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Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer
PURPOSE: There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transp...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793065/ https://www.ncbi.nlm.nih.gov/pubmed/26985194 http://dx.doi.org/10.5114/jcb.2016.57535 |
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author | Bailleux, Caroline Falk, Alexander Tuan Chand-Fouche, Marie-Eve Gautier, Mathieu Barranger, Emmanuel Hannoun-Levi, Jean-Michel |
author_facet | Bailleux, Caroline Falk, Alexander Tuan Chand-Fouche, Marie-Eve Gautier, Mathieu Barranger, Emmanuel Hannoun-Levi, Jean-Michel |
author_sort | Bailleux, Caroline |
collection | PubMed |
description | PURPOSE: There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transperineal parametrial high-dose-rate brachytherapy (HDRB) boost for locally advanced cervical cancer. MATERIAL AND METHODS: From 01.2011 to 12.2014, 33 patients (pts) presenting a locally advanced cervical cancer with parametrial invasion were treated. After the first course of external beam radiation therapy with cisplatinum, HDRB was performed combining endocavitary and interstitial technique for cervical and parametrial disease. Post-operative delineation (CTV, bladder, rectum, sigmoid) and planification were based on CT-scan/MRI. HDRB was delivered in 3-5 fractions over 2-3 consecutive days. Acute toxicities occurring within 6 months after HDRB were retrospectively reviewed. RESULTS: Median age was 56.4 years (27-79). Clinical stages were: T2b = 23 pts (69.7%), T3a = 1 pt (3%), T3b = 6 pts (18.2%), and T4a = 3 pts (9.1%). Median HDRB prescribed dose was 21 Gy (21-27). Median CTV(CT) (16 pts) and HR-CTV(MRI) (17 pts) were 52.6 cc (28.5-74.3), 31.9 cc (17.1-58), respectively. Median EQD2(αβ10) for D90(CTV) and D90(HR-CTV) were 82.9 Gy (78.2-96.5), 84.8 Gy (80.6-91.4), respectively. Median EQD2(αβ3) (CT/MRI) for D(2cc) bladder, rectum and sigmoid were 75.5 Gy (66.6-90.9), 64.4 Gy (51.9-77.4), and 60.4 Gy (50.9-81.1), respectively. Median follow-up was 14 months (ranged 6-51). Among the 24 pts with MFU = 24 months, 2-year LRFS rate, RRFS, and OS were 86.8%, 88.8%, and 94.1%, respectively. The rates of acute genitourinary and gastrointestinal toxicities were 36% (G1 dysuria = 8 pts, G2 infection = 2 pts, G3 infection = 2 pts), and 27% (G1 diarrhea = 9 pts), respectively. One patient presented vaginal bleeding at the time of applicator withdrawal (G3-blood transfusion); no bleeding was observed due to the parametrial implant. CONCLUSIONS: Concomitant cervical and transperineal parametrial HDRB boost for locally advanced cervical cancer appears feasible and safe with no specific acute toxicity compare to cervical HDRB alone. Longer follow-up and larger patient cohort will be needed. |
format | Online Article Text |
id | pubmed-4793065 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-47930652016-03-16 Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer Bailleux, Caroline Falk, Alexander Tuan Chand-Fouche, Marie-Eve Gautier, Mathieu Barranger, Emmanuel Hannoun-Levi, Jean-Michel J Contemp Brachytherapy Original Paper PURPOSE: There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transperineal parametrial high-dose-rate brachytherapy (HDRB) boost for locally advanced cervical cancer. MATERIAL AND METHODS: From 01.2011 to 12.2014, 33 patients (pts) presenting a locally advanced cervical cancer with parametrial invasion were treated. After the first course of external beam radiation therapy with cisplatinum, HDRB was performed combining endocavitary and interstitial technique for cervical and parametrial disease. Post-operative delineation (CTV, bladder, rectum, sigmoid) and planification were based on CT-scan/MRI. HDRB was delivered in 3-5 fractions over 2-3 consecutive days. Acute toxicities occurring within 6 months after HDRB were retrospectively reviewed. RESULTS: Median age was 56.4 years (27-79). Clinical stages were: T2b = 23 pts (69.7%), T3a = 1 pt (3%), T3b = 6 pts (18.2%), and T4a = 3 pts (9.1%). Median HDRB prescribed dose was 21 Gy (21-27). Median CTV(CT) (16 pts) and HR-CTV(MRI) (17 pts) were 52.6 cc (28.5-74.3), 31.9 cc (17.1-58), respectively. Median EQD2(αβ10) for D90(CTV) and D90(HR-CTV) were 82.9 Gy (78.2-96.5), 84.8 Gy (80.6-91.4), respectively. Median EQD2(αβ3) (CT/MRI) for D(2cc) bladder, rectum and sigmoid were 75.5 Gy (66.6-90.9), 64.4 Gy (51.9-77.4), and 60.4 Gy (50.9-81.1), respectively. Median follow-up was 14 months (ranged 6-51). Among the 24 pts with MFU = 24 months, 2-year LRFS rate, RRFS, and OS were 86.8%, 88.8%, and 94.1%, respectively. The rates of acute genitourinary and gastrointestinal toxicities were 36% (G1 dysuria = 8 pts, G2 infection = 2 pts, G3 infection = 2 pts), and 27% (G1 diarrhea = 9 pts), respectively. One patient presented vaginal bleeding at the time of applicator withdrawal (G3-blood transfusion); no bleeding was observed due to the parametrial implant. CONCLUSIONS: Concomitant cervical and transperineal parametrial HDRB boost for locally advanced cervical cancer appears feasible and safe with no specific acute toxicity compare to cervical HDRB alone. Longer follow-up and larger patient cohort will be needed. Termedia Publishing House 2016-01-28 2016-02 /pmc/articles/PMC4793065/ /pubmed/26985194 http://dx.doi.org/10.5114/jcb.2016.57535 Text en Copyright © 2016 Termedia Sp. z o. o. http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Bailleux, Caroline Falk, Alexander Tuan Chand-Fouche, Marie-Eve Gautier, Mathieu Barranger, Emmanuel Hannoun-Levi, Jean-Michel Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title | Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title_full | Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title_fullStr | Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title_full_unstemmed | Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title_short | Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
title_sort | concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793065/ https://www.ncbi.nlm.nih.gov/pubmed/26985194 http://dx.doi.org/10.5114/jcb.2016.57535 |
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