Rate Intracavitary Irradiation Research Articles

Symptom relief effect of palliative high dose rate intracavitary radiotherapy for advanced esophageal cancer with dysphagia.

Intracavitary radiotherapy (ICRT) for the palliative treatment of advanced esophageal cancer with dysphagia is currently performed at the University of Tokyo Hospital (Tokyo, Japan). In the present study, 24 patients exhibiting advanced esophageal cancer with dysphagia received palliative ICRT. ICRT, which was delivered 5 mm below the esophageal mucous membrane, with the exception of one case, was administered at a dose of 6 Gy/fraction. Specific patients additionally underwent definitive or palliative external beam radiation therapy for esophageal cancer a minimum of three months prior to ICRT. The effect of treatment on symptom alleviation was examined by comparing the dysphagia score prior to and following ICRT, with the patients’ medical records and a questionnaire used to calculate a dysphagia score ranging from zero (no dysphagia) to four (total dysphagia). In consideration of the individual efficacy of the treatment, the maximum number of repeated ICRT fractions was four (median, 1.7 times). A trend in the improvement of the symptom of dysphagia was observed in response to esophageal ICRT, with the average dysphagia score markedly decreasing from 2.54 to 1.65, however, the difference was not significant (P=0.083). Furthermore, pain was the most frequent side-effect of the esophageal ICRT and no patients exhibited severe complications. Thus, esophageal ICRT at a dose of 6 Gy/fraction may present an effective strategy for relieving the symptom of dysphagia in cases of advanced esophageal cancer.

Treatment results of radical radiotherapy of carcinoma uterine cervix using external beam radiotherapy and high dose rate intracavitary radiotherapy

To report the outcome of carcinoma cervix patients treated radically by external beam radiotherapy and high dose rate intracavitary radiotherapy. From January 2005 to December 2006, a total of 709 newly diagnosed cases of carcinoma cervix were reported in our department. All cases were staged according to the International Federation of Gynecologist and Oncologist staging system. Out of 709 cases, 342 completed radical radiotherapy and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reaction, and disease free survival. There were 11(3.22%), 82(23.98%), 232(67.83%), and 17(4.97%) patients in stages I, II, III, and IV, respectively. The median follow up time for all patients was 36 months (range 3 -54 months). The overall treatment time (OTT) ranged from 52 to 69 days (median 58 days). The 3 year disease free survival rate was 81.8%, 70.7%, 40.08%, and 11.76% for stages I, II, III, and IV, respectively. There were 91 (26.6%) cases with local residual diseases, 27(7.9%) developed distant metastasis, and 18(5.26%) pts had local recurrence. The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of early staged cancer of uterine cervix. For locally advanced cancer of cervix addition of concurrent chemotherapy, higher radiation doses, reduction of overall treatment time to less than 8 weeks, and use of latest radiotherapy techniques such as IMRT is recommended to improve the results.

Phase I Study of Concurrent Chemoradiotherapy With Weekly Cisplatin and Paclitaxel Chemotherapy for Locally Advanced Cervical Carcinoma in Japanese Women

The purpose of this study was to evaluate the use of concurrent chemoradiotherapy involving weekly administration of cisplatin and paclitaxel for the treatment of locally advanced cervical carcinoma in Japanese women. Twenty Japanese patients were registered for this phase I study. Radiation therapy was performed using external irradiation and high-dose rate intracavitary irradiation of the pelvis. Chemotherapy was performed once a week until termination of the radiation therapy. The dose of cisplatin was decided as 30 mg/m2, and the initial dose of paclitaxel was set as 30 mg/m2, with a planned incremental increase of 10 mg/m2 up to 70 mg/m2. When 3 to 6 patients were registered at each dose level and dose-limiting toxicity (DLT) was noted in more than 3 patients, the dose level was assumed to be the maximum tolerated dose. Among the 20 patients, 1 patient experienced DLT during 2 courses because of dehydration and arrhythmia. In another patient, chemotherapy was discontinued after 4 courses because of a hypersensitivity reaction to paclitaxel at dose level 3. No patient experienced DLT resulting from hematologic toxicities. All patients underwent radiation therapy according to schedule without any discontinuations. A complete response was obtained in 16 patients. Based on the results obtained from this study, weekly administration of 30 mg/m2 cisplatin and 50 mg/m2 paclitaxel with concurrent chemoradiotherapy can be considered a tolerable and safe dose for the treatment of locally advanced cervical carcinoma in Japanese women.

