Brachytherapy In Cervical Cancer Patients Research Articles

74 poster: PET Scan Guided Interstitial Brachytherapy in Cervical Cancer Patients with Clinically Suspected Residual Disease

74 poster: PET Scan Guided Interstitial Brachytherapy in Cervical Cancer Patients with Clinically Suspected Residual Disease

Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound

To determine if transabdominal ultrasound (US) can be used for conformal brachytherapy in cervical cancer patients. Seventy-one patients with locoregionally advanced cervix cancer treated with chemoradiation and brachytherapy were included in this study. The protocol consisted of US-assisted tandem insertion and conformal US-based planning. Orthogonal films for applicator reconstruction were also taken. A standard plan was modified to suit the US-based volume and treatment was delivered. The patient then underwent a magnetic resonance imaging (MRI) scan with the applicators in situ. Retrospectively, individual standard (STD), US, and MRI plans were extrapolated for five fractions and superimposed onto the two-dimensional sagittal MRI images for comparison. Doses to Point A, target volume, International Commission on Radiation Units and Measurements (ICRU) 38 bladder and rectal points, and individualized bowel points were calculated on original implant geometry on Plato for each planning method. STD (high-dose-rate) plans reported higher doses to Point A, target volume, ICRU 38 bladder and rectal points, and individualized bowel point compared with US and MRI plans. There was a statistically significant difference between standard plans and image-based plans-STD vs. US, STD vs. MRI, and STD vs. Final-having consistent (p <or= 0.001) respectively for target volume, Point A, ICRU 38 bladder, and bowel point. US plan assessed on two-dimensional MRI image was comparable for target volume (p = 0.11), rectal point (p = 0.8), and vaginal mucosa (p = 0.19). Local control was 90%. Late bowel morbidity (G3, G4) was <2%. Transabdominal ultrasound offers an accurate, quick, accessible, and cost-effective method of conformal brachytherapy planning.

Physics Contributions and Clinical Outcome With 3D-MRI–Based Pulsed-Dose-Rate Intracavitary Brachytherapy in Cervical Cancer Patients

To assess the physics contributions and clinical outcome with three-dimensional magnetic resonance imaging-guided pulsed-dose-rate (PDR) intracavitary brachytherapy in cervical cancer patients. The data from 45 patients with primary locally advanced cervical carcinoma were analyzed. The median tumor cervical volume was 64.0 cm(3) (range, 3-178). Of the 45 patients, 24 (53%) had histologic and/or radiologic pelvic involvement. After pelvic with or without para-aortic concomitant chemoradiotherapy, a PDR brachytherapy boost was delivered to a three-dimensional magnetic resonance imaging-based clinical target volume, taking into account the dose-volume constraints for critical organs and optimization of the target volume coverage. At a median follow-up of 26 months (range, 9-47), the 2-year overall survival and disease-free survival rate was 78% and 73%, respectively. At the last follow-up visit, the disease of all patients remained locally controlled. Adding external beam radiotherapy and PDR using the equivalent dose in 2-Gy fractions model, the median dose received by 100% and 90% of the target was 54.4 Gy(alpha/beta10) and 63.5 Gy(alpha/beta10) for the intermediate-risk clinical target volume and 61.6 Gy(alpha/beta10) and 74.9 Gy(alpha/beta10) for the high-risk clinical target volume, respectively. Of the 45 patients, 23 and 2 developed acute Grade 1-2 and Grade 3 complications, respectively; 21 patients presented with delayed Grade 1-2 complications. One other patient presented with Grade 3 vesicovaginal fistula. No Grade 4 or greater complications, whether acute or delayed, were observed. Magnetic resonance imaging-guided PDR brachytherapy with optimization integrating the limits of tolerance to critical organs allows for excellent local control rates. Moreover, the present results have confirmed that the ability to optimize dwell times can contribute to an improvement in local control rates with a low level of late side effects.

