Intracavitary Irradiation Research Articles

Radiation therapy for carcinoma of the uterine cervix: comparison of two brachytherapy schedules

We compared the survival rates and late effects for two groups of cervical cancer patients treated with almost the same external radiotherapy but different remote afterloading systems (RALS) for high-dose-rate intracavitary radiation therapy regimens. A total of 218 patients with carcinoma of the uterine cervix were treated. For 98 patients, intracavitary brachytherapy was delivered with 6–7.5 Gy/fraction to Point A (Group A), and for 120, 5 Gy/fraction with a modified source step size (Group B). The 3-year cause-specific survival rates by stage and treatment schedule were Group A: 91% and Group B: 96% in Stage I, 89% and 92% in Stage II, 64% and 75% in Stage III, 44% and 69% in Stage IV. The survival curves did not reveal any statistically significant differences at any stage. The 3-year cumulative local failure rates were 14% in Group A and 7% in Group B (P = 0.1202), while the actuarial rates of developing rectal complication (Grade 2 or more) at 3 years were 25% in Group A and 4% in Group B (P < 0.0001). This retrospective analysis suggests that a low dose per fraction with modified source step size is advantageous because of yielding almost the same local control but with fewer rectal complications.

Treatment outcome and prognostic factors in intermediate risk stage I endometrial carcinoma.

Introducton: The aim of this study was to evaluate the clinical characteristics, post-surgery adjuvant treatment approach and posttreatment disease course in patients with intermediate risk stage I endometrium cancer and also to assess the effects of known prognostic factors on this group of patients. Patients and Methods: A total of 148 patients followed up postoperatively or after adjuvant treatment between 1996 and 2007 were evaluated retrospectively. Median follow-up duration was 67 months (range: 7-166). Among the study population 14.9% had Ib and 83.1% had stage Ic disease. 72 were treated by external beam radiotherapy (EBRT), 7 by intracavitary radiotherapy (ICRT), 65 by external + intracavitary radiotherapy (EBRT + ICRT), and one by chemoradiotherapy (CRT). Results: Vaginal vault is found to be the most common site of recurrences. Five and 10-year local control (LC) rates were 96.6% and 95.9%, respectively, while 5 and 10-year distant control (DC) rates were 94.6% and 91.9%, respectively. One, 5 and 10-year overall survival rates (OS) were 99.3%, 87.6% and 71.2%, respectively, while 1, 5 and 10-year progression-free survival rates (PFS) were 97.3%, 87.6% and 71.2%, respectively. Univariate analysis has revealed that prognostic factors as age (P = 0.0001), menopausal status (P = 0.049) and EBRT duration (P = 0.003) statistically significantly affected OS; while age (P = 0.0001) and EBRT duration (P = 0.006) affected PFS. Multivariate analysis has revealed that only age (P = 0.001) (P = 0.0001) and ERT duration (P = 0.021) (P = 0.027) affected both OS and PFS. Conclusion: LC and OS rates are high in the intermediate risk group. Age over 60 years and EBRT duration of 35 days and over both have negative effects on outcome in this group.

EP-1906: Incidence of uterine perforation and tandem tenting in CT-guided intracavitary radiotherapy for cervical cancer

EP-1906: Incidence of uterine perforation and tandem tenting in CT-guided intracavitary radiotherapy for cervical cancer

Effect of solution-focused approach combined with auricular acupressure on anxiety and pain of patients with postmenopausal cervical cancer during afterloading brachytherapy

