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Sushil Beriwal - One of the best experts on this subject based on the ideXlab platform.
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Gynecologic Brachytherapy: Vaginal Cancer
Brachytherapy, 2016Co-Authors: John A. Vargo, Akila N. Viswanathan, Beth Erickson, Sushil BeriwalAbstract:Primary Vaginal Cancer is the rarest of gynecologic malignancies by anatomic site. Despite the rarity, Vaginal Cancer requires special consideration in treatment and frequently requires brachytherapy for local control and cure.
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Adoption and impact of concurrent chemoradiation therapy for Vaginal Cancer: A National Cancer Data Base (NCDB) study
Gynecologic oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, Paniti Sukumvanich, Thomas C. Krivak, Sushil BeriwalAbstract:Abstract Background Vaginal Cancer is an uncommon entity for which concurrent chemoradiation (CCRT) may be used based on small retrospective series and extrapolation from cervical Cancer. We explored the adoption rate of CCRT and determined its impact on survival. Methods Patients entered into the National Cancer Data Base (NCDB) diagnosed with Vaginal Cancer from 1998 to 2011 who received definitive radiation therapy were included. Univariate/multivariable exploratory analyses of factors associated with CCRT were performed. Log-rank test and Cox proportional hazards modeling identified the contribution of CCRT on survival. Results Of the 13,689 patients identified, 8222 (60.1%) received radiation therapy. Of these, 3932 (47.8%) received CCRT and its use increased from 20.8% to 59.1% (1998–2011). Of the 23 patient, disease, facility, and treatment factors, 13 were significantly associated with patient outcomes and were entered into a binary logistic regression model. This evaluation revealed that younger age, larger tumor size, later year of diagnosis, higher facility volume, squamous histology, and higher stage (in order of increasing association) are independently associated with CCRT use. Median overall survival is longer with CCRT compared to radiation alone (56.2 vs. 41.2months, p Conclusions Use of CCRT for patients with Vaginal Cancer has increased and is associated with a significant improvement in survival in this large, national cohort. CCRT should be integrated into treatment guidelines for Vaginal Cancer.
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Adoption and impact of concurrent chemotherapy with radiation in the treatment of patients with Vaginal Cancer: A National Cancer Data Base (NCDB) study.
Journal of Clinical Oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, Paniti Sukumvanich, Thomas C. Krivak, Joseph L. Kelley, Sushil BeriwalAbstract:5525 Background: Vaginal Cancer is uncommon entity for which concurrent chemoradiation (CCRT) is increasingly used based on extrapolation from cervical Cancer. However, studies supporting CCRT use ...
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dosimetric comparison of multichannel with one single channel Vaginal cylinder for Vaginal Cancer treatments with high dose rate brachytherapy
Brachytherapy, 2014Co-Authors: Hayeon Kim, Malolan S. Rajagopalan, Christopher J. Houser, Sushil BeriwalAbstract:Abstract Purpose To compare the three-dimensional (3D) image (CT/MR)-based planning with a multichannel Vaginal cylinder (MVC) to a single-channel Vaginal cylinder (SVC) for the treatment of Vaginal Cancer. Methods and Materials A total of 20 consecutive patients were treated with 3D CT/MR image-based high-dose-rate (HDR) brachytherapy using an MVC. All patients received external beam radiation therapy before HDR brachytherapy. A brachytherapy dose of 20–25 Gy of more than five fractions was delivered to clinical target volume (CTV). Retrospectively, treatment plans for all patients were generated using the central channel only to mimic an SVC applicator. The SVC plans were optimized to match CTV coverage with MVC plans. Dose homogeneity index as well as bladder, rectum, sigmoid, and urethral doses were compared. Results The mean D90 for CTV was 74.2 Gy (range: 48.8–84.1 Gy). The mean (±standard deviation) of dose homogeneity index for MVC vs. SVC was 0.49 (±0.19) and 0.52 (±0.23), respectively (p = 0.09). Mean bladder 0.1, 1, and 2 cc doses for MVC vs. SVC were 69 vs. 71.2 Gy (p = 0.35), 61.4 vs. 63.8 Gy (p = 0.1), and 59.5 vs. 60.9 Gy (p = 0.31), respectively. Similarly, mean rectum 0.1, 1, and 2 cc doses for MVC vs. SVC were 67.2 vs. 75.4 Gy (p = 0.005), 60.0 vs. 65.6 Gy (p = 0.008), and 57.3 vs. 62.0 Gy (p = 0.015), respectively, and mean sigmoid doses were 56.3 vs. 60.5 Gy (p = 0.10), 50.9 vs. 53.1 Gy (p = 0.09), and 49.1 vs. 50.7 Gy (p = 0.10), respectively. Conclusion The 3D CT-/MR-based plan with MVC may provide better dose distribution in the management of certain clinical situations of Vaginal Cancer requiring intracavitary brachytherapy, especially in minimizing potential late rectal complications.
