Tolerance and Efficacy of Preoperative Intracavitary HDR Brachytherapy in IB and IIA Cervical Cancer

Overview

Journal J Contemp Brachytherapy

Date 2009 Mar 1

PMID 27799952

Citations 2

Authors

Brygida Bialas

Sylwia Kellas-Sleczka

Marek Fijalkowski

Katarzyna Raczek-Zwierzycka

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this work is to analyze the efficacy and tolerance of preoperative intracavitary HDR brachytherapy (HDR-BT) in patients with IB and IIA cervical cancer.

Material And Methods: 139 patients with cervical cancer IB-IIA with preoperative HDR-BT, out of which 60 patients with cervical cancer IB (43.2%) and 79 with IIA (56.8%) were treated since 1996 to 2002. In preoperative BT total dose to point A ranged from 30-45 Gy in 6-9 fractions twice a week. The fraction dose was 4-5 Gy at point A. Six weeks after BT all patients underwent radical Wertheim-Meigs hysterectomy. Patients with disadvantageous risk factors or with positive specimen histology had a complementary therapy: external-beam radiotherapy (EBRT) given to the whole pelvic volume in daily fractions of 2 Gy up to total dose of 36-52 Gy (20 patients) or EBRT with cisplatin-based chemotherapy with the dose of 30-40 mg/m in 5-7 fractions given weekly (7 patients) or chemotherapy (6 patients). Acute and late radiation toxicity was evaluated according to EORTC/RTOG.

Results: In postoperative specimen histopathology the number of 114 women (82%) had tumor-free specimen within brachytherapy target (in cervix and cavity), 96 women (60.1%) had tumor-free specimen both in and outside brachytherapy target (lymph nodes, parametra, adnexis). The 5-year and 10-year DFS were 93.8% and 88% for IB and 89.7% and 64.7% for IIA respectively. 7.9% of patients developed acute toxicity both in rectum and bladder (only in I and II grade of EORTC/RTOG). Late severe complication occurred in rectum in 2.2% of patients and in bladder 1.4%.

Conclusions: 1. Preoperative HDR-BT in patients with IB and IIA cervical cancer is an effective and well tolerated therapy with acceptable rate of side effects. 2. Preoperative HDR-BT followed by surgery in a group without risk factors is a sufficient treatment option with no additional adjuvant therapy requirement.

Citing Articles

Pathologic complete remission after preoperative high-dose-rate brachytherapy in patients with operable cervical cancer: preliminary results of a prospective randomized multicenter study.

Vizkeleti J, Vereczkey I, Frohlich G, Varga S, Horvath K, Pulay T Pathol Oncol Res. 2014; 21(2):247-56.

PMID: 25011515 DOI: 10.1007/s12253-014-9815-5.

The dosimetric impact of vaginal balloon-packing on intracavitary high-dose-rate brachytherapy for gynecological cancer.

Rockey W, Bhatia S, Jacobson G, Kim Y J Contemp Brachytherapy. 2013; 5(1):17-22.

PMID: 23634151 PMC: 3635049. DOI: 10.5114/jcb.2013.34449.

References

Fowler J, Lindstrom M . Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys. 1992; 23(2):457-67. DOI: 10.1016/0360-3016(92)90768-d. View

Chung H, Kang S, Cho J, Kim J, Park N, Song Y . Can preoperative MRI accurately evaluate nodal and parametrial invasion in early stage cervical cancer?. Jpn J Clin Oncol. 2007; 37(5):370-5. DOI: 10.1093/jjco/hym036. View

Nag S, Orton C, Young D, Erickson B . The American brachytherapy society survey of brachytherapy practice for carcinoma of the cervix in the United States. Gynecol Oncol. 1999; 73(1):111-8. DOI: 10.1006/gyno.1998.5334. View

Lyng H, Sundfor K, Trope C, Rofstad E . Disease control of uterine cervical cancer: relationships to tumor oxygen tension, vascular density, cell density, and frequency of mitosis and apoptosis measured before treatment and during radiotherapy. Clin Cancer Res. 2000; 6(3):1104-12. View