Objective To observe the effect of solution-focused approach combined with auricular acupressure on relieving the anxiety and pain of patients with postmenopausal cervical cancer during afterloading brachytherapy .Methods One hundred and twenty patients who treated with uterine cavity for the first time were randomly divided into the observation group （ n =60 ） and the control group （ n =60 ） .The control group received the conventional nursing , and the observation group received the solution-focused approach nursing combined with auricular acupressure on the basis of the conventional nursing .The self-rating anxiety scale （ SAS ） was used before the intervention and one week after the intervention （ once again before afterloading brachytherapy ） , and the score of pain and the satisfaction of patients were evaluated during the afterloading brachytherapy .Results No difference was not found in the score of SAS before the intervention between two groups （P〉0.05）.The score of SAS was （42.3 ±44.46） in the observation group one week after the＆nbsp;intervention , and was significantly lower than （ 49 .76 ±4 .57 ） in the control group , and the difference was statistically significant （t=-9.00, P〈0.05）.The cases of the grade Ⅰof pain were 15 cases （25%）, gradeⅡwere 42 cases （70%）, grade Ⅲ were 2 cases （3.33%）, grade Ⅳ were 1 case （1.67%） in the observation group during operation , and were respectively 2 cases （3.33%）, 28 cases （46.67%）, 27 cases （45%）, 3 cases （5%） in the control group, and the degree of pain in the observation group during operation was significantly better than the control group , and the difference was statistically significant （Z=-5.74, P〈0.001）.The satisfaction of patients in the observation group during operation （4.89 ±0.10） was better than （3.87 ±0.51） in the control group and the difference was statistically significant （t =15.21, P〈0.05）. Conclusions The solution-focused approach combined with auricular acupressure during afterloading brachytherapy can reduce the anxiety , pain, and improve the satisfaction of patient . Key words: Solution-focused approach; Auricular acupressure; Cervical cancer; Intracavitary radiotherapy; Intrauterine device insertion; Pain

Outcome Analysis of Salvage Radiotherapy for Occult Cervical Cancer Found After Simple Hysterectomy

The objective was to analyze the outcomes of the patients, who received salvage radiotherapy for incidentally discovered cervical cancer following simple hysterectomy, and to identify the influence of intracavitary radiotherapy on treatment outcomes. Data from 117 patients with occult cervical cancer who underwent simple hysterectomy followed by salvage radiotherapy from September 1979 to November 2010 were collected. All the patients received external beam radiotherapy with (n = 45) or without (n = 72) intracavitary radiotherapy. Local control, disease-free survival, overall survival and treatment-related toxicity were investigated. The median follow-up time was 75 months. The 5- and 10-year local control/disease-free survival/overall survival rates were 93/87/87% and 90/84/83%, respectively. Among 98 patients who had no residual disease and negative resection margin on surgical specimens, 32 (33%) received intracavitary radiotherapy and 66 (67%) did not. There were no differences in patient and tumor characteristics between patients treated with and without intracavitary radiotherapy. The 5-year local control rate for the non-intracavitary radiotherapy group was 93 versus 94% for the intracavitary radiotherapy group (P = 0.564); the disease-free survival rate was 88 versus 94% (P = 0.894); the overall survival rate was 95 versus 85% (P = 0.106), respectively. Among all patients, there were 5% of Grade 3 or higher late toxicities. Patients with occult invasive cervical cancer discovered following simple hysterectomy could be treated safely and effectively with salvage radiotherapy. For patients with no residual disease and negative resection margin, intracavitary radiotherapy could be omitted.

Patient-specific dosimetry for intracavitary 32P-chromic phosphate colloid therapy of cystic brain tumours