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Patterns of care and brachytherapy boost utilization for Vaginal Cancer in the United States.
Practical radiation oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, K.j. Hansen, Paniti Sukumvanich, Thomas C. Krivak, Joseph L. Kelley, Sushil BeriwalAbstract:Abstract Purpose Vaginal Cancer is an uncommon malignancy that is usually treated with definitive radiation therapy. Following external beam radiation therapy (EBRT), a brachytherapy boost is delivered to achieve a total dose of 70-85 Gy. We sought to determine the trends of brachytherapy boost utilization in the treatment of Vaginal Cancer and to identify the factors associated with its utilization. Methods and materials Using the National Cancer Data Base (NCDB), we identified 1530 patients with Vaginal Cancer from 2004 to 2011 who were treated with radiation therapy and had a recorded boost modality. The following additional variables were identified: age, year of diagnosis, Charlson/Deyo comorbidity score, stage, histology, race, brachytherapy dose rate, brachytherapy applicator technique, treatment facility volume, and utilization of chemotherapy. Multivariable logistic regression analysis was performed to identify factors independently associated with brachytherapy boost. Results Seventy-seven percent of the 1530 women received brachytherapy boost and 23% received EBRT boost. The rate of brachytherapy boost utilization decreased from 87.7% in 2004 to 68.6% in 2011 ( P P = .02). Multivariate analysis revealed that high facility volume was associated with increased odds of brachytherapy boost (odds ratio [OR], 2.3; range, 1.5-3.4). Higher stage and advanced age were associated with decreased odds of brachytherapy boost (OR, 0.2; range, 0.1-0.3 and OR, 0.5; range, 0.3-0.8). Utilization of chemotherapy, histology, race, and comorbidity index were not significantly associated with brachytherapy boost utilization. Conclusions Using the NCDB, we identified a concerning decline in the utilization of brachytherapy boost for those with Vaginal Cancer and a corresponding increase in IMRT boost technique. The strongest factor predicting for brachytherapy boost utilization is treatment at a high volume facility.
Akila N. Viswanathan - One of the best experts on this subject based on the ideXlab platform.
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Outcomes with image-based interstitial brachytherapy for Vaginal Cancer
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2016Co-Authors: Matthias M. Manuel, David T. Miyamoto, Linda P. Cho, Paul J. Catalano, Antonio L. Damato, Clare M. Tempany, Ehud J. Schmidt, Akila N. ViswanathanAbstract:Abstract Purpose To compare clinical outcomes of image-based versus non-image-based interstitial brachytherapy (IBBT) for Vaginal Cancer. Methods and materials Of 72 patients with Vaginal Cancer treated with brachytherapy (BT), 47 had image guidance (CT=31, MRI=16) and 25 did not. Kaplan–Meier (KM) estimates were generated for any recurrence, local control (LC), disease-free interval (DFI), and overall survival (OS) and Cox models were used to assess prognostic factors. Results Median age was 66 and median follow-up time was 24months. Median cumulative EQD2 dose was 80.8Gy in the non-IBBT group and 77Gy in the IBBT group. For non-IBBT versus IBBT, the 2-year KM LC was 71% vs. 93% ( p =0.03); DFI was 54% vs. 86% ( p =0.04); and OS 52% vs. 82% ( p =0.35). On multivariate analysis, IBBT was associated with better DFI (HR 0.24, 95% CI 0.07–0.73). Having any 2 or more of chemotherapy, high-dose-rate (HDR) BT or IBBT (temporally correlated variables) significantly reduced risk of relapse (HR=0.33, 95% CI=0.13–0.83), compared to having none of these factors. Conclusion Over time, the use of chemotherapy, HDR, and IBBT has increased in Vaginal Cancer. The combination of these factors resulted in the highest rates of disease control. Image-guided brachytherapy for Vaginal Cancer patients maximizes disease control.
