open access

Vol 23, No 6 (2018)
Special Issue Papers
Published online: 2018-11-01
Submitted: 2018-06-22
Get Citation

Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra

Elena Villafranca, Paola Navarrete, Amaya Sola, Juan Carlos Muruzabal, Sara Aguirre, Santiago Ostiz, Carmen Sanchez, Rosa Guarch, Nuria Lainez, Marta Barrado
DOI: 10.1016/j.rpor.2018.09.006
·
Rep Pract Oncol Radiother 2018;23(6):510-516.

open access

Vol 23, No 6 (2018)
Special Issue Papers
Published online: 2018-11-01
Submitted: 2018-06-22

Abstract

Purpose

To evaluate dosimetric and clinical findings of MRI-guided HDR brachytherapy (HDR-B) for cervical carcinoma.

Material and methods

All patients had a CT, MRI and pelvic-paraaortic lymphadenectomy. Treatment: pelvic (+/−)para-aortic3D/IMRT radiotherapy (45Gy), weekly cisplatin and HDR-B and pelvic node/parametrial boost 60Gy until interstitial brachytherapy was done. Two implants: 2008–2011: 5 fractions of 6Gy, 2011: 2016, 4 fractions of 7Gy. MRI/TAC were done in each implant. The following were defined: GTV, CTH-HR, CTV-IR; OAR: rectum, bladder and sigmoid.

Results

From 2007 to 2016: 57 patients. Patients: T1b2-T2a: 4p, T2b 41p, T3a: 2p; T3B 8p T4a: 2p; N0: 32p, N1 21p, no lymphadenectomy: 4p. Median follow up: 74.6m (16–122m), recurrence: 5p local, 6p node, 9p metastasis and 37p without recurrence.

Local control 5 years: 90.1%; Ib2-IIB: 94.8%, III-IVa: 72.2%. (p:0.01). RDFS 5y was 92.5%; IB2-IIB: 93%, III: 85% (p:0.024); for pN0: 100%; pN+ iliac-paraaortic: 71.4% (p: 0.007). MFS 5y was 84.1%. Overall survival (OS) at 5y: 66.6% and the cancer specific survival (CEOS) was 74%. Univariate analysis survival: stage Ib2-II 83% vs. III-IVa 41% (p=0.001); histology: squamous 78%, adenocarcinoma 59.7% (p: ns); lymph node: N0 85% vs. PA+P− 72%, and PA+P+ 35% (p=0.010). In relation with: HR-CTV dose>85Gy, CEOS: 82.5% vs. 77%, and volume CTV-HR<30 cc: 81.8% and >30 cc: 67%; p: ns. Acute grade 2–3 toxicity: rectal 15.7%, intestinal 15.7% and vesical 15.5%.

Conclusion

Use of interstitial HDR-BQ guided by RM increased CTV-HR dose and local control, like EMBRACE results. Nodal boost improves RDFS and perhaps OS.

Abstract

Purpose

To evaluate dosimetric and clinical findings of MRI-guided HDR brachytherapy (HDR-B) for cervical carcinoma.

Material and methods

All patients had a CT, MRI and pelvic-paraaortic lymphadenectomy. Treatment: pelvic (+/−)para-aortic3D/IMRT radiotherapy (45Gy), weekly cisplatin and HDR-B and pelvic node/parametrial boost 60Gy until interstitial brachytherapy was done. Two implants: 2008–2011: 5 fractions of 6Gy, 2011: 2016, 4 fractions of 7Gy. MRI/TAC were done in each implant. The following were defined: GTV, CTH-HR, CTV-IR; OAR: rectum, bladder and sigmoid.

Results

From 2007 to 2016: 57 patients. Patients: T1b2-T2a: 4p, T2b 41p, T3a: 2p; T3B 8p T4a: 2p; N0: 32p, N1 21p, no lymphadenectomy: 4p. Median follow up: 74.6m (16–122m), recurrence: 5p local, 6p node, 9p metastasis and 37p without recurrence.

Local control 5 years: 90.1%; Ib2-IIB: 94.8%, III-IVa: 72.2%. (p:0.01). RDFS 5y was 92.5%; IB2-IIB: 93%, III: 85% (p:0.024); for pN0: 100%; pN+ iliac-paraaortic: 71.4% (p: 0.007). MFS 5y was 84.1%. Overall survival (OS) at 5y: 66.6% and the cancer specific survival (CEOS) was 74%. Univariate analysis survival: stage Ib2-II 83% vs. III-IVa 41% (p=0.001); histology: squamous 78%, adenocarcinoma 59.7% (p: ns); lymph node: N0 85% vs. PA+P− 72%, and PA+P+ 35% (p=0.010). In relation with: HR-CTV dose>85Gy, CEOS: 82.5% vs. 77%, and volume CTV-HR<30 cc: 81.8% and >30 cc: 67%; p: ns. Acute grade 2–3 toxicity: rectal 15.7%, intestinal 15.7% and vesical 15.5%.

Conclusion

Use of interstitial HDR-BQ guided by RM increased CTV-HR dose and local control, like EMBRACE results. Nodal boost improves RDFS and perhaps OS.

Get Citation

Keywords

Cervix; Cancer; Brachytherapy; IG-HDR; MRI; IMRT

About this article
Title

Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 23, No 6 (2018)

Pages

510-516

Published online

2018-11-01

DOI

10.1016/j.rpor.2018.09.006

Bibliographic record

Rep Pract Oncol Radiother 2018;23(6):510-516.

Keywords

Cervix
Cancer
Brachytherapy
IG-HDR
MRI
IMRT

Authors

Elena Villafranca
Paola Navarrete
Amaya Sola
Juan Carlos Muruzabal
Sara Aguirre
Santiago Ostiz
Carmen Sanchez
Rosa Guarch
Nuria Lainez
Marta Barrado

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl