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C Haiemeder - One of the best experts on this subject based on the ideXlab platform.
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physics contributions and clinical outcome with 3d mri based pulsed dose rate Intracavitary Brachytherapy in cervical cancer patients
International Journal of Radiation Oncology Biology Physics, 2009Co-Authors: Cyrus Chargari, Nicolas Magne, Isabelle Dumas, T Messai, Lisa Vicenzi, Norman Gillion, Philippe Morice, C HaiemederAbstract:Purpose 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. Methods and Materials 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. Results 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 α/β10 and 63.5 Gy α/β10 for the intermediate-risk clinical target volume and 61.6 Gy α/β10 and 74.9 Gy α/β10 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. Conclusion 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.
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inverse planning approach for 3 d mri based pulse dose rate Intracavitary Brachytherapy in cervix cancer
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: E Chajon, I Dumas, Mahmoud Touleimat, Nicolas Magne, Jeremy Coulot, R Verstraet, Dimitri Lefkopoulos, C HaiemederAbstract:Purpose The purpose of this study was to evaluate the inverse planning simulated annealing (IPSA) software for the optimization of dose distribution in patients with cervix carcinoma treated with MRI-based pulsed-dose rate Intracavitary Brachytherapy. Methods and Materials Thirty patients treated with a technique using a customized vaginal mold were selected. Dose-volume parameters obtained using the IPSA method were compared with the classic manual optimization method (MOM). Target volumes and organs at risk were delineated according to the Gynecological Brachytherapy Group/European Society for Therapeutic Radiology and Oncology recommendations. Because the pulsed dose rate program was based on clinical experience with low dose rate, dwell time values were required to be as homogeneous as possible. To achieve this goal, different modifications of the IPSA program were applied. Results The first dose distribution calculated by the IPSA algorithm proposed a heterogeneous distribution of dwell time positions. The mean D90, D100, and V100 calculated with both methods did not differ significantly when the constraints were applied. For the bladder, doses calculated at the ICRU reference point derived from the MOM differed significantly from the doses calculated by the IPSA method (mean, 58.4 vs. 55 Gy respectively; p = 0.0001). For the rectum, the doses calculated at the ICRU reference point were also significantly lower with the IPSA method. Conclusions The inverse planning method provided fast and automatic solutions for the optimization of dose distribution. However, the straightforward use of IPSA generated significant heterogeneity in dwell time values. Caution is therefore recommended in the use of inverse optimization tools with clinical relevance study of new dosimetric rules.
Takafumi Toita - One of the best experts on this subject based on the ideXlab platform.
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national survey of Intracavitary Brachytherapy for intact uterine cervical cancer in japan
Journal of Radiation Research, 2018Co-Authors: Takafumi Toita, Kazuhiko Ogawa, Hiroshi Onishi, Tatsuya Ohno, Hitoshi Ikushima, Tetsuo Nishimura, Takashi Uno, Takushi Dokiya, Jun ItamiAbstract:To review the current status of, and labor expended for (in terms of time required), Intracavitary Brachytherapy (ICBT) in definitive radiotherapy/chemoradiotherapy for cervical cancer patients, two national surveys were performed. The first survey was conducted between July and August 2016 and consisted of a questionnaire of 12 items regarding ICBT procedures for cervical cancer, which was sent to 173 centers installed with high-dose-rate remote after-loading Brachytherapy systems. Between November and December 2016, another survey was performed in 79 centers to evaluate labor required for ICBT procedures in terms of time spent and number of staff involved. In the first survey, the response rate was 77% of the 173 centers. ICBT was performed for cervical cancer in 118 (89%) centers. Imaging modalities used after applicator insertion were X-ray alone in 46 (40%), computed tomography in 69 (60%) and magnetic resonance imaging in 5 (4%) centers. Three-dimensional (3D) planning was performed in 55 centers (48%). Fifty-five (70%) centers responded to the second survey regarding ICBT-mandated labor. The median cumulative duration of the entire ICBT procedure was 330 min (the sum of the times spent by each staff member) and was longer in the 3D image-guided Brachytherapy (3D-IGBT) (405 min) than in the X-ray group (230 min). This trend was significant for the specific processes of image acquisition and treatment planning, especially for radiation oncologists. In definitive radiotherapy/chemoradiotherapy for cervical cancer patients, 3D-IGBT use has been gradually spreading in Japan. The present survey revealed that ICBT, especially 3D-IGBT, requires substantial labor and time from staff.