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Gynecologic Brachytherapy: Vaginal Cancer
Brachytherapy, 2016Co-Authors: John A. Vargo, Akila N. Viswanathan, Beth Erickson, Sushil BeriwalAbstract:Primary Vaginal Cancer is the rarest of gynecologic malignancies by anatomic site. Despite the rarity, Vaginal Cancer requires special consideration in treatment and frequently requires brachytherapy for local control and cure.
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Concurrent Chemoradiation for Vaginal Cancer
PloS one, 2013Co-Authors: David T. Miyamoto, Akila N. ViswanathanAbstract:Background It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary Vaginal Cancer. Here, we review clinical outcomes in patients with primary Vaginal Cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT). Methods Seventy-one patients with primary Vaginal Cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS) and disease-free survival (DFS) rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. Results The median age at diagnosis was 61 years (range, 18–92 years) and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011). Twenty-three patients (45%) in the RT group had a relapse at any site compared to 3 (15%) in the CRT group (p = 0.027). With regard to the sites of first relapse, 10 patients (14%) had local only, 4 (6%) had local and regional, 9 (13%) had regional only, 1 (1%) had regional and distant, and 2 (3%) had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10–0.97; p = 0.04)). Conclusions Vaginal Cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for Vaginal Cancer patients.
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American Brachytherapy Society consensus guidelines for interstitial brachytherapy for Vaginal Cancer
Brachytherapy, 2012Co-Authors: Sushil Beriwal, Jason Rownd, D. Jeffrey Demanes, Beth Erickson, Ellen L. Jones, Jennifer F. De Los Santos, Robert A. Cormack, Catheryn M. Yashar, Akila N. ViswanathanAbstract:Abstract Purpose To present recommendations for the use of interstitial brachytherapy in patients with Vaginal Cancer or recurrent endometrial Cancer in the vagina. Methods A panel of members of the American Brachytherapy Society reviewed the literature, supplemented that with their clinical experience, and formulated recommendations for interstitial brachytherapy for primary or recurrent Cancers in the vagina. Results Patients with bulky disease (approximately >0.5 cm thick) should be considered for treatment with interstitial brachytherapy. The American Brachytherapy Society reports specific recommendations for techniques, target volume definition, and dose–fractionation schemes. Three-dimensional treatment planning is recommended with CT scan and/or MRI. The treatment plan should be optimized to conform to the clinical target volume and should reduce the dose to critical organs, including the rectum, bladder, urethra, and sigmoid colon. Suggested doses in combination with external beam radiation therapy and summated equivalent doses in 2 Gy fractions are tabulated. Conclusion Recommendations are made for interstitial brachytherapy for Vaginal Cancer and recurrent disease in the vagina. Practitioners and cooperative groups are encouraged to use these recommendations to formulate treatment and dose-reporting policies. Such a process will result in meaningful outcome comparisons, promote technical advances, and lead to appropriate utilization of these techniques.
Malolan S. Rajagopalan - One of the best experts on this subject based on the ideXlab platform.