Epidural analgesia during brachytherapy for cervical cancer patients

To find out the efficacy of epidural analgesia in providing continuous pain relief for patients undergoing brachytherapy for cervical cancer. Teaching Hospital. Retrospective Study. A total of 152 patients of cervical cancer received epidural analgesia during 18 to 21 hours of pelvic brachytherapy. Epidural top up was given using 60-100 microg of buprenorphine every 08-10 hrs. Additional top up or systemic analgesics were given for breakthrough pain. Majority of patients 119 out of 152 received epidural top up twice during their stay in the brachytherapy ward. Only 20 out of 152 needed additional analgesics. Epidural analgesia is safe and provides satisfactory pain relief during brachytherapy and makes patient's stay more comfortable.

46 Comparison of Late Toxicity Between Continuous Low-Dose-Rate and Pulsed-Dose-Rate Brachytherapy In Cervical Cancer Patients

46 Comparison of Late Toxicity Between Continuous Low-Dose-Rate and Pulsed-Dose-Rate Brachytherapy In Cervical Cancer Patients

Comparison of late toxicity between continuous low-dose-rate and pulsed-dose-rate brachytherapy in cervical cancer patients

To compare survival and severe late radiation toxicity between patients who received continuous low-dose-rate (LDR) brachytherapy (BT) and pulsed-dose-rate (PDR) BT for cervical cancer. A retrospective review of cervical cancer patients who underwent primary radiotherapy with or without concurrent cisplatin was performed. Late Grade 3 or worse toxicities were assessed using the National Cancer Institute Common Toxicity Criteria. The study endpoints were overall and disease-free survival and the probability of severe late toxicity. A total of 109 patients (65.7%) received LDR BT and 57 (34.3%) received PDR BT. Seventy patients received concurrent chemotherapy with cisplatin. The 3-year overall survival and disease-free survival rate was 70% and 57% for the LDR group and 82% and 70% for the PDR group, respectively (p = 0.25 and p = 0.19). The 3-year probability rate for late Grade 3 or worse toxicity was 7.4% for LDR BT patients and 7.6% for PDR BT patients, respectively (p = 0.69) and 6.9% and 7.6%, respectively, for concurrent chemotherapy vs. none (p = 0.69). No difference was found in severe late toxicity, overall survival, or disease-free survival between the LDR and PDR groups.

229 poster Multivariate analysis of quality of life after HDR brachytherapyin cervical cancer patients

229 poster Multivariate analysis of quality of life after HDR brachytherapyin cervical cancer patients

Twice-per-day fractionated high versus continuous low dose rate intracavitary therapy in the radical treatment of cervical cancer: A nonrandomized comparison of treatment results

To compare the efficacy of two twice-per-day fractionated high dose rate (HDR) brachytherapies with a historical control group treated with low dose rate (LDR) brachytherapy for cervical cancer patients. From 1985 to 1988, 92 patients with cancer of the cervic were treated by remote-controlled, HDR brachytherapy, six fractions of 7 Gy per fraction (42 Gy) at point A (HDR-6). Fifty-seven patients were treated with four fractions of 8 Gy per fraction (32 Gy) at point A (HDR-4). A twice-per-day program was used for all HDR patients by two split courses. As a historical control, treatment results of 259 patients treated with LDR brachytherapy (40 Gy in two split courses) were compared with those of the two HDR regimens. All patients received whole pelvic external irradiation, 36-45 Gy (mostly 40 Gy) before brachytherapy. Five-year local control rates were not significantly different for the three groups (HDR-6 = 82.0%, HDR-4 = 85.5%, and LDR = 89.5%, respectively). Five-year survival rates were also comparable (67.7%, 77.9%, and 74.1%, respectively). However, late complications were lower in HDR-4 than HDR-6 (11.0% vs. 25.6%). Both 5-year local control and survival rates were comparable among the three groups. However, HDR-4, which was more biologically equivalent to our LDR regimen, showed fewer complications compared to HDR-6. In addition, our twice-per-day schedule shortened the hospital stay.