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phase ii study of concurrent chemoradiotherapy with high dose rate Intracavitary Brachytherapy in patients with locally advanced uterine cervical cancer efficacy and toxicity of a low cumulative radiation dose schedule
Gynecologic Oncology, 2012Co-Authors: Takafumi Toita, Ryo Kitagawa, Tetsutaro Hamano, Kenji Umayahara, Yasuyuki Hirashima, Yoichi Aoki, Masahiko Oguchi, Mikio Mikami, Ken TakizawaAbstract:Abstract Objective A multicenter phase II trial was conducted to assess the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) using a low cumulative prescribed dose schedule in patients with locally advanced uterine cervical cancer. Methods The Japanese Gynecologic Oncology Group (JGOG) study JGOG1066 enrolled patients with FIGO stages III–IVA uterine cervical cancer who had no para-aortic lymphadenopathy (>10mm) assessed by CT. Patients received definitive radiotherapy (RT) consisting of external beam whole pelvic RT and HDR-ICBT. The cumulative linear quadratic equivalent dose (EQD2) was 62–65Gy prescribed at point A. Cisplatin 40mg/m 2 weekly was administered concurrently with RT for 5 courses. Results Of the 72 patients registered, 71 were eligible. With a median follow-up of 28months, the 2-year progression-free survival rate and pelvic disease progression-free rate were 66% (95% CI, 54% to 76%) and 73% (95% CI, 61% to 82%), respectively. Progression-free survival decreased significantly with increased central tumor size (P=0.036). The 2-year cumulative late complication rates were 24% for all grades, 9% for grade 1, 12% for grade 2, 3% for grade 3, and 0 for grades 4/5. Conclusions The JGOG1066 demonstrated that CCRT using HDR-ICBT with a low cumulative RT dose schedule achieved comparable outcome as those achieved with global dose schedules (EQD2=85Gy) with a lower incidence of late toxicity for locally advanced uterine cervical cancer in a Japanese population.
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prospective multi institutional study of definitive radiotherapy with high dose rate Intracavitary Brachytherapy in patients with nonbulky 4 cm stage i and ii uterine cervical cancer jarog0401 jrosg04 2
International Journal of Radiation Oncology Biology Physics, 2012Co-Authors: Takafumi Toita, Yuzuru Niibe, Masahiro Kenjo, Tomoko Kazumoto, Shingo Kato, Tatsuya Ohno, Takeshi Kodaira, Masaaki Kataoka, Naoto Shikama, Sunao TokumaruAbstract:Purpose To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size Results Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6–39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7–72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%–100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%–98%) and 95% (95% CI, 89%–100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade ≥1) were 18% (95% CI, 8%–28%) for large intestine/rectum, 4% (95% CI, 0%–8%) for small intestine, and 0% for bladder. No Grade ≥3 cases were observed for genitourinary/gastrointestinal late complications. Conclusions These results suggest that definitive radiotherapy using HDR-ICBT with a low cumulative dose schedule (BED, 62 Gy10 at point A) can provide excellent local control without severe toxicity in nonbulky (
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Concurrent chemoradiotherapy using high-dose-rate Intracavitary Brachytherapy for uterine cervical cancer
Gynecologic oncology, 2005Co-Authors: Takafumi Toita, Hidehiko Moromizato, Kazuhiko Ogawa, Yasumasa Kakinohana, Toshiyuki Maehama, Koji Kanazawa, Sadayuki MurayamaAbstract:Abstract Objective We retrospectively reviewed our experience with concurrent chemoradiotherapy (CCRT) using high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) to assess its feasibility and efficacy in the treatment of patients with uterine cervical cancer. Methods Forty patients with uterine cervical squamous cell carcinoma treated with CCRT using HDR-ICBT were analyzed. The median cervical tumor size assessed by MRI was 63 mm (range: 40–86 mm). Eighteen patients (45%) had enlarged pelvic nodes on MRI (≥10 mm). Cisplatin (20 mg/m 2 /day) was concurrently administered