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Adoption and impact of concurrent chemoradiation therapy for Vaginal Cancer: A National Cancer Data Base (NCDB) study
Gynecologic oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, Paniti Sukumvanich, Thomas C. Krivak, Sushil BeriwalAbstract:Abstract Background Vaginal Cancer is an uncommon entity for which concurrent chemoradiation (CCRT) may be used based on small retrospective series and extrapolation from cervical Cancer. We explored the adoption rate of CCRT and determined its impact on survival. Methods Patients entered into the National Cancer Data Base (NCDB) diagnosed with Vaginal Cancer from 1998 to 2011 who received definitive radiation therapy were included. Univariate/multivariable exploratory analyses of factors associated with CCRT were performed. Log-rank test and Cox proportional hazards modeling identified the contribution of CCRT on survival. Results Of the 13,689 patients identified, 8222 (60.1%) received radiation therapy. Of these, 3932 (47.8%) received CCRT and its use increased from 20.8% to 59.1% (1998–2011). Of the 23 patient, disease, facility, and treatment factors, 13 were significantly associated with patient outcomes and were entered into a binary logistic regression model. This evaluation revealed that younger age, larger tumor size, later year of diagnosis, higher facility volume, squamous histology, and higher stage (in order of increasing association) are independently associated with CCRT use. Median overall survival is longer with CCRT compared to radiation alone (56.2 vs. 41.2months, p Conclusions Use of CCRT for patients with Vaginal Cancer has increased and is associated with a significant improvement in survival in this large, national cohort. CCRT should be integrated into treatment guidelines for Vaginal Cancer.
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Adoption and impact of concurrent chemotherapy with radiation in the treatment of patients with Vaginal Cancer: A National Cancer Data Base (NCDB) study.
Journal of Clinical Oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, Paniti Sukumvanich, Thomas C. Krivak, Joseph L. Kelley, Sushil BeriwalAbstract:5525 Background: Vaginal Cancer is uncommon entity for which concurrent chemoradiation (CCRT) is increasingly used based on extrapolation from cervical Cancer. However, studies supporting CCRT use ...
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dosimetric comparison of multichannel with one single channel Vaginal cylinder for Vaginal Cancer treatments with high dose rate brachytherapy
Brachytherapy, 2014Co-Authors: Hayeon Kim, Malolan S. Rajagopalan, Christopher J. Houser, Sushil BeriwalAbstract:Abstract Purpose To compare the three-dimensional (3D) image (CT/MR)-based planning with a multichannel Vaginal cylinder (MVC) to a single-channel Vaginal cylinder (SVC) for the treatment of Vaginal Cancer. Methods and Materials A total of 20 consecutive patients were treated with 3D CT/MR image-based high-dose-rate (HDR) brachytherapy using an MVC. All patients received external beam radiation therapy before HDR brachytherapy. A brachytherapy dose of 20–25 Gy of more than five fractions was delivered to clinical target volume (CTV). Retrospectively, treatment plans for all patients were generated using the central channel only to mimic an SVC applicator. The SVC plans were optimized to match CTV coverage with MVC plans. Dose homogeneity index as well as bladder, rectum, sigmoid, and urethral doses were compared. Results The mean D90 for CTV was 74.2 Gy (range: 48.8–84.1 Gy). The mean (±standard deviation) of dose homogeneity index for MVC vs. SVC was 0.49 (±0.19) and 0.52 (±0.23), respectively (p = 0.09). Mean bladder 0.1, 1, and 2 cc doses for MVC vs. SVC were 69 vs. 71.2 Gy (p = 0.35), 61.4 vs. 63.8 Gy (p = 0.1), and 59.5 vs. 60.9 Gy (p = 0.31), respectively. Similarly, mean rectum 0.1, 1, and 2 cc doses for MVC vs. SVC were 67.2 vs. 75.4 Gy (p = 0.005), 60.0 vs. 65.6 Gy (p = 0.008), and 57.3 vs. 62.0 Gy (p = 0.015), respectively, and mean sigmoid doses were 56.3 vs. 60.5 Gy (p = 0.10), 50.9 vs. 53.1 Gy (p = 0.09), and 49.1 vs. 50.7 Gy (p = 0.10), respectively. Conclusion The 3D CT-/MR-based plan with MVC may provide better dose distribution in the management of certain clinical situations of Vaginal Cancer requiring intracavitary brachytherapy, especially in minimizing potential late rectal complications.
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Patterns of care and brachytherapy boost utilization for Vaginal Cancer in the United States.
