TY - JOUR
T1 - Vienna-II ring applicator for distal parametrial/pelvic wall disease in cervical cancer brachytherapy: An experience from two institutions: Clinical feasibility and outcome
AU - Mahantshetty, Umesh
AU - Sturdza, Alina
AU - Naga CH, Pushpa
AU - Berger, Daniel
AU - Fortin, Israel
AU - Motisi, Laura
AU - Schmid, Maximilian P.
AU - Aravindakshan, Dheera
AU - Ghadi, Yogesh
AU - Swamidas, Jamema V.
AU - Chopra, Supriya
AU - Gurram, Lavanya
AU - Nesvacil, Nicole
AU - Kirisits, Christian
AU - Pötter, Richard
N1 - Funding Information:
Department of Radiation Oncology and Medical Physics acknowledges Nucletron-An Elekta Company for partial funding towards education and research related to Brachytherapy. We are also grateful to Dr Vinod Hande, our study co-ordinator for taking care of the research patients and help compile the data sets for the study. Department of Radiotherapy at the Medical University of Vienna receives financial and/or equipment support for research and educational purposes from Nucletron-An Elekta Company and Varian Medical Systems, Inc.
Publisher Copyright:
© 2019 Elsevier B.V.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - Purpose: Recent evidence from EMBRACE shows that around 16% patients with locally advanced cervical cancer (LACC) have residual tumor in distal parametrium (DP) and pelvic wall disease (LPW) after concurrent radio-chemotherapy (CCRT). Adequate target coverage with standard brachytherapy approaches represents a challenge. Therefore, we modified the Vienna I applicator with an add-on cap allowing for additional oblique needles into the DP/LPW (Vienna II). We report here the feasibility and clinical outcomes using Vienna II applicator in LACC patients treated in 2 institutions. Methods and materials: 69 patients with residual disease in DP/LPW after CCRT were accrued. FIGO (2009) stage was 26% IIB, 52% III, 15% IVA, 7% IVB (para-aortic nodes). At diagnosis 91% had disease involving DP/LPW. After CCRT, patients underwent image guided adaptive brachytherapy (IGABT) using Vienna II applicator. IGABT details, acute complications, dose volume parameters and clinical outcome variables were compiled and analyzed. Results: Residual DP/LPW disease at BT was found in 90% patients. Median total number of needles were 7 [3–15], oblique 4 [1–7]. Manageable intraoperative utero-vaginal complications occurred in 8 patients and manageable arterial bleeding in 6 patients during removal. Mean distance between tandem and outer contour of CTVHR was 38 mm and mean CTVHR (±SD) volume was 69 ± 32 cm3. The mean D90 CTVHR was 86 ± 7 Gy (EQD2) and mean (±SD) D2cm 3 (Gy, EQD2) 86 ± 12, 68 ± 7, 68 ± 9 for bladder, rectum and sigmoid respectively. Actuarial LC, PFS, OS at 3/5 years was 76/72%, 56/50%, 62/54% and G3-4 late toxicities (n = 23) were observed in 14 patients (20%). Conclusions: IGABT using Vienna II applicator allows for appropriate target coverage in tumors extending into DP/LPW at the time of BT. Clinical use is feasible and results in good local control, DFS and OS with moderate rate of acute and late ≥G3 toxicity.
AB - Purpose: Recent evidence from EMBRACE shows that around 16% patients with locally advanced cervical cancer (LACC) have residual tumor in distal parametrium (DP) and pelvic wall disease (LPW) after concurrent radio-chemotherapy (CCRT). Adequate target coverage with standard brachytherapy approaches represents a challenge. Therefore, we modified the Vienna I applicator with an add-on cap allowing for additional oblique needles into the DP/LPW (Vienna II). We report here the feasibility and clinical outcomes using Vienna II applicator in LACC patients treated in 2 institutions. Methods and materials: 69 patients with residual disease in DP/LPW after CCRT were accrued. FIGO (2009) stage was 26% IIB, 52% III, 15% IVA, 7% IVB (para-aortic nodes). At diagnosis 91% had disease involving DP/LPW. After CCRT, patients underwent image guided adaptive brachytherapy (IGABT) using Vienna II applicator. IGABT details, acute complications, dose volume parameters and clinical outcome variables were compiled and analyzed. Results: Residual DP/LPW disease at BT was found in 90% patients. Median total number of needles were 7 [3–15], oblique 4 [1–7]. Manageable intraoperative utero-vaginal complications occurred in 8 patients and manageable arterial bleeding in 6 patients during removal. Mean distance between tandem and outer contour of CTVHR was 38 mm and mean CTVHR (±SD) volume was 69 ± 32 cm3. The mean D90 CTVHR was 86 ± 7 Gy (EQD2) and mean (±SD) D2cm 3 (Gy, EQD2) 86 ± 12, 68 ± 7, 68 ± 9 for bladder, rectum and sigmoid respectively. Actuarial LC, PFS, OS at 3/5 years was 76/72%, 56/50%, 62/54% and G3-4 late toxicities (n = 23) were observed in 14 patients (20%). Conclusions: IGABT using Vienna II applicator allows for appropriate target coverage in tumors extending into DP/LPW at the time of BT. Clinical use is feasible and results in good local control, DFS and OS with moderate rate of acute and late ≥G3 toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85071676716&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2019.08.004
DO - 10.1016/j.radonc.2019.08.004
M3 - Journal articles
C2 - 31495516
AN - SCOPUS:85071676716
SN - 0167-8140
VL - 141
SP - 123
EP - 129
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -
