Time to loading and locoregional control in perioperative high-dose-rate brachytherapy: The tumor bed effect revisited
| Autor: | Germán Valtueña, Marta Santisteban, L. Arbea, Luis Naval-Gías, Matías Jurado, Mikel San-Julian, Juan Alcalde, Mauricio Cambeiro, Alicia Olarte, Luis Isaac Ramos, Rafael Martínez-Monge |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Neoplasm Residual Time Factors medicine.medical_treatment Brachytherapy Subgroup analysis Neoplasms Tumor Microenvironment medicine Humans Radiology Nuclear Medicine and imaging Tumor bed Prospective Studies Treatment Failure Prospective cohort study business.industry Rate control Perioperative High-Dose Rate Brachytherapy Surgery Catheter Oncology Female Radiotherapy Adjuvant Dose Fractionation Radiation Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | Brachytherapy. 14:565-570 |
| ISSN: | 1538-4721 |
| DOI: | 10.1016/j.brachy.2015.01.006 |
| Popis: | Purpose To determine whether the time to loading (TTL) affects locoregional control. Methods and Materials Locoregional control status was determined in 301 patients enrolled in several perioperative high-dose-rate brachytherapy (PHDRB) prospective studies conducted at the University of Navarre. The impact of the time elapsed from catheter implantation to the first PHDRB treatment (TTL) was analyzed. Patients treated with PHDRB alone (n = 113), mainly because of prior irradiation, received 32 Gy in eight twice-a-day treatments or 40 Gy in 10 twice-a-day treatments for negative or close/positive margins, respectively. Patients treated with PHDRB + external beam radiation therapy (EBRT) (n = 188) received 16 Gy in four twice-a-day treatments or 24 Gy in six twice-a-day treatments for negative or close/positive margins followed by 45 Gy of EBRT in 25 treatments. Results After a median followup of 6.5 years (range, 2–13.6+), 113 patients have failed (37.5%), 65 in the PHDRB-alone group (57.5%) and 48 in the combined PHDRB + EBRT group (25.5%). Patients who started PHDRB before Postoperative Day 5 had a 10-year locoregional control rate of 66.7% and patients who started PHDRB on Postoperative Day 5 or longer had a 10-year locoregional control rate of 51.8% (p = 0.009). Subgroup analysis detected that this difference was only observed in the recurrent cases treated with PHDRB alone (Subset 2; n = 99; p = 0.004). No correlation could be detected between locoregional control rate and TTL in the other patient subsets although a trend toward a decreased locoregional control rate after a longer TTL was observed when they were grouped together (p = 0.089). Conclusions Patients should start PHDRB as soon as possible to maximize locoregional control especially in those recurrent cases treated with PHDRB alone. The time effect in other disease scenarios is less clear. |
| Databáze: | OpenAIRE |
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