with radiotherapy for 5 days at 21-day intervals for a median of three courses (range: 1–5 courses). Thirty-eight (95%) patients received whole pelvic external beam radiotherapy (EBRT) with 40 Gy/20 fractions followed by HDR-ICBT with 18 Gy/3 fractions to point A. Subsequently, additional pelvic EBRT with 10 Gy/5 fractions was delivered with a midline block. The cumulative biological effective dose (BED) at point A of this schedule was 77 Gy 10 . The median follow-up period for all 40 patients was 37 months (range: 8–71 months). Results Grade 3/4 leukopenia was the most common acute side effect (83%). The actuarial 3-year pelvic control rate, disease-free survival rate, and overall survival rate were 91%, 67%, and 79%, respectively. Eight (20%) patients suffered late gastrointestinal complications (all grades). No patient suffered radiation cystitis (all grades). Only one patient experienced grade 3 complication (enterocolitis). The actuarial 3-year late complication rate (all grades) was 9% for proctitis and 15% for enterocolitis. Conclusion This preliminary study suggests that CCRT using HDR-ICBT is feasible and efficacious for patients with locoregionally advanced uterine cervical cancer.
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combination external beam radiotherapy and high dose rate Intracavitary Brachytherapy for uterine cervical cancer analysis of dose and fractionation schedule
International Journal of Radiation Oncology Biology Physics, 2003Co-Authors: Takafumi Toita, Hidehiko Moromizato, Kazuhiko Ogawa, Yasumasa Kakinohana, Toshiyuki Maehama, Koji Kanazawa, Kaoru Sakumoto, Genki Adachi, Yutaka Nagai, Sadayuki MurayamaAbstract:Abstract Purpose To determine an appropriate dose and fractionation schedule for a combination of external beam radiotherapy (EBRT) and high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) for uterine cervical cancer. Methods Eighty-eight patients with uterine cervical squamous cell carcinoma treated with EBRT and HDR-ICBT were analyzed. Twenty-five patients were classified as early disease (nonbulky Stage I/II, less than 4-cm diameter) and 63 patients as advanced disease (greater than 4 cm diameter or Stage IIIB) according to the American Brachytherapy Society definition. Tumor diameter was measured by MRI. Pelvic EBRT was delivered before applications of ICBT. HDR-ICBT was performed once a week, with a fraction point A dose of 6 Gy. Source loadings corresponded to the Manchester System for uterine cervical cancer. No planned optimization was done. A Henschke-type applicator was mostly used (86%). Median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 64.8 Gy 10 (range: 48–76.8 Gy 10 ) for early disease, and 76.8 Gy 10 (range: 38.4–86.4 Gy 10 ) for advanced disease. Median cumulative BED at ICRU 38 reference points (EBRT + ICBT) was 97.7 Gy 3 (range: 59.1–134.4 Gy 3 ) at the rectum, 97.8 Gy 3 (range: 54.6–130.4 Gy 3 ) at the bladder, and 324 Gy 3 (range: 185.5–618 Gy 3 ) at the vagina. Actuarial pelvic control rate and late complication rate were analyzed according to cumulative dose and calculated BED. Results The 3-year actuarial pelvic control rate was 82% for all 88 patients: 96% for those with early disease, and 76% for advanced disease. For pelvic control, no significant dose–response relationship was observed by treatment schedules and cumulative BED at point A for both early and advanced disease. The 3-year actuarial late complication rates (Grade ≥1) were 12% for proctitis, 11% for cystitis, and 14% for enterocolitis. There were significant differences on the incidence of proctitis ( p p 10 at point A suffered both proctitis and enterocolitis. Patients with cumulative BED at rectal point of ≥100 Gy 3 had significantly higher incidence of proctitis (31% vs. 4%, p = 0.013). Conclusions In view of the therapeutic ratio, cumulative BED 70–80 Gy 10 at point A is appropriate for uterine cervical cancer patients treated with a combination of EBRT and HDR-ICBT. Present results and data from other literatures suggested that cumulative BED at the rectal point should be kept below 100–120 Gy 3 to prevent late rectal complication.