Practical radiation oncology, 2014Co-Authors: Malolan S. Rajagopalan, J.f. Lin, K.j. Hansen, Paniti Sukumvanich, Thomas C. Krivak, Joseph L. Kelley, Sushil BeriwalAbstract:Abstract Purpose Vaginal Cancer is an uncommon malignancy that is usually treated with definitive radiation therapy. Following external beam radiation therapy (EBRT), a brachytherapy boost is delivered to achieve a total dose of 70-85 Gy. We sought to determine the trends of brachytherapy boost utilization in the treatment of Vaginal Cancer and to identify the factors associated with its utilization. Methods and materials Using the National Cancer Data Base (NCDB), we identified 1530 patients with Vaginal Cancer from 2004 to 2011 who were treated with radiation therapy and had a recorded boost modality. The following additional variables were identified: age, year of diagnosis, Charlson/Deyo comorbidity score, stage, histology, race, brachytherapy dose rate, brachytherapy applicator technique, treatment facility volume, and utilization of chemotherapy. Multivariable logistic regression analysis was performed to identify factors independently associated with brachytherapy boost. Results Seventy-seven percent of the 1530 women received brachytherapy boost and 23% received EBRT boost. The rate of brachytherapy boost utilization decreased from 87.7% in 2004 to 68.6% in 2011 ( P P = .02). Multivariate analysis revealed that high facility volume was associated with increased odds of brachytherapy boost (odds ratio [OR], 2.3; range, 1.5-3.4). Higher stage and advanced age were associated with decreased odds of brachytherapy boost (OR, 0.2; range, 0.1-0.3 and OR, 0.5; range, 0.3-0.8). Utilization of chemotherapy, histology, race, and comorbidity index were not significantly associated with brachytherapy boost utilization. Conclusions Using the NCDB, we identified a concerning decline in the utilization of brachytherapy boost for those with Vaginal Cancer and a corresponding increase in IMRT boost technique. The strongest factor predicting for brachytherapy boost utilization is treatment at a high volume facility.
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Urethral dosimetry and toxicity with high-dose-rate interstitial brachytherapy for Vaginal Cancer.
Brachytherapy, 2013Co-Authors: Malolan S. Rajagopalan, Neeta Kannan, Hayeon Kim, Christopher J. Houser, Sushil BeriwalAbstract:Abstract Purpose The tolerance and complication rates of the urethra are unknown for the interstitial high-dose-rate brachytherapy (HDR-BT) for Vaginal Cancer. Methods and Materials Patients with Vaginal Cancer near/involving the urethra who were treated with HDR-BT between 2008 and 2011 were included. Patients received mean external beam dose of 48.0 Gy followed by mean HDR-BT dose of 4.5 Gy/fraction for five fractions. With CT-based planning, the urethra was contoured from the bladder neck to the meatus. Doses were converted to the biologically equivalent dose in 2 Gy/fraction (EQD2). Results A total of 16 patients were included, and the EQD2 D90 was 74.9 Gy. The urethral volume was 1.31 cm3, and the EQD2 to 0.1 and 1 cm3 were 76.2 and 48.9 Gy, respectively. Two of the 6 patients with urethral involvement developed urethral necrosis. The D90 for these 2 patients was 76.8 Gy, and the urethral doses to 0.1 and 1 cm3 were 95.1 and 45.8, respectively. Those who developed severe urethral toxicity had a trend to urethral EQD2 (95.1 Gy vs. 73.4 Gy, p = 0.1) and significantly higher dose per fraction of HDR-BT to 0.1 cm3 of the urethra (5.7 Gy vs. 3.7 Gy, p = 0.02) when compared with those who did not develop severe urethral toxicity. Conclusions This study is among the first to assess urethral dosimetry for patients treated with HDR-BT for Vaginal Cancer. Patients who received five fractions of higher than 5 Gy/fraction to 0.1 cm3 of urethra (estimated EQD2 of 85 Gy) are at increased risk of severe urethral toxicity.
Hayeon Kim - One of the best experts on this subject based on the ideXlab platform.