(32)P-chromic phosphate colloid treatments of astrocytoma and craniopharyngioma cystic brain tumours in paediatric patients are conventionally based on a sphere model under the assumption of uniform uptake. The aims of this study were to determine the distribution of the absorbed dose delivered by (32)P on a patient-specific basis and to evaluate the accuracy with which this can be predicted from a pretherapy administration of (99m)Tc-Sn colloid. Three patients were treated with (32)P-chromic phosphate colloid following (99m)Tc-Sn colloid administrations. Convolution dosimetry was performed using pretherapy and posttherapy sequential SPECT imaging, and verified with EGSnrc Monte Carlo radiation transport simulations. Mean absorbed doses to the cyst wall and dose-volume histograms were also calculated and compared with those obtained by the sphere model approach. Highly nonuniform uptake distributions of both the (99m)Tc and (32)P colloids were observed and characterized by dose-volume histograms to the cyst wall. Mean absorbed doses delivered to the cyst wall, obtained with the convolution method, were on average 21 % (SD 18 %) and 50 % (SD 30 %) lower than those predicted by the (99m)Tc distribution and the uniform assumption of the sphere model, respectively. Absorbed doses delivered to the cyst wall by (32)P are more accurately predicted from image-based patient-specific convolution dosimetry than from simple sphere models. These results indicate the necessity to perform personalized treatment planning and verification for intracavitary irradiation of cystic brain tumours treated with radiocolloids. Patient-specific dosimetry can be used to guide the frequency and levels of repeated administrations and would facilitate data collection and comparison to support the multicentre trials necessary to progress this therapy.

Comparison of Clinical Efficacy of Three Different Neoadjuvant Approaches (Chemotherapy Combined Vaginal Intracavitary Irradiation, Neoadjuvant Chemotherapy Alone or Radiotherapy) Combined with Surgery for Patients with Stage Ib2 and IIa2 Cervical Cancer

A total of 285 patients with stage Ib2 and IIa2 cervical cancer were categorized into three groups, and received preoperative neoadjuvant chemotherapy combined with vaginal intracavitary irradiation, neoadjuvant chemotherapy alone or radiotherapy, respectively. The effective rate of 70.6 % in group 1 was much higher than 41.4% in group 2 (P=0.000) and 46.9 % in group 3 (P=0.000); The percentage of patients receiving postoperative adjuvant therapy was 44.1% in group 1, much lower than 67.8% in group 2 (P=0.001) and 64.6% in group 3 (P=0.004); The percentage of patients with no postoperative risk factor in group 1 was 52.0%, much higher than 32.2% in group 2 (P=0.006) and 35.4% in group 3 (P=0.019); The occurrence rate of surgery-related complications in groups 1, 2 and 3 were 29.4%, 28.7%, and 33.3%, respectively, with no statistical differences among the groups (P=0.981). Regarding preoperative neoadjuvant complications, none were obvious in group 3, while occurrence rates of myelosuppression in groups 1 and 2 were 89.1% and 86.6%, of nausea and vomitting were 78.4% and 78.2%, but without significant differences (all P>0.05). Among 166 patients who received postoperative adjuvant therapy in the three groups, the occurrence rates were: 65.4%, 64.3% and 61.1% respectively for myelosuppression; 42.3%, 38.1%, and 38.9% for nausea and vomiting; 9.6%, 9.5% and 9.7% for urocystitis; and 63.5%, 69.0% and 65.3% enteritis and rectitis. There were no statistically significant differences among them (all P>0.05). The five-year disease-free survival rates (DFS) in groups 1, 2, 3 were 78.3%, 75.1%, 80.9%, respectively; the five-year overall survival rates (OS) were 81.4%, 78.2%, and 81.1%, respectively. The five-year OS of 166 patients receiving postoperative in the three groups were 72.4%, 69.5%, and 71.8%, respectively, with no significant variation (all P>0.05). Although there were no differences among three groups in DFS and OS, preoperative neoadjuvant chemotherapy combined with intracavitary radiotherapy may increase the effective rate and the percentage of patients with no postoperative risk factors and decrease the percentage of patients receiving postoperative adjuvant therapy, thereby decreasing complications indirectly and increasing quality of life.

