities (>6 months) were reported.RESULTS:
From 2007 to 2018, 191 patients were included. Median follow-up was 57 months [45-132] and median EQD210D90CTVHR was 84, 82 and 90 Gy for groups 2, 3 and 4 respectively (dosimetric data missing for group 1). The 5-year LFS, NFS, MFS, PFS and OS were 85% [81-90], 83% [79-86], 70% [67-73], 61% [57-64] and 75% [69-78] respectively, with no significant difference between the groups. EQD210D90CTVHR < 85 Gy was a prognostic factor for local recurrence in univariate analysis (p = 0.045). The rates of acute/late grade ≥ 2 urinary, digestive and gynecological toxicities were 9%/15%, 3%/15% and 9%/25% respectively.CONCLUSION:
Bi-fractionated HDR-BT boost seems feasible with good oncological outcome and slightly more toxicity after dose escalation.
BED, biologically effective dose; BID, twice-a-day; BMI, body-mass index; BT, brachytherapy; Brachytherapy; CT, computerized tomography; CTCAE, common terminology criteria for adverse events; CTV, clinical target volume; Cervical cancer; EBRT, external beam radiotherapy; EMBRACE, image guided intensity modulated External beam radiochemotherapy and MRI based Adaptative BRAchytherapy in locally advanced CErvical cancer; EQD2Gy, equivalent dose at 2 Gy; ESTRO, European Society for Radiotherapy and Oncology; FIGO, International Federation of Gynecology and Obstetrics; Fractionation scheme; GEC, groupe européen de curiethérapie; GTV, gross tumor volume; HDR, high-dose-rate; HIV, human immunodeficiency virus; HR, high-risk; High-dose-rate; ICRU, International Commission on Radiation Units and measurements; IGABT, image-guided adaptative brachytherapy; IMRT, intensity modulated radiotherapy; IR, intermediate-risk; LACC, locally advanced cervical cancer; LDR, low-dose-rate; LFS, local recurrence-free survival; LQ, linear quadratic; MFS, metastatic recurrence-free survival; MFU, median follow up; MRI, magnetic resonance imaging; NA, not available; NCI, national cancer institute; NFS, nodal recurrence-free survival; OAR, organs at risk; OS, overall survival; OTT, overall treatment time; PDR, pulsed-dose-rate; PET, positron emission tomography; PFS, progression-free survival; PTV, planning target volume; RCT, radio-chemotherapy; SCC, squamous cell cancer; SEER, surveillance, epidemiology and end results; pt, patient; pts, patients
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Prognostic_studies
Idioma:
En
Revista:
Clin Transl Radiat Oncol
Año:
2022
Tipo del documento:
Article
País de afiliación:
Francia