Phase II Study of Radiation Therapy Combined with Weekly Nedaplatin in Locally Advanced Uterine Cervical Carcinoma: Kitasato Gynecologic Radiation Oncology Group (KGROG 0501)

In order to evaluate the safety and efficacy of chemoradiotherapy using nedaplatin for locally advanced uterine cervical carcinoma in Japanese patients, we have started a single-institute phase II trial. Eligibility criteria include: (i) pathologically proven squamous cell carcinoma or adenocarcinoma, (ii) clinical FIGO stage Ib, IIa, or IIb with bulky tumor (> 40 mm) or pelvic lymph node swelling, or (iii) clinical FIGO stage IIIa, IIIb and IVa, (iv) no para-aortic lymph node swelling. A combination of external beam radiation and high dose rate intracavitary irradiation is given. Nedaplatin (30 mg/m2) is intravenously infused on a weekly basis for five times. The primary endpoint is 3-year overall survival, and the secondary endpoints are tumor response, 2-year overall survival, 3-year progression-free survival, acute adverse events, protocol treatment compliance, and late adverse events. We plan to recruit 45 patients within 3 years.

Incidence and temporal pattern of anorexia, diarrhea, weight loss, and leukopenia in patients with cervical cancer treated with concurrent radiation therapy and weekly cisplatin: Comparison with radiation therapy alone

Objective. To investigate the temporal patterns of anorexia, diarrhea, weight loss, and leukopenia in chemoradiation therapy (CRT) for cervical cancer compared with radiation therapy (RT) alone. Methods. Acute toxicities in 43 patients receiving RT alone and 40 patients receiving CRT were retrospectively analyzed. Patients were treated with a combination of external beam irradiation and high-dose rate intracavitary irradiation. Cisplatin was given once a week for 5 weeks concurrently with the external beam irradiation. CRT was divided into low-dose CRT group (cisplatin, 20–30 mg/m 2, n = 16) and high-dose CRT group (cisplatin, 35–40 mg/m 2, n = 24). Toxicities were evaluated before, every week up to 7 weeks during the cycle, and 12 weeks after initial irradiation, according to the National Cancer Institute Common Toxicity Criteria version 2. Results. In the high-dose CRT group, anorexia during the first 5 weeks, leukopenia after 5 weeks, and weight loss after 3 weeks were significantly higher than those in the RT alone group. In the low-dose CRT group, anorexia between 1 and 2 weeks, leukopenia after 5 weeks, and weight loss between 3 and 4 weeks were significantly higher than those in the RT alone group. Diarrhea between 1 and 2 weeks in the high-dose CRT group ( P = 0.037, P = 0.025) and between 2 and 3 weeks in the low-dose CRT group ( P = 0.015, P = 0.036) was significantly lower compared with RT alone. Conclusion. These data can help us understand when patients are likely to develop maximal toxicities and to manage them with optimal timing.