Interstitial brachytherapy vs. intensity-modulated radiation therapy for patients with cervical carcinoma not suitable for intracavitary radiation therapy

Interstitial brachytherapy (IBT) is the standard alternative treatment for patients with cervical carcinoma not suitable for intracavitary radiotherapy. There is an emerging belief that intensity-modulated radiotherapy (IMRT) has the potential to replace IBT. We aimed to compare the dosimetry achieved by IBT and IMRT in such patients. The CT imaging data, previously used for IBT planning of 12patients with cervical carcinoma, were transferred to IMRT planning system to generate parallel IMRT plans. Prescribed dose to the planning target volume (PTV) was 20Gy delivered in 2-weekly high-dose-rate fractions of 10Gy each with IBT (biologically equivalent dose [BED10] 40Gy) and 33Gy/13 fractions/2.5 wk with IMRT (BED10 41Gy). For comparison, dose-volume parameters for target and organs at risk were recorded and expressed in terms of BED10 and BED3, respectively. For PTV, the mean D95 (dose received by 95% of PTV) was better with IBT (57.16Gy vs. 41.47Gy, p=0.003). The mean conformity index was 0.94 and 0.90 with IBT and IMRT, respectively (p=0.034). IBT delivered significantly reduced doses to 1.0cc (Dmax), 5.0cc (D5 cc), 50% (D50), and 75% (D75) of bladder volume as compared with IMRT. The mean rectal Dmax was significantly better with IBT as compared with IMRT (54.64Gy vs. 62.63Gy, p=0.02). IBT provides superior PTV coverage and organs at risk sparing to IMRT. Thus, IBT remains the standard treatment for patients with cervical carcinoma unsuitable for intracavitary radiotherapy.

Comparison of intracavitary brachytherapy and stereotactic body radiotherapy dose distribution for cervical cancer: In regard to Cengiz et al.

Comparison of intracavitary brachytherapy and stereotactic body radiotherapy dose distribution for cervical cancer: In regard to Cengiz et al.

A prospective observational study with dose volume parameters predicting rectosigmoidoscopic findings and late rectosigmoid bleeding in patients with uterine cervical cancer treated by definitive radiotherapy

PurposeWe assessed the value of dose-volumetric parameters predicting rectosigmoid mucosal changes (RMC) and late rectosigmoid complications (LRC).MethodsBetween January 2004 and February 2006, 77 patients with stage IB-IIIB cervical cancer underwent external beam radiotherapy and computed tomography (CT)-based intracavitary irradiation. Total dose to the rectal point and several dose-volumetric parameters for rectosigmoid colon (D20cc, D15cc, D10cc, D5cc, D2cc, D1cc, and D0.1cc , defined as the minimal doses received by the highest irradiated volumes of 20, 15, 10, 5, 2, 1, and 0.1 cc, respectively), were calculated using the equivalent dose in 2 Gy fractions (α/β = 3, Gy3). The RMC and LRC were graded by rectosigmoidoscopy and Radiation Therapy Oncology Group criteria every 6 months, respectively.ResultsOf 77 patients, 27 (35.1%) patients developed RMC ≥ score 3 and 22 (28.6 %) patients developed LRC ≥ grade 2. There was a positive correlation between RMC score and LRC grade (r = 0.728, p < 0.001). In multivariate analyses, D5cc, among the dose-volumetric parameters, was significant parameter for the risks of RMC ≥ score 3 and LRC ≥ grade 2 (p < 0.05).ConclusionsD5cc may be a more reliable estimate than other dose-volumetric parameters for predicting the risk of RMC ≥ score 3 and LRC ≥ grade 2 in CT-based brachytherapy.

Endoscopic findings of rectal mucosal damage after pelvic radiotherapy for cervical carcinoma: correlation of rectal mucosal damage with radiation dose and clinical symptoms

PurposeTo describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose.Materials and MethodsThirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, α/β = 3).ResultsRectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, BEDICR, BEDICR+EBRT was significantly associated with the VRS (RP ratio, median 76.5%; BEDICR, median 37.1 Gy3; BEDICR+EBRT, median 102.5 Gy3; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038).ConclusionThe most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.

