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Five-year results for image-guided brachytherapy (IGBT) for cervical carcinoma: a report from single institute of Thailand

Published online by Cambridge University Press:  21 December 2016

Ekkasit Tharavichitkul*
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Somvilai Chakrabandhu
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Pitchayaponne Klunklin
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wimrak Onchan
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Bongkot Jia-Mahasap
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Suwapim Janla-or
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Damrongsak Tippanya
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wannapa Nobnop
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Somsak Wanwilairat
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Nantaka Pukanhaphan
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Razvan M. Galalae
Affiliation:
Faculty of Medicine, Christian-Albrechts-University, Kiel, Germany Department of Radio-Oncology, Evangelical Clinics, Gelsenkirchen, Germany
Imjai Chitapanarux
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*
Correspondence to: Ekkasit Tharavichitkul, The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Tel: +66 85 0361113 Fax: +66 053 945491. Email: [email protected]

Abstract

Aim

To report of long-term results and toxicity profiles using image-guided brachytherapy (IGBT) combined with whole pelvic radiation therapy (WPRT) for cervical carcinoma.

Materials and Methods

In total, 52 patients with locally advanced cervical carcinoma were enrolled into the study. WPRT was used to treat the clinical target volume (CTV) with a dose of 45–50·4 Gy in 23–28 fractions. IGBT using computed tomography was performed at the dose of 6·5–7 Gy×4 fractions to the minimum dose covering 90% of target volume (D90) of high-risk clinical target volume (HR-CTV).

Results

The mean cumulative dose in equivalent doses of 2 Gy for the D90 of HR-CTV, dose at 2% at refereed volume (D2cc) of bladder, D2cc of rectum and D2cc of sigmoid colon were 92·4, 87·9, 69·6, and 72 Gy, respectively. At the median follow-up time of 61 months, the 5-year local control, disease-free survival, and overall survival rates were 96·2, 75 and 84·6% respectively. Two patients (3·8%) developed grade 3–4 gastrointestinal and two patients (3·8%) developed grade 3–4 genitourinal toxicities.

Conclusion

The combination of WPRT plus IGBT showed very promising long-term results with excellent local control and toxicity profiles.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