B Micaily - One of the best experts on this subject based on the ideXlab platform.
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image guided high dose rate Intracavitary Brachytherapy in the treatment of medically inoperable early stage endometrioid type endometrial adenocarcinoma
Brachytherapy, 2017Co-Authors: Scott Jordan, Ida Micaily, Enrique Hernandez, Stuart J Ferriss, C Miyamoto, B MicailyAbstract:Abstract Purpose The purpose of this case series is to describe the treatment and outcomes of a cohort of patients with inoperable early-stage endometrioid endometrial cancer with 3D image-guided high-dose-rate (HDR) Intracavitary Brachytherapy. Materials and Methods A review was performed of patients with early-stage endometrial cancer who underwent primary radiation treatment between 2010 and 2016. Staging and treatment planning were performed CT, pelvic ultrasound, and pelvic MRI. Gross tumor volume (GTV) was defined as the MRI or ultrasound demonstrated endometrial stripe width, with the entire uterine corpus, cervix, and proximal vagina representing the clinical target volume (CTV). Dosimetry calculations were performed in each fraction of HDR Brachytherapy. RESULTS Eight patients received external beam radiation therapy followed by Intracavitary HDR Brachytherapy. Seven patients underwent Intracavitary HDR Brachytherapy alone. In all patients, mean cumulative dose to 90% (D90) of GTV was 95.99 Gy in equivalent dose in 2 Gy fractions (EQD2, α/β = 10). Mean cumulative D90 EQD2 to CTV was 51.64 Gy. Average follow-up was 29 months. Four patients died from concurrent disease(s) at an average of 2.83 years after completion of treatment. Except for 1 (6.6%) patient who recurred at 9 months following completion of treatment, all patients remained disease-free for the remainder of follow-up. Conclusions In patients who are poor surgical candidates and have early-stage endometrioid type endometrial carcinoma, image-guided HDR Intracavitary Brachytherapy carries minimal side effects and a high response rate.
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use of image guided stereotactic body radiation therapy in lieu of Intracavitary Brachytherapy for the treatment of inoperable endometrial neoplasia
International Journal of Radiation Oncology Biology Physics, 2013Co-Authors: Eric Kemmerer, Enrique Hernandez, C Miyamoto, James S Ferriss, Vladimir Valakh, B MicailyAbstract:Purpose Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or Brachytherapy. Methods and Materials We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or Intracavitary Brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction × 5). Results The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.
Sadayuki Murayama - One of the best experts on this subject based on the ideXlab platform.