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Image-based multichannel Vaginal cylinder brachytherapy for Vaginal Cancer
Brachytherapy, 2014Co-Authors: John A. Vargo, Paniti Sukumvanich, Joseph L. Kelley, Hayeon Kim, Christopher J. Houser, Alexander B. Olawaiye, Robert P. Edwards, John T. Comerci, Marilyn Huang, Madeleine Courtney-brooksAbstract:Abstract Purpose To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel Vaginal cylinder for the definitive treatment of Vaginal Cancers. Methods and Materials A total of 41 patients with Vaginal Cancer (24% primary Vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel Vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2 Gy per fraction. Endpoints examined were dose–volume parameters and early clinical outcomes. Results The median high-risk clinical target volume was 24.2 cc (interquartile range [IQR], 12.6), with a median dose to 90% ( D 90 ) of 77.1 Gy (IQR, 3.4). The median dose to 2 cc ( D 2 cc ) for the bladder, rectum, and sigmoid were 59.4 Gy (IQR, 5.6), 58.2 Gy (IQR, 4.1), and 52.3 Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3–35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for Vaginal, bladder, urethral, and gastrointestinal, respectively. Conclusions Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive Vaginal Cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.
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dosimetric comparison of multichannel with one single channel Vaginal cylinder for Vaginal Cancer treatments with high dose rate brachytherapy
Brachytherapy, 2014Co-Authors: Hayeon Kim, Malolan S. Rajagopalan, Christopher J. Houser, Sushil BeriwalAbstract:Abstract Purpose To compare the three-dimensional (3D) image (CT/MR)-based planning with a multichannel Vaginal cylinder (MVC) to a single-channel Vaginal cylinder (SVC) for the treatment of Vaginal Cancer. Methods and Materials A total of 20 consecutive patients were treated with 3D CT/MR image-based high-dose-rate (HDR) brachytherapy using an MVC. All patients received external beam radiation therapy before HDR brachytherapy. A brachytherapy dose of 20–25 Gy of more than five fractions was delivered to clinical target volume (CTV). Retrospectively, treatment plans for all patients were generated using the central channel only to mimic an SVC applicator. The SVC plans were optimized to match CTV coverage with MVC plans. Dose homogeneity index as well as bladder, rectum, sigmoid, and urethral doses were compared. Results The mean D90 for CTV was 74.2 Gy (range: 48.8–84.1 Gy). The mean (±standard deviation) of dose homogeneity index for MVC vs. SVC was 0.49 (±0.19) and 0.52 (±0.23), respectively (p = 0.09). Mean bladder 0.1, 1, and 2 cc doses for MVC vs. SVC were 69 vs. 71.2 Gy (p = 0.35), 61.4 vs. 63.8 Gy (p = 0.1), and 59.5 vs. 60.9 Gy (p = 0.31), respectively. Similarly, mean rectum 0.1, 1, and 2 cc doses for MVC vs. SVC were 67.2 vs. 75.4 Gy (p = 0.005), 60.0 vs. 65.6 Gy (p = 0.008), and 57.3 vs. 62.0 Gy (p = 0.015), respectively, and mean sigmoid doses were 56.3 vs. 60.5 Gy (p = 0.10), 50.9 vs. 53.1 Gy (p = 0.09), and 49.1 vs. 50.7 Gy (p = 0.10), respectively. Conclusion The 3D CT-/MR-based plan with MVC may provide better dose distribution in the management of certain clinical situations of Vaginal Cancer requiring intracavitary brachytherapy, especially in minimizing potential late rectal complications.
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Urethral dosimetry and toxicity with high-dose-rate interstitial brachytherapy for Vaginal Cancer.