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References

1. Kamnerdsupaphon, P, Srisukho, S, Sumitsawan, Y, Lorvidhaya, V, Sukthomya, V. Cancers in Northern Thailand. Biomed Imaging Interv J 2008; 4: e46.Google Scholar
2. De Brabandere, M 1, Mousa, A G, Nulens, A, Swinnen, A, Van Limbergen, E. Potential of dose optimization in MRI-based PDR brachytherapy of cervix carcinoma. Radiother Oncol 2008; 88: 217226.CrossRefGoogle Scholar
3. Tanderup, K, Nielsen, S K, Nyvang, G B et al. From point A to the sculpted pear: MR image guidance significantly improves tumor dose and sparing of organs at risk in brachytherapy of cervical cancer. Radiother Oncol 2010; 94: 173180.Google Scholar
4. Zwahlen, D, Jezioranski, J, Chan, P et al. Magnetic resonance imaging-guided intracavitary brachytherapy for cancer of the cervix. Int J Radiat Oncol Biol Phys 2009; 74: 11571164.Google Scholar
5. Haie-Meder, C, Pötter, R, Van Limbergen, E et al. Recommendations from gynaecological (GYN) GEC-ESTRO working group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005; 74: 235245.CrossRefGoogle Scholar
6. Pötter, R, Haie-Meder, C, Van Limbergen, E et al. Recommendations from gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78: 6777.Google Scholar
7. Pötter, R, Dimopoulos, J, Georg, P et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 2007; 83: 148155.Google Scholar
8. Tan, L T, Coles, C E, Hart, C, Tait, E. Clinical impact of computed tomography-based imaged-guided brachytherapy for cervix cancer using the tandem-ring applicator-the Addenbrooke’s experience. Clin Oncol (R Coll Radiol) 2009; 21: 175182.CrossRefGoogle Scholar
9. Tharavichitkul, E, Mayurasakorn, S, Lorvidhaya, V et al. Preliminary results of conformal computed tomography (CT)-based intracavitary brachytherapy (ICBT) for locally advanced cervical cancer: a single institution’s experience. J Radiat Res 2011; 52: 634640.CrossRefGoogle ScholarPubMed
10. Tharavichitkul, E, Sivasomboon, C, Wanwilairat, S et al. Preliminary results of MRI-guided brachytherapy in cervical carcinoma: the Chiangmai University experience. J Radiat Res 2012; 53: 313318.Google Scholar
11. Tharavichitkul, E, Wanwilairat, S, Chakrabandhu, S et al. Image-guided brachytherapy (IGBT) combined with whole pelvic intensity-modulated radiotherapy (WP-IMRT) for locally advanced cervical cancer: a prospective study from Chiang Mai University Hospital, Thailand. J Contemp Brachytherapy 2013; 5: 1016.CrossRefGoogle Scholar
12. Tharavichitkul, E, Chakrabandhu, S, Wanwilairat, S et al. Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience. Gynecol Oncol 2013; 130: 8185.CrossRefGoogle Scholar
13. Bentzen, S M, Joiner, M C. The linear-quadratic approach in clinical practice. In Joiner M, Van Der Kogel A (eds) Basic Clinical Radiobiology, 4th edition. London: Edward Arnold, 2009: 120134.CrossRefGoogle Scholar
14. Viswanathan, A N, Dimopoulos, J, Kirisits, C, Berger, D, Pötter, R. Computed tomography versus magnetic resonance image-based contouring in cervical cancer brachytherapy: result of a prospective trial and preliminary guidelines for standard contours. Int J Radiat Oncol Biol Phys 2007; 68: 491498.CrossRefGoogle Scholar
15. Pötter, R, Georg, P, Dimopoulos, J C et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol. 2011; 100: 116123.CrossRefGoogle ScholarPubMed
16. Lindegaard, J C, Tanderup, K, Nielsen, S K, Haack, S, Gelineck, J. MRI-guided 3D optimization significantly improves DVH parameters of plused-dose-rate brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71: 756764.CrossRefGoogle ScholarPubMed
17. Tan, L T, Diane Whitney, D, Coles, C E. Long term outcome of CT-based image-guided brachytherapy for cervix cancer using the tandem-ring applicator. OMIC J Radiol 2014: S1.Google Scholar
18. Tharavichitkul, E, Meungwong, P, Chitapanarux, T et al. The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Radiat Oncol J 2014; 32: 5762.Google Scholar
19. Eskander, R, Scanderbeg, D, Saenz, C C, Brown, M, Yashar, C. Comparison of computed tomography and magnetic resonance imaging in cervical cancer brachytherapy target and normal tissue contouring. Int J Gynecol Cancer 2010; 20: 4753.CrossRefGoogle ScholarPubMed
20. Krishnatry, R, Patel, F D, Singh, P, Sharma, S C, Oinam, A S, Shukla, A K. CT or MRI for image-based brachytherapy in cervical cancer. Jpn J Clin Oncol 2012; 42: 309313.CrossRefGoogle ScholarPubMed
21. Galalae, R, Tharavichitkul, E, Wanwilairat, S et al. University Cooperation Platform (UCP) between Christian-Albrechts-University Kiel (Germany) and Chiang Mai University (Thailand): implementation of image-guided gynecological brachytherapy. J Contemp Brachytherapy 2015; 7: 8692.CrossRefGoogle Scholar
22. Castelnau-Marchand, P, Chargari, C, Maroun, P et al. Clinical outcomes of definitive chemoradiation followed by intracavitary pulsed-dose rate image-guided adaptive brachytherapy in locally advanced cervical cancer. Gynecol Oncol. 2015; 139: 288294.Google Scholar
23. Lindegaard, J C, Fokdal, L U, Nielsen, S K, Juul-Christensen, J, Tanderup, K. MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective. Acta Oncol 2013; 52: 15101519.Google Scholar
24. Gill, B S, Kim, H, Houser, C J et al. MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience. Int J Radiat Oncol Biol Phys 2015; 91: 540547.CrossRefGoogle ScholarPubMed