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Concurrent chemoradiotherapy using high-dose-rate Intracavitary Brachytherapy for uterine cervical cancer
Gynecologic oncology, 2005Co-Authors: Takafumi Toita, Hidehiko Moromizato, Kazuhiko Ogawa, Yasumasa Kakinohana, Toshiyuki Maehama, Koji Kanazawa, Sadayuki MurayamaAbstract:Abstract Objective We retrospectively reviewed our experience with concurrent chemoradiotherapy (CCRT) using high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) to assess its feasibility and efficacy in the treatment of patients with uterine cervical cancer. Methods Forty patients with uterine cervical squamous cell carcinoma treated with CCRT using HDR-ICBT were analyzed. The median cervical tumor size assessed by MRI was 63 mm (range: 40–86 mm). Eighteen patients (45%) had enlarged pelvic nodes on MRI (≥10 mm). Cisplatin (20 mg/m 2 /day) was concurrently administered with radiotherapy for 5 days at 21-day intervals for a median of three courses (range: 1–5 courses). Thirty-eight (95%) patients received whole pelvic external beam radiotherapy (EBRT) with 40 Gy/20 fractions followed by HDR-ICBT with 18 Gy/3 fractions to point A. Subsequently, additional pelvic EBRT with 10 Gy/5 fractions was delivered with a midline block. The cumulative biological effective dose (BED) at point A of this schedule was 77 Gy 10 . The median follow-up period for all 40 patients was 37 months (range: 8–71 months). Results Grade 3/4 leukopenia was the most common acute side effect (83%). The actuarial 3-year pelvic control rate, disease-free survival rate, and overall survival rate were 91%, 67%, and 79%, respectively. Eight (20%) patients suffered late gastrointestinal complications (all grades). No patient suffered radiation cystitis (all grades). Only one patient experienced grade 3 complication (enterocolitis). The actuarial 3-year late complication rate (all grades) was 9% for proctitis and 15% for enterocolitis. Conclusion This preliminary study suggests that CCRT using HDR-ICBT is feasible and efficacious for patients with locoregionally advanced uterine cervical cancer.
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combination external beam radiotherapy and high dose rate Intracavitary Brachytherapy for uterine cervical cancer analysis of dose and fractionation schedule
International Journal of Radiation Oncology Biology Physics, 2003Co-Authors: Takafumi Toita, Hidehiko Moromizato, Kazuhiko Ogawa, Yasumasa Kakinohana, Toshiyuki Maehama, Koji Kanazawa, Kaoru Sakumoto, Genki Adachi, Yutaka Nagai, Sadayuki MurayamaAbstract:Abstract Purpose To determine an appropriate dose and fractionation schedule for a combination of external beam radiotherapy (EBRT) and high-dose-rate Intracavitary Brachytherapy (HDR-ICBT) for uterine cervical cancer. Methods Eighty-eight patients with uterine cervical squamous cell carcinoma treated with EBRT and HDR-ICBT were analyzed. Twenty-five patients were classified as early disease (nonbulky Stage I/II, less than 4-cm diameter) and 63 patients as advanced disease (greater than 4 cm diameter or Stage IIIB) according to the American Brachytherapy Society definition. Tumor diameter was measured by MRI. Pelvic EBRT was delivered before applications of ICBT. HDR-ICBT was performed once a week, with a fraction point A dose of 6 Gy. Source loadings corresponded to the Manchester System for uterine cervical cancer. No planned optimization was done. A Henschke-type applicator was mostly used (86%). Median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 64.8 Gy 10 (range: 48–76.8 Gy 10 ) for early disease, and 76.8 Gy 10 (range: 38.4–86.4 Gy 10 ) for advanced disease. Median cumulative BED at ICRU 38 reference points (EBRT + ICBT) was 97.7 Gy 3 (range: 59.1–134.4 Gy 3 ) at the rectum, 97.8 Gy 3 (range: 54.6–130.4 Gy 3 ) at the bladder, and 324 Gy 3 (range: 185.5–618 Gy 3 ) at the vagina. Actuarial pelvic control rate and late complication rate were analyzed according to cumulative dose and calculated BED. Results The 3-year actuarial pelvic control rate was 82% for all 88 patients: 96% for those with early disease, and 76% for advanced disease. For pelvic control, no significant dose–response relationship was observed by treatment schedules and cumulative BED at point A for both early and advanced disease. The 3-year actuarial late complication rates (Grade ≥1) were 12% for proctitis, 11% for cystitis, and 14% for enterocolitis. There were significant differences on the incidence of proctitis ( p p 10 at point A suffered both proctitis and enterocolitis. Patients with cumulative BED at rectal point of ≥100 Gy 3 had significantly higher incidence of proctitis (31% vs. 4%, p = 0.013). Conclusions In view of the therapeutic ratio, cumulative BED 70–80 Gy 10 at point A is appropriate for uterine cervical cancer patients treated with a combination of EBRT and HDR-ICBT. Present results and data from other literatures suggested that cumulative BED at the rectal point should be kept below 100–120 Gy 3 to prevent late rectal complication.