Brachytherapy, 2013Co-Authors: Malolan S. Rajagopalan, Neeta Kannan, Hayeon Kim, Christopher J. Houser, Sushil BeriwalAbstract:Abstract Purpose The tolerance and complication rates of the urethra are unknown for the interstitial high-dose-rate brachytherapy (HDR-BT) for Vaginal Cancer. Methods and Materials Patients with Vaginal Cancer near/involving the urethra who were treated with HDR-BT between 2008 and 2011 were included. Patients received mean external beam dose of 48.0 Gy followed by mean HDR-BT dose of 4.5 Gy/fraction for five fractions. With CT-based planning, the urethra was contoured from the bladder neck to the meatus. Doses were converted to the biologically equivalent dose in 2 Gy/fraction (EQD2). Results A total of 16 patients were included, and the EQD2 D90 was 74.9 Gy. The urethral volume was 1.31 cm3, and the EQD2 to 0.1 and 1 cm3 were 76.2 and 48.9 Gy, respectively. Two of the 6 patients with urethral involvement developed urethral necrosis. The D90 for these 2 patients was 76.8 Gy, and the urethral doses to 0.1 and 1 cm3 were 95.1 and 45.8, respectively. Those who developed severe urethral toxicity had a trend to urethral EQD2 (95.1 Gy vs. 73.4 Gy, p = 0.1) and significantly higher dose per fraction of HDR-BT to 0.1 cm3 of the urethra (5.7 Gy vs. 3.7 Gy, p = 0.02) when compared with those who did not develop severe urethral toxicity. Conclusions This study is among the first to assess urethral dosimetry for patients treated with HDR-BT for Vaginal Cancer. Patients who received five fractions of higher than 5 Gy/fraction to 0.1 cm3 of urethra (estimated EQD2 of 85 Gy) are at increased risk of severe urethral toxicity.
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Three-dimensional image-based high-dose-rate interstitial brachytherapy for Vaginal Cancer.
Brachytherapy, 2011Co-Authors: Sushil Beriwal, Paniti Sukumvanich, Joseph L. Kelley, Hayeon Kim, Christopher J. Houser, Alexander B. Olawaiye, Jean-claude M. Rwigema, Emma Higgins, Scott D. Richard, Robert P. EdwardsAbstract:Abstract Purpose To evaluate dosimetric and clinical outcomes of three-dimensional (3D) image–based high-dose-rate (HDR) interstitial brachytherapy (HDRB) in patients with Vaginal Cancers. Methods and Materials Thirty patients with Vaginal Cancers were treated with HDRB using Syed-Neblett template. CT scan was done after placement of needles for confirmation of placement and treatment planning. The target volume and organs at risk, including clinical target volume (CTV), rectum, bladder, and sigmoid colon, were contoured on CT scans. Twenty-eight (93.3%) patients received external beam radiation therapy at a median 45 (24.0–50.4) Gy in 12–28 fractions, followed by HDRB at 3.75–5.0 Gy per fraction in five fractions. Total doses for CTV and organs at risk from external beam radiation therapy and HDRB were summated and normalized to a biologically equivalent dose of 2 Gy per fraction. Results Seventeen patients (56.7%) with primary Vaginal Cancer and 13 patients (43.3%) with recurrent Vaginal Cancers were treated with 3D HDRB. The mean CTV was 39.3 ± 25.7 cm 3 , and the median tumor diameter was 3.3 (1.3–8.0) cm. The median biologically equivalent dose of 2 Gy per fraction for 2 cc of bladder, rectum, and sigmoid was 55.0, 56.3, 50.0 Gy, respectively. The median D 90 for high-risk CTV was 74.3 (36.3–81.1) Gy. The mean volume receiving 100%, 150%, and 200% of prescribed dose was 90.7 ± 10.0%, 41.3 ± 14.6%, and 17.7 ± 8.3%, respectively. With a median followup of 16.7 months, the respective 1-/2-year locoregional and overall survival rates were 84.4%/78.8% and 82.1%/70.2%, respectively. There were no Grade ≥3 gastrointestinal complications. Late complications of Grade 3 Vaginal ulceration and Grade 4 Vaginal necrosis were seen in two cases. Conclusions Initial results of 3D HDRB using our fractionation schedule in the treatment of Vaginal Cancers showed good local response with acceptable morbidities.
Toshiaki Saito - One of the best experts on this subject based on the ideXlab platform.