Intracavitary Radiation Therapy for Recurrent Cystic Brain Tumors with Holmium-166-Chico : A Pilot Study

ObjectiveIntracavitary injection of beta-emitting radiation source for control of cystic tumors has been tried with a benefit of localized internal radiation. The authors treated cystic brain tumor patients with Holmium-166-chitosan complex (Ho-166-chico), composed of a beta-emitting radionuclide Holmium-166 and biodegradable chit polymer, and evaluated the safety and effective measurement for response.MethodsTwenty-two patients with recurrent cystic brain tumor and/or located in a deep or eloquent area were enrolled in this pilot study. The cyst volume and wall thickness were determined on CT or MRI to assess radiological response. The activity of Ho-166-chico injected via Ommaya reservoir was prescribed to be 10-25 Gy to the cyst wall in a depth of 4 mm.ResultsThere was neither complications related to systemic absorption nor leakage of Ho-166-chico in all 22 patients. But, two cases of oculomotor paresis were observed in patients with recurrent craniopharyngioma. Radiological response was seen in 14 of 20 available follow-up images (70%). Seven patients of 'evident' radiological response experienced more than 25% decrease of both cyst volume and wall thickness. Another 7 patients with 'suggestive' response showed decrease of cyst volume without definitive change of the wall thickness or vice versa. All patients with benign tumors or low grade gliomas experienced symptomatic improvement.ConclusionHo-166-chico intracavitary radiation therapy for cystic tumor is a safe method of palliation without serious complications. The determination of both minimal effective dosage and time interval of repeated injection through phase 1 trial could improve the results in the future.

Interstitial Brachytherapy With and Without Central Tandem in the Treatment of Cervical Carcinoma: A Dosimetric Study

For cervical carcinoma, interstitial brachytherapy (ISBT) is performed if intracavitary radiation therapy is not technically feasible due to obliterated os or it provides inadequate dosimetry. The placement of central tandem in ISBT may affect the dosimetry in target region and organs at risk (OAR). The variation in dosimetry due to central tandem can influence the tumor control and toxicity profile. The present study was designed to compare the dosimetry of ISBT with and without central tandem in patients of cervical carcinoma.

New Approach to Relief Pain and Distress During High-dose-rate Intracavitary Irradiation for Cervical Cancer

New Approach to Relief Pain and Distress During High-dose-rate Intracavitary Irradiation for Cervical Cancer

High-dose-rate Intracavitary Radiotherapy in the Management of Cervical Intraepithelial Neoplasia 3 and Carcinoma In Situ Presenting With Poor Histologic Factors After Undergoing Excisional Procedures

To assess the effectiveness of high-dose-rate intracavitary radiotherapy (HDR-ICR) in patients with cervical intraepithelial neoplasia 3 (CIN 3) and carcinoma in situ (CIS) presenting with poor histologic factors for predicting residual disease after undergoing diagnostic excisional procedures. This study was a retrospective analysis of 166 patients with CIN 3 (n=15) and CIS (n=151) between October 1986 and December 2005. They were diagnosed by conization (n=158) and punch biopsy (n=8). Pathologic analysis showed 135 cases of endocervical gland involvement (81.4%), 74 cases of positive resection margins (44.5%), and 52 cases of malignant cells on endocervical curettage (31.3%). All patients were treated with HDR-ICR using Co⁶⁰ or Ir¹⁹² at a cancer center. The dose was prescribed at point A located 2 cm superior to the external os and 2 cm lateral to the axis of the tandem for intact uterus. Median age was 61 years (range, 29-77). The median total dose of HDR-ICR was 30 Gy/6 fractions (range, 30-52). At follow-up (median, 152 months), 2 patients developed recurrent diseases: 1 CIN 2 and 1 invasive carcinoma. One hundred and forty patients survived and 26 patients died, owing to nonmalignant intercurrent disease. Rectal bleeding occurred in one patient; however, this symptom subsided with conservative management. Our data showed HDR-ICR is an effective modality for CIN 3 and CIS patients presenting with poor histologic factors after excisional procedures. HDR-ICR should be considered as a definitive treatment in CIN 3 and CIS patients with possible residual disease after undergoing excisional procedures.

Outcomes of young patients (age younger than 40) with cervical cancer treated with (chemo) radiotherapy: A Japanese multi-institutional study.

e15533 Background: To analyze treatment outcomes of young patients (age: &lt;40 years) with uterine cervical cancer treated with definitive (chemo) radiotherapy in Japanese institutions. Methods: The records of 118 patients (age: &lt;40 years) with cervical cancer were reviewed retrospectively. The median age was 35 years (range: 24-39 years). Clinical FIGO stages were as follows: Stages 1b1/1b2/1b/2a/2b/3a/3b/4a/unknown in 6/9/2/6/40/2/49/3/1 patients, respectively. Median maximum tumor diameter was 5.5 cm (range: 2-9.2 cm). Forty-six patients (39%) had enlarged pelvic nodes (&gt;10 mm in the shortest diameter). One hundred five patients had squamous cell carcinoma, and 13 patients had non-squamous cell carcinoma. Definitive radiotherapy consisted of high-dose rate intracavitary brachytherapy and whole-pelvis external beam radiation therapy. The cumulative linear quadratic equivalent dose (EQD2) was 64 Gy (range: 30-80 Gy) prescribed at point A. Concurrent chemotherapy was delivered in 95 patients (81%). Results: Within a median follow-up time of 35 months, 44 patients developed recurrence. Thirty-nine patients (33%) had pelvic recurrence only, four patients (3%) had distant metastasis only, and one patient had both pelvic and distant metastasis. The 5-year overall survival rate (OS) and local control rate (LC) of all patients were 62 % and 64 %, respectively. The 5-year OS for patients with disease stages 1b1/1b2/2a/2b/3/4a were 80%/89 %/100 %/75 %/40 %/0 %, respectively. The 5-year LC for patients with disease stages 1b1/1b2/2a/2b/3/4a were 100%/78%/50%/75%/51%/0%, respectively. Twelve patients (10%) suffered grade 3 or higher late radiation morbidity. Conclusions: Our results suggest that young patients (age: &lt;40 years) with cervical cancer, especially in locally advanced stages (stage III and IVA), might have a worse prognosis than older patients when treated with definitive (chemo) radiotherapy.

OC-42 INTERSTITIAL BRACHYTHERAPY VERSUS IMRT IN PATIENTS WITH CARCINOMA CERVIX UNSUITABLE FOR ICRT

Purpose/Objective: IBT (interstitial brachytherapy) is the standard of treatment in patients with carcinoma cervix not suitable for ICRT (Intracavitary radiotherapy). We have designed this study to assess the role of IMRT (intensity modulated radiotherapy) in such patients and compare dose conformality, coverage of target and doses to OARs (Organ at risk) between IBT and IMRT. Materials and Methods: 12 patients were selected for this study. Target volume and OARs viz bladder, rectum and urethra were contoured on planning CT scans on brachytherapy treatment planning system(PLATO version 14.1 Nucletron®, Netherlands).The contoured images were then transferred to external beam planning system(Eclipse version 6.5).With IBT 20 Gy was prescribed in 2 fractions over 2 weeks (BED 40 Gy) and 33 Gy was prescribed with IMRT in 13 fractions over 2.5 weeks(BED 41 Gy).PTV D95%,PTV minimum, conformality index was used for comparison of target and dose maximum and dose to 5cm 3 and dose to 50% and 75% volume of rectum, bladder and urethra were used for comparison of doses to OARs. All doses were expressed in BED calculated by LQ-L formulae. For analysis a two-tailed paired t test was used with p value <0.05 considered as significant. SPSS version 16.0 was used Results: A total of 24 plans were generated; 12 for IMRT and 12 for IBT.IBT delivered higher mean doses to 95% volume of PTV 57.16+/5.54 Gy versus 41.47+/-0.19 Gy (p value 0.003) and also produced a more conformal plan as the mean conformity index was better with IBT 0.94+/-0.01 versus 0.908+/-0.02 for IMRT (p value 0.034).The hot spots were more inside the PTV with IBT as compared with IMRT. The mean maximum doses to the bladder and urethra were significantly reduced with IBT when compared with IMRT 50.64+/-7.2 Gy versus 66.31+/-2.79 (p value 0.004) and 34.90+/-13.01 versus 60.77+/-1.96 Gy (p value 0.009) respectively. In comparison, 5cm3 volume of bladder and urethra was better with IBT than IMRT:37.28+/-5.92 Gy versus 50.04+/-7.16 Gy(p value 0.05) and 21.04+/-8.24 Gy versus 24.08+/-8.06 Gy(p value 0.05).Though mean rectal dose maximum was statistically significantly lower with IBT as compared with IMRT 54.64+/-3.57 Gy versus 62.63+/-3.94 Gy (p value 0.02),the doses to 5 cm3 volume and dose to 50% and 75% volume of rectum were comparable and not statistically significant

