Clinical outcomes using image-guided interstitial brachytherapy for definitive cervical cancer patients with high-risk clinical target volumes greater than 30 cc
| Autor: | Shane Mesko, Sang-June Park, Chenyang Wang, Uma Swamy, Lalaine Zaide, Mitchell Kamrava, Jagdeep Raince, D. Jeffrey Demanes |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Time Factors medicine.medical_treatment Brachytherapy Planning target volume Uterine Cervical Neoplasms 030218 nuclear medicine & medical imaging Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Radiology Nuclear Medicine and imaging External beam radiotherapy Toxicity profile Aged Retrospective Studies Aged 80 and over Cervical cancer business.industry Radiotherapy Planning Computer-Assisted Interstitial brachytherapy Middle Aged medicine.disease Confidence interval Survival Rate Treatment Outcome Oncology 030220 oncology & carcinogenesis Toxicity Female Dose Fractionation Radiation Radiology Tomography X-Ray Computed business Follow-Up Studies |
| Zdroj: | Brachytherapy. 17:392-398 |
| ISSN: | 1538-4721 |
| DOI: | 10.1016/j.brachy.2017.10.004 |
| Popis: | Purpose Given the limited data using an interstitial approach with 3D-based planning for definitive cervical cancer utilizing the GEC-ESTRO defined high-risk clinical target volume (HR-CTV), we reviewed our institutional experience of cervical cancer patients with HR-CTVs ≥ 30 cc to determine whether our clinical and toxicity outcomes are acceptable. Methods A retrospective review of 37 cervical cancer patients with high-risk clinical target volumes (HR-CTVs) ≥30 cc treated with interstitial image-guided brachytherapy (IS IGBT) was performed. All patients received external beam radiotherapy to a median dose of 45 Gy, followed by IS IGBT delivered in a single implant to a median dose of 6 Gy × 5 fractions. Median HR-CTV was 59 cc. A median HR-CTV D90 of 87.44 Gy was achieved. Kaplan–Meier method was used to evaluate local control (LC), distant control, and overall survival (OS), with stratification by overall treatment time (OTT) ≤ 7 or >7 weeks. Results Median followup was 17 months. The estimated 2-year LC, distant control, and OS were 77.6% (confidence interval [CI]: 63.8–94.5%), 56.8% (CI: 41.3–78.1%), and 54.4% (CI: 39.4–75%), respectively. The 2-year LC for OTT ≤7 weeks and >7 weeks were 100% and 58.3%, respectively (p = 0.026). The 2-year OS for OTT ≤7 weeks and >7 weeks were 77.8% and 38%, respectively (p = 0.021). Discussions IS IGBT can achieve a high D90 to the HR-CTV even in the setting of large-volume disease and results in a favorable LC and toxicity profile. OTT > 7 weeks is associated with significant decrease in LC and OS. Conclusions Efforts should be made to complete whole treatment within 7 weeks as this is associated with improved clinical outcomes. |
| Databáze: | OpenAIRE |
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