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Surgery for Vulvar Cancer and Vaginal Cancer
Comprehensive Gynecology and Obstetrics, 2019Co-Authors: Toshiaki SaitoAbstract:Vulvar Cancer and Vaginal Cancer are relatively rare Cancer in the field of gynecologic oncology. Nevertheless, several advancements have been achieved in the surgical treatment for these Cancers in the past two or three decades, especially in vulvar Cancer. Individualization and minimization is the modern trend in the surgical treatment of vulvar Cancer. However, the skills and techniques of the surgery for vulvar Cancer are derived from the traditional surgery. Especially, the inguinal lymph node dissection is an essential part of the surgery but is not common as a daily practice. It is important for a surgeon to be well acquainted before surgery with the anatomy of the femoral triangle and the skills of the dissection before surgery. Reconstruction surgery is also important to close the wound adequately and safely reducing the postoperative wound breakdown, but is not familiar to most of the gynecologists. In the present chapter, these basic surgical methods in vulvar Cancer are mainly described showing examples of the surgery.
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Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar Cancer and Vaginal Cancer
International Journal of Clinical Oncology, 2018Co-Authors: Toshiaki Saito, Tsutomu Tabata, Hitoshi Ikushima, Hiroyuki Yanai, Hironori Tashiro, Hitoshi Niikura, Takeo Minaguchi, Toshinari Muramatsu, Tsukasa Baba, Wataru YamagamiAbstract:Background Vulvar Cancer and Vaginal Cancer are relatively rare tumors, and there had been no established treatment principles or guidelines to treat these rare tumors in Japan. The first version of the Japan Society of Gynecologic Oncology (JSGO) guidelines for the treatment of vulvar Cancer and Vaginal Cancer was published in 2015 in Japanese. Objective The JSGO committee decided to publish the English version of the JSGO guidelines worldwide, and hope it will be a useful guide to physicians in a similar situation as in Japan. Methods The guideline was created according to the basic principles in creating the guidelines of JSGO. Results The guidelines consist of five chapters and five algorithms. Prior to the first chapter, basic items are described including staging classification and history, classification of histology, and definition of the methods of surgery, radiation, and chemotherapy to give the reader a better understanding of the contents of the guidelines for these rare tumors. The first chapter gives an overview of the guidelines, including the basic policy of the guidelines. The second chapter discusses vulvar Cancer, the third chapter discusses Vaginal Cancer, and the fourth chapter discusses vulvar Paget’s disease and malignant melanoma. Each chapter includes clinical questions, recommendations, backgrounds, objectives, explanations, and references. The fifth chapter provides supplemental data for the drugs that are mentioned in the explanation of clinical questions. Conclusion Overall, the objective of these guidelines is to clearly delineate the standard of care for vulvar and Vaginal Cancer with the goal of ensuring a high standard of care for all women diagnosed with these rare diseases.
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Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar Cancer and Vaginal Cancer
International journal of clinical oncology, 2017Co-Authors: Toshiaki Saito, Tsutomu Tabata, Hitoshi Ikushima, Hiroyuki Yanai, Hironori Tashiro, Hitoshi Niikura, Takeo Minaguchi, Toshinari Muramatsu, Tsukasa Baba, Wataru YamagamiAbstract:Vulvar Cancer and Vaginal Cancer are relatively rare tumors, and there had been no established treatment principles or guidelines to treat these rare tumors in Japan. The first version of the Japan Society of Gynecologic Oncology (JSGO) guidelines for the treatment of vulvar Cancer and Vaginal Cancer was published in 2015 in Japanese. The JSGO committee decided to publish the English version of the JSGO guidelines worldwide, and hope it will be a useful guide to physicians in a similar situation as in Japan. The guideline was created according to the basic principles in creating the guidelines of JSGO. The guidelines consist of five chapters and five algorithms. Prior to the first chapter, basic items are described including staging classification and history, classification of histology, and definition of the methods of surgery, radiation, and chemotherapy to give the reader a better understanding of the contents of the guidelines for these rare tumors. The first chapter gives an overview of the guidelines, including the basic policy of the guidelines. The second chapter discusses vulvar Cancer, the third chapter discusses Vaginal Cancer, and the fourth chapter discusses vulvar Paget’s disease and malignant melanoma. Each chapter includes clinical questions, recommendations, backgrounds, objectives, explanations, and references. The fifth chapter provides supplemental data for the drugs that are mentioned in the explanation of clinical questions. Overall, the objective of these guidelines is to clearly delineate the standard of care for vulvar and Vaginal Cancer with the goal of ensuring a high standard of care for all women diagnosed with these rare diseases.