Postoperative radiotherapy for endometrial cancer

PurposeTo investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma.Materials and MethodsSixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months.ResultsFive year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications.ConclusionStage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

Is a Low Dose of Concomitant Chemotherapy With Extended-Field Radiotherapy Acceptable as an Efficient Treatment for Cervical Cancer Patients With Metastases to the Para-Aortic Lymph Nodes?

Extended-field radiotherapy (EFRT) with the concomitant administration of chemotherapy for patients with advanced cervical cancer has problems regarding its feasibility. The goal of the present study was to assess the tolerability and control rate of low-dose cisplatin with EFRT in patients with imaging-confirmed positive para-aortic lymph nodes (PALs). Sixteen patients with cervical cancer metastatic to the PALs treated with EFRT were evaluated. The patients included those with stages I to III disease according to the International Federation of Gynecology and Obstetrics with positive PALs diagnosed by computed tomographic imaging. The patients were treated with 25 to 30 mg/m weekly of cisplatin concurrently with radiation therapy. Doses of 48.6 to 51.0 Gy were delivered in 1.8-Gy fractions to the pelvis and included the PALs field. In addition, boost doses for the involved nodes of PALs were delivered contiguously for a total dose of 54 to 60 Gy. All patients were treated with a high dose rate of intracavitary brachytherapy combined with external irradiation. All patients completed the radiation therapy. Grade 3 or 4 acute hematologic toxicity occurred in 7 patients, but there were no cases of grade 3 or 4 nonhematologic acute toxicity. As a late toxicity, 1 patient developed a grade 3 small bowel obstruction. No grade 4 or worse late toxicity occurred. The 4-year overall survival rate was 56.3%. The 4-year distant metastasis-free survival rate was 50%. Seven patients had no recurrence. Eight patients developed distant failures, and another had an isolated local intrapelvic recurrence. A dose greater than 54 Gy for positive PALs in EFRT, in combination with intracavitary irradiation and low-dose weekly cisplatin administration, was safely completed by all of our patients. However, half of the patients had distant failure. This study provided relatively favorable local control and survival. Further considering modifications of the treatment should therefore be encouraged.

Primary Ewing’s sarcoma/primitive neuroectodermal tumor of the vagina in a 54-year-old woman: a case report

Ewing's sarcoma (ES)/primitive neuroectodermal tumor (PNET) of the genital tract of women is uncommon. Presentation in vagina is exceedingly rare. A 54-year-old Chinese woman presented with complaints of vaginal bleeding with fragmented bits occasionally. Physical examination revealed two nodules about 4 cm × 3 cm in the vagina. The immunohistochemical stains revealed a rare presentation of a primitive neuroectodermal tumor. The patient was treated with whole-pelvis external beam radiation, vaginal cylinder intracavitary brachytherapy, intracavitary afterloading radiotherapy and bilateral groin area radiotherapy. She died of clinical recurrence after 18 months of treatment. This is the oldest but virgin case, treated with radiation completely, of primitive neuroectodermal tumor located in the vagina reported in the literature.