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high dose rate Intracavitary Brachytherapy for carcinoma in situ of the vagina occurring after hysterectomy a rational prescription of radiation dose
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Yoko Teruya, Takafumi Toita, Hidehiko Moromizato, Kazuhiko Ogawa, Sadayuki Murayama, Kaoru Sakumoto, Koji KanazawaAbstract:Abstract Objective: Our purpose was to profile patients who were treated with high dose-rate Intracavitary Brachytherapy for carcinoma in situ of the vagina that occurred after hysterectomy, with special reference to a rational prescription of radiation dose. Study Design: We reviewed 13 patients who were treated for posthysterectomy carcinoma in situ of the vagina by the Brachytherapy as the sole treatment. The Brachytherapy was delivered by a remote-controlled afterloading Intracavitary radiation system. Results: The mean age of the patients was 62 years. The total dose of absorbed radiation was 36 and 30 Gy that was prescribed at 1.0-cm depth to the vaginal surface in 3 cases and at 40 and 30 Gy that was prescribed at 0.5-cm depth in 10 cases. All patients had vaginal mucosal radiation changes of mild to moderate grade. Three cases that were irradiated to a total dose of 30 Gy at 1.0-cm depth had rectal bleeding and/or macroscopic hematuria. Complaints regarding sexual functioning were not found in this retrospective analysis. All patients remain free of disease after a median follow-up period of 127 months. Conclusion: High dose-rate Brachytherapy with a dose prescription at 0.5-cm depth can yield a promising rate of tumor control, with lower associated morbidity than that with a dose prescription at 1.0-cm depth in the treatment of posthysterectomy carcinoma in situ of the vagina. (Am J Obstet Gynecol 2002;187:360-4.)
Subir Nag - One of the best experts on this subject based on the ideXlab platform.
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Controversies and new developments in gynecologic Brachytherapy: image-based Intracavitary Brachytherapy for cervical carcinoma.
Seminars in radiation oncology, 2006Co-Authors: Subir NagAbstract:The current clinical practice for cervical cancer Intracavitary Brachytherapy in most centers is to prescribe the dose to point A. However, this is an empirical point and does not necessarily reflect dose to the tumor. Although 3-dimensional image-based treatment planning is extensively used in prostate Brachytherapy, only a few institutions have used it to shape the dose distribution in cervical Brachytherapy. To facilitate and standardize image-based dosimetry for cervical cancer Brachytherapy, the American Image-guided Brachytherapy Working Group and the European Gynecological GEC-ESTRO Working Group have recently proposed nomenclature for volume definition and recommendations for image-based Intracavitary Brachytherapy for cervical cancer. The recommendations of the 2 groups are very similar and are discussed together in this article. Proposals are made for research in image-based Brachytherapy for cervical cancer. At a recent transatlantic image-based cervical cancer Brachytherapy workshop (Chicago, IL, July 28, 2005), it was suggested that because the recommendations are so similar and to prevent confusion, the nomenclature suggested by the European Group be adopted and future joint contouring workshops be organized to facilitate image-based cervical cancer Brachytherapy.
