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Author Simpson, Daniel R. ♦ Scanderbeg, Daniel J. ♦ Carmona, Ruben ♦ McMurtrie, Riley M. ♦ Einck, John ♦ Mell, Loren K. ♦ McHale, Michael T. ♦ Saenz, Cheryl C. ♦ Plaxe, Steven C. ♦ Harrison, Terry ♦ Mundt, Arno J. ♦ Yashar, Catheryn M.
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ BLADDER ♦ BRACHYTHERAPY ♦ CARCINOMAS ♦ CHEMOTHERAPY ♦ COMPUTERIZED TOMOGRAPHY ♦ CONTROL ♦ DIAGNOSIS ♦ DOSE EQUIVALENTS ♦ DOSE RATES ♦ EXTERNAL BEAM RADIATION THERAPY ♦ GYNECOLOGY ♦ NMR IMAGING ♦ PATIENTS ♦ PLANNING ♦ RADIATION DOSES ♦ RECTUM ♦ SIMULATION ♦ TOXICITY ♦ WOMEN
Abstract Purpose/Objectives: A report of clinical outcomes of a computed tomography (CT)-based image guided brachytherapy (IGBT) technique for treatment of cervical cancer. Methods and Materials: Seventy-six women with International Federation of Gynecology and Obstetrics stage IB to IVA cervical carcinoma diagnosed between 2007 and 2014 were treated with definitive external beam radiation therapy (EBRT) with or without concurrent chemotherapy followed by high-dose-rate (HDR) IGBT. All patients underwent planning CT simulation at each implantation. A high-risk clinical target volume (HRCTV) encompassing any visible tumor and the entire cervix was contoured on the simulation CT. When available, magnetic resonance imaging (MRI) was performed at implantation to assist with tumor delineation. The prescription dose was prescribed to the HRCTV. Results: The median follow-up time was 17 months. Thirteen patients (17%) had an MRI done before brachytherapy, and 16 patients (21%) were treated without MRI guidance. The mean EBRT/IGBT sum 2-Gy equivalent dose (EQD2) delivered to the 90% volume of the HRCTV was 86.3 Gy. The mean maximum EQD2s delivered to 2 cm{sup 3} of the rectum, sigmoid, and bladder were 67.5 Gy, 66.2 Gy, and 75.3 Gy, respectively. The 2-year cumulative incidences of local, locoregional, and distant failure were 5.8% (95% confidence interval [CI]: 1.4%-14.8%), 15.1% (95% CI: 5.4%-29.4%), and 24.3% (95% CI: 12.1%-38.9%), respectively. The 2-year overall and disease-free survival rates were 75% (95% CI, 61%-91%) and 73% (95% CI, 60%-90%), respectively. Twenty-nine patients (38%) experienced grade ≥2 acute toxicity, with 5 cases of acute grade 3 toxicity and no grade ≥4 toxicities. One patient experienced grade 3 gastrointestinal toxicity. No other late grade ≥3 events were observed. Conclusions: This is the largest report to date of CT/MRI-based IGBT for the treatment of cervical cancer. The results are promising, with excellent local control and acceptable toxicity. Further investigation is needed to assess the long-term safety and efficacy of this treatment.
ISSN 03603016
Educational Use Research
Learning Resource Type Article
Publisher Date 2015-09-01
Publisher Place United States
Journal International Journal of Radiation Oncology, Biology and Physics
Volume Number 93
Issue Number 1


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