Vienna-II ring applicator for distal parametrial/pelvic wall disease in cervical cancer brachytherapy: An experience from two institutions: Clinical feasibility and outcome.

Autor: Mahantshetty U; Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India. Electronic address: mahantshettyum@tmc.gov.in., Sturdza A; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria. Electronic address: alina.strudza@meduniwien.ac.at., Naga Ch P; Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India., Berger D; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria., Fortin I; Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Montréal, Canada., Motisi L; Department of Radiation Oncology, University of Lübeck, Lübeck, Germany., Schmid MP; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria., Aravindakshan D; Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India., Ghadi Y; Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India., Swamidas JV; Department of Radiation Oncology & Medical Physics, ACTREC, Tata Memorial Centre, HBNI, Mumbai, India., Chopra S; Department of Radiation Oncology & Medical Physics, ACTREC, Tata Memorial Centre, HBNI, Mumbai, India., Gurram L; Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India., Nesvacil N; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria., Kirisits C; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria., Pötter R; Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna (MUV), Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2019 Dec; Vol. 141, pp. 123-129. Date of Electronic Publication: 2019 Sep 05.
DOI: 10.1016/j.radonc.2019.08.004
Abstrakt: Purpose: Recent evidence from EMBRACE shows that around 16% patients with locally advanced cervical cancer (LACC) have residual tumor in distal parametrium (DP) and pelvic wall disease (LPW) after concurrent radio-chemotherapy (CCRT). Adequate target coverage with standard brachytherapy approaches represents a challenge. Therefore, we modified the Vienna I applicator with an add-on cap allowing for additional oblique needles into the DP/LPW (Vienna II). We report here the feasibility and clinical outcomes using Vienna II applicator in LACC patients treated in 2 institutions.
Methods and Materials: 69 patients with residual disease in DP/LPW after CCRT were accrued. FIGO (2009) stage was 26% IIB, 52% III, 15% IVA, 7% IVB (para-aortic nodes). At diagnosis 91% had disease involving DP/LPW. After CCRT, patients underwent image guided adaptive brachytherapy (IGABT) using Vienna II applicator. IGABT details, acute complications, dose volume parameters and clinical outcome variables were compiled and analyzed.
Results: Residual DP/LPW disease at BT was found in 90% patients. Median total number of needles were 7 [3-15], oblique 4 [1-7]. Manageable intraoperative utero-vaginal complications occurred in 8 patients and manageable arterial bleeding in 6 patients during removal. Mean distance between tandem and outer contour of CTV HR was 38 mm and mean CTV HR (±SD) volume was 69 ± 32 cm 3 . The mean D 90 CTV HR was 86 ± 7 Gy (EQD2) and mean (±SD) D 2cm 3 (Gy, EQD2) 86 ± 12, 68 ± 7, 68 ± 9 for bladder, rectum and sigmoid respectively. Actuarial LC, PFS, OS at 3/5 years was 76/72%, 56/50%, 62/54% and G3-4 late toxicities (n = 23) were observed in 14 patients (20%).
Conclusions: IGABT using Vienna II applicator allows for appropriate target coverage in tumors extending into DP/LPW at the time of BT. Clinical use is feasible and results in good local control, DFS and OS with moderate rate of acute and late ≥G3 toxicity.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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