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proposed guidelines for image based Intracavitary Brachytherapy for cervical carcinoma report from image guided Brachytherapy working group
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Subir Nag, Higinia R Cardenes, Silvia D Chang, Indra J Das, Beth Erickson, G Ibbott, J Lowenstein, J RollAbstract:Abstract Purpose To present issues to be considered in, and make proposals for, image-based Brachytherapy for cervical cancer. Methods and materials The Image-Guided Brachytherapy Working Group, consisting of representatives from the Gynecology Oncology Group (GOG), Radiologic Physics Center (RPC), American Brachytherapy Society (ABS), American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN), American Association of Physicists in Medicine (AAPM), Radiation Therapy Oncology Group (RTOG), and American Society for Therapeutic Radiology and Oncology (ASTRO), proposed guidelines for image-based Brachytherapy for cervical cancer. This report was based on their aggregate clinical experience and a review of the literature. It reflects only the personal opinions of the authors and is not meant to be an endorsement from any of the above organizations. Results The Group recommended T 2 -weighted MRI using a pelvic surface coil with MRI-compatible Brachytherapy applicators in place for image-based Intracavitary Brachytherapy for cervical cancer. Imaging must be performed with the patient in the treatment position, with all other treatment conditions duplicated as closely as possible. Future use of positron emission tomography or positron emission tomography/CT may obviate the need for special applicators. The group proposed the following terminology for image-based Brachytherapy. The GTV (I) is defined as the gross tumor volume as defined through imaging, GTV is defined as the GTV (I) plus any clinically visualized or palpable tumor extensions, and GTV + cx is defined as the GTV plus the entire cervix. The dose–volume histograms (DVH) of the GTV, GTV (I) , GTV + cx should be performed, and the dose to 100%, 95%, or 90% of the GTV (D 100 , D 95 , and D 90 , respectively) and the percentage of the GTV covered by Point A dose (V 100 ) should be reported. Similarly, the DVH of the bladder and rectum wall should be performed, and the maximal dose at any point within the bladder and rectal wall should be reported, along with the maximal dose to a contiguous 1, 2, and 5 cm 3 volume of the bladder and rectum, respectively. In addition, the dose at the International Commission on Radiation Units and Measurements reference point for the bladder and rectum should be reported. The Group thought that the current dose prescription method in use for cervical cancer Brachytherapy (i.e., to prescribe to Point A in most institutions) should not be changed as yet, because image-based dosimetry is not ready for routine practice. The Group proposes that for research purposes, individual centers and cooperative groups (e.g., GOG, RTOG, ACRIN) collect image-based dosimetry information and perform DVHs and correlate these data with the clinical outcome to determine which of the above parameters are relevant. The Group encourages external funding for image-based dosimetry and recommends that Brachytherapy manufacturers develop image-compatible applicators. Conclusion Although current institutional Brachytherapy prescription for cervical cancer should continue, image-based data collection and analysis are needed to optimize cervical cancer Brachytherapy. Proposals are made for research in image-based Brachytherapy for cervical cancer.
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Interstitial Brachytherapy in the Management of Primary Carcinoma of the Cervix and Vagina
Gynecologic Oncology, 1998Co-Authors: Subir Nag, Rafael Martínez-monge, Alberto E. Selman, Larry J. CopelandAbstract:Abstract Purpose. The purpose of this study was to determine the role of interstitial Brachytherapy in the management of selected primary cancers of the cervix and the vagina. Methods. Thirty-nine previously untreated patients with histologically confirmed carcinoma of the cervix (31 patients) and of the vagina (8 patients) were treated by a combination of external beam radiotherapy and fluoroscopic-guided interstitial Brachytherapy between November 1989 and May 1995 at the Ohio State University Medical Center because they were not suitable for standard Intracavitary Brachytherapy. Clinical indications for interstitial Brachytherapy were extensive parametrial involvement in 22 patients, extensive vaginal involvement in 10, and poor vaginal anatomy in 7. Results. With a median follow-up of 36 months (range 12–66 months), 16 patients (51%) with cervical carcinomas and 5 patients (62.5%) with vaginal carcinomas have experienced local control of their tumor. The local control was better for tumors 6 cm in largest diameter. The 5-year actuarial survival was 34 and 38% for cervical and vaginal cancers, respectively. Only 1 patient experienced grade 3 complications (2.5%). Conclusions. Interstitial Brachytherapy can be safely used to treat patients unsuitable for standard Intracavitary Brachytherapy. When Intracavitary dose distribution is expected to be suboptimal, interstitial Brachytherapy is a good alternative.
