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Brachytherapy versus External Beam Boost in Cervical Cancer Radiotherapy
I. J. Radiation Oncology d Biology d Physics
S468
2538
Volume 81, Number 2, Supplement, 2011
The Treatment Outcome Of Cervix Cancer Treated With External Beam Radiotherapy, High-dose-rate Brachytherapy And Concurrent Chemotherapy
J. Lee1, K. Lee1, R. Lee1, H. Suh1, M. Kim1, S. C. Kim2, H. Moon2, W. Ju2 1
Dept. of Radiation Oncology, Ewha Women’s University, School of Medicine, Seoul, Korea, Republic of Korea, 2Dept. of Obstetrics and Gynecology, Ewha Women’s University, School of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): To analyze the treatment outcome of cervix cancer treated with definitive concurrent radiochemotherapy and to evaluate the appropriacy of HDR brachytherapy fractionation of our institute. Materials/Methods: 64 patients with cervix cancer stage IB1-IIIB who were treated between 2001 and 2009 at our institute were included in this analysis. External beam radiotherapy was delivered to whole pelvis with dose of 41.4 - 50.4 Gy followed by midline block delivering total dose up to 50.4 - 59.4 Gy in 28 - 33 fractions. In patients with para-aortic nodal involvement, extended filed was used receiving 45 - 50.4 Gy. High-dose-rate intracavitary brachytherapy was performed twice a week with 192-Ir. The prescription dose was 24 - 32 Gy in 6 - 8 fractions to point A. In all patients, platinum-based chemotherapy was administered during the radiation therapy period except a day of brachytherapy. Results: Seven patients had stage I disease (10.9%), 47 patients stage II (73.5%) and 10 patients stage III (15.6%). Median follow up was 40 months (range, 6.5 - 119.2 months). The actual delivered dose to point A was median 74 GyEQD2 with a/b ratio of 10 (range, 64 to 80 GyEQD2). Persistent disease was found in 1 patient and 3-year local control rate was 94.1%. 3-year rate of pelvic control and disease-free survival were 86.5% and 82.9%, respectively. Late rectal and urinary toxicities of Grade 2 were developed in 7 patients (10.9%) and 8 patients (12.5%), respectively. Only one patient experienced Grade 4 rectal toxicity and there was no Grade 3 - 4 late urinary toxicity. Conclusions: We achieved good local and pelvic control comparable to historical data with a median radiation dose of 74 GyEQD2 to point A which is lower than the generally recommended dose of 85 - 90 GyEQD2. To confirm this result, longer follow up is needed. Author Disclosure: J. Lee: None. K. Lee: None. R. Lee: None. H. Suh: None. M. Kim: None. S.C. Kim: None. H. Moon: None. W. Ju: None.
2539
Brachytherapy versus External Beam Boost in Cervical Cancer Radiotherapy
R. A. Sethi, G. Jozsef, A. Marciscano, M. Babcock, P. B. Schiff NYU Clinical Cancer Center, New York, NY Purpose/Objective(s): To determine the dosimetric feasibility of using IMRT or volumetric arc therapy (VMAT) to deliver the boost dose in cervical cancer radiotherapy. Materials/Methods: High dose rate brachytherapy plans of 20 consecutive patients previously treated with definitive chemoradiotherapy for stage IIB cervical cancer at NYU were included in this IRB-approved study. Each patient had undergone CT scanning with tandem and ovoids in place prior to the first boost fraction. 650 - 700 cGy had been prescribed to point A. We attempted to replicate the boost dose distribution using IMRT or VMAT technique. The planning target volume (PTV) was defined as the 100% isodose line from the brachytherapy plan. An eleven field non-coplanar field arrangement was used for the IMRT plans. VMAT plans applying two 270o arcs were calculated using the same optimization criteria as IMRT plans. Target coverage, normal tissue dose, and point doses for RTOG recommended points were compared using paired t-test (p\0.05 considered significant). Dose values were normalized to the prescription dose. Results: There was no difference in point A dose between IMRT and brachytherapy plans. With IMRT, 98% of the PTV received at least 95% of the prescribed dose on average, and the mean Dmax was 120% of the prescribed dose. Regarding normal tissue dose, there was no difference in rectal Dmax, rectal Dmean, or rectum point dose between brachytherapy and IMRT plans. Bladder Dmax was significantly lower with IMRT than brachytherapy (147% versus 97%), although Dmean was not different. Small bowel Dmax and Dmean were significantly lower with IMRT: 101% versus 130%, and 17% versus 21%, respectively. Femoral head Dmax was higher with IMRT (32/38% versus 12/15%, right/left), although Dmean did not differ. Vaginal mucosa point dose was also significantly lower with IMRT, with average Dmax 102/103% versus 137/144% (right/left). VMAT had either higher bladder mean dose and/or higher dose inhomogeneity in the PTV than IMRT plans, depending on the weighting of criteria. The sparing of other organs was similar. Conclusions: It is dosimetrically feasible to deliver an external beam cervical boost using IMRT technique, with equivalent target coverage and improved normal tissue sparing compared to brachytherapy. Based on this data, we plan to conduct prospective clinical trial of image-guided external beam chemoradiotherapy for cervical cancer. Author Disclosure: R.A. Sethi: None. G. Jozsef: None. A. Marciscano: None. M. Babcock: None. P.B. Schiff: None.