Oxygenated and reoxygenated tumors show better local control in radiation therapy for cervical cancer

The presence of hypoxic cells is one of the major factors affecting resistance against radiation therapy. In the clinical setting, little information exists as to the relationship between intratumoral oxygen partial pressure (pO(2)) and outcome. This study involved 30 consecutive patients with cervical cancer, who were treated with a combination of external and high-dose rate intracavitary irradiation. The pO(2) was measured before radiation therapy and at 9 Gy, using a needle-type polarographic oxygen electrode. The mean intratumoral pO(2) before radiation therapy was 17.3 +/- 10.8 mm Hg. The 3-year local control rates of patients with pO(2)< or = 20 mm Hg and pO(2) > 20 mm Hg before radiation therapy were 52% and 100%, respectively, representing a significant difference (P= 0.035). At 9 Gy, mean intratumoral pO(2) was 23.6 +/- 9.1 mm Hg, a significant increase compared to the value before radiation therapy (P= 0.006). The 3-year local control rates of tumors with pO(2)< or = 20 mm Hg and pO(2) > 20 mm Hg at 9 Gy were 35% and 93%, respectively, representing a significant difference (P= 0.001). The significantly better local control for oxygenated tumors at 9 Gy as well as before radiation therapy indicated that the oxygen effect and reoxygenation by radiation played an important role in local control in radiation therapy for cervical cancer.

Oxygenated and reoxygenated tumors show better local control in radiation therapy for cervical cancer

The presence of hypoxic cells is one of the major factors affecting resistance against radiation therapy. In the clinical setting, little information exists as to the relationship between intratumoral oxygen partial pressure (pO2) and outcome. This study involved 30 consecutive patients with cervical cancer, who were treated with a combination of external and high–dose rate intracavitary irradiation. The pO2was measured before radiation therapy and at 9 Gy, using a needle-type polarographic oxygen electrode. The mean intratumoral pO2before radiation therapy was 17.3 ± 10.8 mm Hg. The 3-year local control rates of patients with pO2≤ 20 mm Hg and pO2&gt; 20 mm Hg before radiation therapy were 52% and 100%, respectively, representing a significant difference (P= 0.035). At 9 Gy, mean intratumoral pO2was 23.6 ± 9.1 mm Hg, a significant increase compared to the value before radiation therapy (P= 0.006). The 3-year local control rates of tumors with pO2≤ 20 mm Hg and pO2&gt; 20 mm Hg at 9 Gy were 35% and 93%, respectively, representing a significant difference (P= 0.001). The significantly better local control for oxygenated tumors at 9 Gy as well as before radiation therapy indicated that the oxygen effect and reoxygenation by radiation played an important role in local control in radiation therapy for cervical cancer.

External-beam boost is an equivalently effective alternative to intracavitary radiotherapy in cervical cancer patients with involved vaginal resection margin after radical hysterectomy

Adjuvant radiotherapy (RT) was used for cervical cancer patients who had risk factors after radical hysterectomy. For a subgroup with involved vaginal resection margin (VRM), we usually add low dose rate intracavitary radiotherapy (ICR) to pelvic RT. However, some patients received external-beam boost (EBB) to VRM instead of ICR. We compared outcome of patients receiving EBB to that of those receiving ICR.

High-dose rate versus low-dose rate intracavitary radiotherapy in the treatment of cervical carcinoma: a meta-analysis

Purpose/Objective: Controversy still persists regarding the clinical efficacy of high dose rate (HDR) intracavitary radiotherapy (ICR), which was introduced in early 1960s, compared with conventional low dose rate (LDR) ICR in the treatment of cervical carcinoma. We performed meta-analysis to determine the effectiveness of HDR ICR compared to LDR ICR for overall survival, disease free survival, local recurrence, and complication rate of rectum and bladder in the treatment of cervical carcinoma.