Barranger E, Coutant C, Cortez A, Uzan S, Darai E . Sentinel node biopsy is reliable in early-stage cervical cancer but not in locally advanced disease. Ann Oncol. 2005; 16(8):1237-42. DOI: 10.1093/annonc/mdi245. View

Morice P, Uzan C, Zafrani Y, Delpech Y, Gouy S, Haie-Meder C . The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecol Oncol. 2007; 107(1 Suppl 1):S122-4. DOI: 10.1016/j.ygyno.2007.07.015. View

Candelaria M, Cetina L, Garcia-Arias A, Lopez-Graniel C, de la Garza J, Robles E . Radiation-sparing managements for cervical cancer: a developing countries perspective. World J Surg Oncol. 2006; 4:77. PMC: 1660541. DOI: 10.1186/1477-7819-4-77. View

Jacinto A, Castilho M, Novaes P, Novick P, Viani G, Salvajoli J . Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response. Radiat Oncol. 2007; 2:9. PMC: 1817645. DOI: 10.1186/1748-717X-2-9. View

Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A, Cetina L, Rivera L, Mariscal I . A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Ann Oncol. 2003; 14(8):1278-84. DOI: 10.1093/annonc/mdg333. View

10.

Georg D, Kirisits C, Hillbrand M, Dimopoulos J, Potter R . Image-guided radiotherapy for cervix cancer: high-tech external beam therapy versus high-tech brachytherapy. Int J Radiat Oncol Biol Phys. 2008; 71(4):1272-8. DOI: 10.1016/j.ijrobp.2008.03.032. View

11.

Perez C, Grigsby P, CAMEL H, Galakatos A, Mutch D, Lockett M . Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys. 1995; 31(4):703-16. DOI: 10.1016/0360-3016(94)00523-0. View

12.

Haie-Meder C, Potter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J . 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(3):235-45. DOI: 10.1016/j.radonc.2004.12.015. View

13.

Kim W, Kim G, Suh C, Loh J . High versus low dose rate intracavitary irradiation for adenocarcinoma of the uterine cervix. Jpn J Clin Oncol. 2001; 31(9):432-7. DOI: 10.1093/jjco/hye098. View

14.

Grigsby P, Perez C, Chao K, Elbendary A, Herzog T, Rader J . Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix Stage IB and IIA treated with preoperative irradiation and surgery. Int J Radiat Oncol Biol Phys. 1999; 45(3):645-51. DOI: 10.1016/s0360-3016(99)00217-5. View

15.

Chen S, Liang J, Yang S, Ko H, Lin F . The adverse effect of treatment prolongation in cervical cancer by high-dose-rate intracavitary brachytherapy. Radiother Oncol. 2003; 67(1):69-76. DOI: 10.1016/s0167-8140(02)00439-5. View

16.

Mandic A, Novakovic P, Erak M, Vitorovic S, Zikic D, Nincic D . Stage IB2 cervical cancer: brachytherapy followed by radical hysterectomy. J BUON. 2007; 10(3):371-5. View

17.

Cox J, Stetz J, Pajak T . Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5):1341-6. DOI: 10.1016/0360-3016(95)00060-C. View

18.

Wright J, Grigsby P, Brooks R, Powell M, Gibb R, Gao F . Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy. Cancer. 2007; 110(6):1281-6. DOI: 10.1002/cncr.22899. View

19.

Atlan D, Touboul E, Deniaud-Alexandre E, Lefranc J, Antoine J, Jannet D . Operable Stages IB and II cervical carcinomas: a retrospective study comparing preoperative uterovaginal brachytherapy and postoperative radiotherapy. Int J Radiat Oncol Biol Phys. 2002; 54(3):780-93. DOI: 10.1016/s0360-3016(02)02971-1. View

20.

Nicolet V, Carignan L, Bourdon F, Prosmanne O . MR imaging of cervical carcinoma: a practical staging approach. Radiographics. 2000; 20(6):1539-49. DOI: 10.1148/radiographics.20.6.g00nv111539. View