2540
Clinical Results Of External Radiotherapy Alone With 3DCRT For Cervical Cancer: Can We Provide Better Local Control Without Combination Treatment Including Intracavitary Brachytherapy?
K. Matsuura1, T. Okabe1, Y. Akagi2, K. Fujita3, M. Kagemoto1 1 Hiroshima City Hospital, Hiroshima, Japan, 2Hiroshima Heiwa Clinic, State of the Art Treatment Center, Hiroshima, Japan, 3 Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan Purpose/Objective(s): The use of intracavitary brachytherapy (ICBT) was a factor significantly associated with decreased local failure according to results of a pattern of care study, and therefore it has been thought that the local control rate of external radiotherapy (ERT) alone without ICBT was poor. However, in the actual clinical setting one sometimes may need to treat with ERT alone in cases where ICBT is not feasible. In this presentation, the results of 3-dimensional conformal radiotherapy (3DCRT) alone in patients with cervical cancer were evaluated. Materials/Methods: Between 2002 and 2009, 19 patients with cervical cancer were treated with 3DCRT. Eighteen were squamous cell carcinoma, and 1 was adenocarcinoma. The median patient age was 74 years, ranging from 39 to 99 years. There were 1
S468
2538
Volume 81, Number 2, Supplement, 2011
The Treatment Outcome Of Cervix Cancer Treated With External Beam Radiotherapy, High-dose-rate Brachytherapy And Concurrent Chemotherapy
J. Lee1, K. Lee1, R. Lee1, H. Suh1, M. Kim1, S. C. Kim2, H. Moon2, W. Ju2 1
Dept. of Radiation Oncology, Ewha Women’s University, School of Medicine, Seoul, Korea, Republic of Korea, 2Dept. of Obstetrics and Gynecology, Ewha Women’s University, School of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): To analyze the treatment outcome of cervix cancer treated with definitive concurrent radiochemotherapy and to evaluate the appropriacy of HDR brachytherapy fractionation of our institute. Materials/Methods: 64 patients with cervix cancer stage IB1-IIIB who were treated between 2001 and 2009 at our institute were included in this analysis. External beam radiotherapy was delivered to whole pelvis with dose of 41.4 - 50.4 Gy followed by midline block delivering total dose up to 50.4 - 59.4 Gy in 28 - 33 fractions. In patients with para-aortic nodal involvement, extended filed was used receiving 45 - 50.4 Gy. High-dose-rate intracavitary brachytherapy was performed twice a week with 192-Ir. The prescription dose was 24 - 32 Gy in 6 - 8 fractions to point A. In all patients, platinum-based chemotherapy was administered during the radiation therapy period except a day of brachytherapy. Results: Seven patients had stage I disease (10.9%), 47 patients stage II (73.5%) and 10 patients stage III (15.6%). Median follow up was 40 months (range, 6.5 - 119.2 months). The actual delivered dose to point A was median 74 GyEQD2 with a/b ratio of 10 (range, 64 to 80 GyEQD2). Persistent disease was found in 1 patient and 3-year local control rate was 94.1%. 3-year rate of pelvic control and disease-free survival were 86.5% and 82.9%, respectively. Late rectal and urinary toxicities of Grade 2 were developed in 7 patients (10.9%) and 8 patients (12.5%), respectively. Only one patient experienced Grade 4 rectal toxicity and there was no Grade 3 - 4 late urinary toxicity. Conclusions: We achieved good local and pelvic control comparable to historical data with a median radiation dose of 74 GyEQD2 to point A which is lower than the generally recommended dose of 85 - 90 GyEQD2. To confirm this result, longer follow up is needed. Author Disclosure: J. Lee: None. K. Lee: None. R. Lee: None. H. Suh: None. M. Kim: None. S.C. Kim: None. H. Moon: None. W. Ju: None.