498 High-dose rate versus low-dose rate intracavitary radiotherapy in the treatment of cervical carcinoma: a meta-analysis

Spinal cord arteriovenous malformations (AVM) are rare lesions associated with recurrent hemorrhage and progressive ischemia. Occasionally a favorable location, size or vascular anatomy may allow management with endovascular embolization and/or microsurgical resection. For most, however, there is no good treatment option. Between 1997 and 2014, we treated 37 patients (19 females, 18 males, median age 30 years) at our institution diagnosed with intramedullary spinal cord AVM (19 cervical, 12 thoracic, and six conus medullaris) with CyberKnife (Accuray, Sunnyvale, CA, USA) stereotactic radiosurgery. A history of hemorrhage was present in 50% of patients. The mean AVM volume of 2.3 cc was treated with a mean marginal dose of 20.5 Gy in a median of two sessions. Clinical and MRI follow-up were carried out annually, and spinal angiography was repeated at 3 years. We report an overall obliteration rate of 19% without any post-treatment hemorrhagic events. In those AVM that did not undergo obliteration, significant volume reduction was noted at 3 years. Although the treatment paradigm for spinal cord AVM continues to evolve, radiosurgical treatment is capable of safely obliterating or significantly shrinking most intramedullary spinal cord AVM.

Measurement of serum squamous cell carcinoma antigen levels as a predictor of radiation response in patients with carcinoma of the uterine cervix.

Optimal timing of the measurement of serum squamous cell carcinoma (SCC) antigen during radiation therapy (RT) and its significance for predicting the response of cervical carcinoma patients as early as possible remain unknown. Sixty-three patients with SCC of the uterine cervix who received RT only were studied. Patients were treated with a combination of external beam irradiation and high-dose rate intracavitary irradiation. The serum SCC antigen level was measured before, every 2 or 3 weeks during, and 1 or 2 months after RT. Clinical outcome was divided into complete response and incomplete response. Forty-seven patients (74.6%) had serum SCC antigen levels 1.5 ng/mL (the reference value) before RT. Normalization of serum SCC antigen levels at the end of RT were found to be significantly correlated with complete response in the SCC-positive patients. It was especially noted that in patients with serum SCC levels between 5-30 ng/mL before RT, a > 70% decrease in the serum SCC antigen level at 4 weeks was correlated significantly with complete response. In this group, a significant correlation also was found between a > 70% decrease in serum SCC level at 4 weeks and the normalization of SCC at the end of RT. The current study data suggest that the serum SCC antigen level not only before, but also during and at the end of RT can predict the response of patients with cervical carcinoma and help in identifying those patients who are at high risk of local recurrence and/or distant metastasis.

In vivo dosimetric analysis between rectal dose and rectal complication in patients with cervix cancer treated with high dose rate intracavitary radiotherapy

In vivo dosimetric analysis between rectal dose and rectal complication in patients with cervix cancer treated with high dose rate intracavitary radiotherapy

High versus low dose rate intracavitary irradiation for adenocarcinoma of the uterine cervix.

Traditionally, low dose rate (LDR) brachytherapy has been used as a standard modality in the treatment of patients with carcinoma of the uterine cervix. The purpose of this work was to evaluate the effects of high dose rate (HDR) brachytherapy on patients with adenocarcinoma of the uterine cervix and to compare them with the effects of LDR brachytherapy. From January 1971 to December 1992, 104 patients suffering from adenocarcinoma of the uterine cervix were treated with radiation therapy in the Department of Radiation Oncology, Yonsei University. LDR brachytherapy was carried out on 34 patients and HDR brachytherapy on 70 patients. In the LDR group, eight patients were in stage IB, six in IIA, 12 in IIB, three in IIIA and five in IIIB. External radiation therapy was delivered with 10 MV X-rays, 2 Gy fraction per day, total dose of whole pelvis 36-52 Gy (median 46 Gy). LDR radium intracavitary irradiation was performed with a Henschke applicator, 37-59 Gy targeted at point A (median 43 Gy). In the HDR group, there were 16 patients in stage IB, six in IIA, 32 in IIB and 16 in IIIB. The total whole pelvis dose of external radiation was 40-50 Gy (median 44 Gy), daily 1.8-2.0 Gy. HDR Co-60 intracavitary irradiation was performed with a remotely controlled after-loading system (RALS), 30-48 Gy (median 39 Gy) targeted at point A, three times per week, 3 Gy per fraction. The 5-year overall survival rate in the LDR group was 72.9, 61.9 and 35.7% in stage I, II and III, respectively and the corresponding figures for HDR were 87.1, 58.3 and 43.8% (p > 0.05). There was no statistical difference between the HDR group and the LDR group in terms of the 5-year overall survival rate from adenocarcinoma of the uterine cervix. There was a late complication rate of 12% in the LDR group and 27% in the HDR group. The incidence of late complications in stages II and III was higher in the HDR group than in the LDR group (31.6 vs 16.7% in stage II, 37.3% vs 12.5% in stage III, p > 0.05). No prognostic factors were evident in the comparison between the two groups. There was no difference in terms of 5-year survival rate in the patients with adenocarcinoma of the uterine cervix between those treated with HDR and those treated with LDR brachytherapy. Even though late complication rates were higher in the HDR group, most of them were classified as grade I. This retrospective study suggests that HDR brachytherapy may be able to replace LDR brachytherapy in the treatment of adenocarcinoma of the uterine cervix.