2539
Brachytherapy versus External Beam Boost in Cervical Cancer Radiotherapy
R. A. Sethi, G. Jozsef, A. Marciscano, M. Babcock, P. B. Schiff NYU Clinical Cancer Center, New York, NY Purpose/Objective(s): To determine the dosimetric feasibility of using IMRT or volumetric arc therapy (VMAT) to deliver the boost dose in cervical cancer radiotherapy. Materials/Methods: High dose rate brachytherapy plans of 20 consecutive patients previously treated with definitive chemoradiotherapy for stage IIB cervical cancer at NYU were included in this IRB-approved study. Each patient had undergone CT scanning with tandem and ovoids in place prior to the first boost fraction. 650 - 700 cGy had been prescribed to point A. We attempted to replicate the boost dose distribution using IMRT or VMAT technique. The planning target volume (PTV) was defined as the 100% isodose line from the brachytherapy plan. An eleven field non-coplanar field arrangement was used for the IMRT plans. VMAT plans applying two 270o arcs were calculated using the same optimization criteria as IMRT plans. Target coverage, normal tissue dose, and point doses for RTOG recommended points were compared using paired t-test (p\0.05 considered significant). Dose values were normalized to the prescription dose. Results: There was no difference in point A dose between IMRT and brachytherapy plans. With IMRT, 98% of the PTV received at least 95% of the prescribed dose on average, and the mean Dmax was 120% of the prescribed dose. Regarding normal tissue dose, there was no difference in rectal Dmax, rectal Dmean, or rectum point dose between brachytherapy and IMRT plans. Bladder Dmax was significantly lower with IMRT than brachytherapy (147% versus 97%), although Dmean was not different. Small bowel Dmax and Dmean were significantly lower with IMRT: 101% versus 130%, and 17% versus 21%, respectively. Femoral head Dmax was higher with IMRT (32/38% versus 12/15%, right/left), although Dmean did not differ. Vaginal mucosa point dose was also significantly lower with IMRT, with average Dmax 102/103% versus 137/144% (right/left). VMAT had either higher bladder mean dose and/or higher dose inhomogeneity in the PTV than IMRT plans, depending on the weighting of criteria. The sparing of other organs was similar. Conclusions: It is dosimetrically feasible to deliver an external beam cervical boost using IMRT technique, with equivalent target coverage and improved normal tissue sparing compared to brachytherapy. Based on this data, we plan to conduct prospective clinical trial of image-guided external beam chemoradiotherapy for cervical cancer. Author Disclosure: R.A. Sethi: None. G. Jozsef: None. A. Marciscano: None. M. Babcock: None. P.B. Schiff: None.
2540
Clinical Results Of External Radiotherapy Alone With 3DCRT For Cervical Cancer: Can We Provide Better Local Control Without Combination Treatment Including Intracavitary Brachytherapy?
K. Matsuura1, T. Okabe1, Y. Akagi2, K. Fujita3, M. Kagemoto1 1 Hiroshima City Hospital, Hiroshima, Japan, 2Hiroshima Heiwa Clinic, State of the Art Treatment Center, Hiroshima, Japan, 3 Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan Purpose/Objective(s): The use of intracavitary brachytherapy (ICBT) was a factor significantly associated with decreased local failure according to results of a pattern of care study, and therefore it has been thought that the local control rate of external radiotherapy (ERT) alone without ICBT was poor. However, in the actual clinical setting one sometimes may need to treat with ERT alone in cases where ICBT is not feasible. In this presentation, the results of 3-dimensional conformal radiotherapy (3DCRT) alone in patients with cervical cancer were evaluated. Materials/Methods: Between 2002 and 2009, 19 patients with cervical cancer were treated with 3DCRT. Eighteen were squamous cell carcinoma, and 1 was adenocarcinoma. The median patient age was 74 years, ranging from 39 to 99 years. There were 1