461 poster Combined external beam and low dose rate intracavitary radiotherapy for carcinoma of the esophagus

461 poster Combined external beam and low dose rate intracavitary radiotherapy for carcinoma of the esophagus

2085 Risk of late rectal complications following definitive external radiotherapy and high dose rate intracavitary irradiation for figo stage IIB carcinoma of the uterine cervix

2085 Risk of late rectal complications following definitive external radiotherapy and high dose rate intracavitary irradiation for figo stage IIB carcinoma of the uterine cervix

2083 High-dose rate intracavitary irradiation using linear source arrangement for squamous cell carcinoma of the uterine cervix

2083 High-dose rate intracavitary irradiation using linear source arrangement for squamous cell carcinoma of the uterine cervix

The adverse effect of treatment prolongation in cervical carcinoma

Purpose : Proliferation of surviving tumor clonogens during a course of protracted radiation therapy may be a cause of local failure in cervical carcinoma. The effect of total treatment time was analyzed retrospectively in relation to pelvic control and overall survival for squamous cell carcinomas of the uterine cervix. Methods and Materials : Two hundred and nine patients (Stage IB-IIIB) treated with a combination of external beam and low dose rate intracavitary irradiation were evaluable for study. Multivariate analysis and Kaplan-Meier statistical methods were used to determine the effect of treatment time on pelvic control and survival at 5 years. Results : The median treatment duration was 55 days. For all stages combined, the 5-year survival and pelvic control rates were significantly different with treatment times < days vs. ≥ 55 days 65 and 54% ( p = 0.03), 87 and 72% ( p = 0.006), respectively. By stage, a shorter treatment duration (i.e., < 55 days vs. ≥ 55 days) was significant for 5-year overall survival and pelvic control for Stages IB/IIA and III, but not for Stage IIB: Stage IB/IIA (81 and 67%, and 84%), Stage III disease (52 and 42%, 76 and 55%) and Stage IIB (43 and 50%, 74 and 80%, respectively). Survival decreased 0.6%/day and pelvic control decreased 0.7%/day for each additional day of treatment beyond 55 days for all stages of disease. Additionally, significantly late complications were not influenced by treatment time. Conclusion : These results that prolongation of treatment time is associated with decreased local control and survival in patients with cervical carcinoma. This is consistent with emerging data from other institutions. Therapeutic implications include avoidance of unnecessary treatment breaks, the design of fractionation schemes that decrease treatment duration, and possibly the use of tumor cytostatic drugs during conventional radiation.

Remote afterloading system radiotherapy through sphenoid sinus for T4 nasopharyngeal cancer

In the therapy of nasopharyngeal cancer (NPC), when the tumor remains at the primary site after a radical course of external beam irradiation (60 to 70 Gy), both additional external beam therapy with a reduced field and high dose rate intracavitary irradiation through the nasopharynx by a remote afterloading system (RALS)le3 have been reported. However, when the tumor remains in the intracranial region, increasing the external beam dose may lead to lethal complications,4.5 and the RALS therapy through the nasopharynx is not available because the tumor is distant from the source, and the dose distributed to the tumor is insufficient for cure. To salvage such cases, the investigators applied RALS therapy through the sphenoid sinus to locate the source closer to the tumor. Good results were obtained.

Evaluation of external beam therapy and three brachytherapy fractions for carcinoma of the uterine cervix

Purpose : A retrospective analysis was performed to evaluate external beam therapy and three brachytherapy fractions for patients with squamous cell carcinoma of the uterine cervix, compared with those with other histological types. Methods and Materials : Three hundred and twenty-two patients with carcinoma of the uterine cervix received external pelvic irradiation combined with three sessions of low dose rate intracavitary irradiation within 6 weeks. Two hundred and ninety-three patients had squamous cell carcinoma (SCC), whereas 29 patients had nonsquamous cell histology (N-SCC): 18 had adenocarcinoma, 5 had undifferentiated carcinoma, 4 had adenosquamous carcinoma, and 2 had adenoacanthoma. Survival rates, patterns of failure, local control rates, and complications in the patients with SCC were compared with those in the patients with N-SCC. Results : The 5-year overall actuarial survival rates for the patients with SCC and for those with N-SCC were: 84% and 100% in Stage I disease, 72% and 38% in Stage II disease, 52% and 17% in Stage III disease, and 29% and 0% in Stage IV disease, respectively. The 5-year cause specific survival rates for the patients with SCC in Stages I to IV disease were 100%, 87%, 72%, and 39%. Corresponding rates for the patients with N-SCC were 100%, 43%, 25%, and 0%. There was a statistically significant difference between the survival curves for two histological types in Stage II B, III B, and IV A diseases. The local control for the patients with N-SCC was worse than in the patients with SCC. The crude moderate and severe rectal complication rates (Grades 3 and 4) for the patients with SCC and for the patients with N-SCC were 7.5% and 3.4%, respectively. Only one patient with SCC developed chronic small intestinal injury in this series. We observed four patients with SCC who developed Grade 2 and four with Grade 4 urinary bladder complications. Conclusions : Three sessions of intracavitary brachytherapy were a safe and effective procedure for the patients with SCC and the outcome of radiation therapy in the patients with SCC was satisfactory even in advanced cases. However, local control of N-SCC is difficult to achieve by this method and the prognosis for patients with N-SCC was significantly worse than that for patients with SCC.

Basic and clinical study of high dose rate intracavitary radiotherapy of bladder tumor

Since 1984, through 8 years, 29 cases of bladder tumor were treated with high dose rate intracavitary radiotherapy. All cases were transitional cell carcinoma in histology and consisted of 12 cases of CIS, 7 of Ta, 3 of T1, 1 of T2 and 6 of T3. At the intracavitary therapy, 3-way catheter made specially for high dose rate intracavitary radiotherapy was inserted into the bladder and the balloon of the catheter was inflated with air of 80 to 100 ml. A radioactive source of 60Co was remotely controlled and drove through the catheter into the bladder. The delivered dose was 5 Gy per fraction and total dose was 40 to 50 Gy in 8 to 10 fractions. Complete response (CR) rate was 7/12 (58.3%) in CIS, 4/6 in Ta, 1/3 in T1, 1/1 in T2 and 1/6 in T3. CR rate of CIS and superficial tumor (Ta, T1) was 57.1% (12/21), whereas that of invasive cancer was 2/7. Regarding complications, one case suffered severe cystitis as an acute reaction, however, the remaining cases only noted a mild or moderate acute reaction. It was concluded that high dose rate intracavitary radiotherapy was a useful treatment for CIS of the bladder and superficial bladder cancer.