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Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?

PURPOSE: Recent guidelines recommend magnetic resonance imaging–based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with ch...

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Autores principales: Mittal, Prachi, Chopra, Supriya, Pant, Sidharth, Mahantshetty, Umesh, Engineer, Reena, Ghosh, Jaya, Gupta, Sudeep, Ghadi, Yogesh, Menachery, Siji, Swamidas, Jamema, Gurram, Lavanya, Shrivastava, Shyam Kishore
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Clinical Oncology 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223510/
https://www.ncbi.nlm.nih.gov/pubmed/30085892
http://dx.doi.org/10.1200/JGO.18.00028
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author Mittal, Prachi
Chopra, Supriya
Pant, Sidharth
Mahantshetty, Umesh
Engineer, Reena
Ghosh, Jaya
Gupta, Sudeep
Ghadi, Yogesh
Menachery, Siji
Swamidas, Jamema
Gurram, Lavanya
Shrivastava, Shyam Kishore
author_facet Mittal, Prachi
Chopra, Supriya
Pant, Sidharth
Mahantshetty, Umesh
Engineer, Reena
Ghosh, Jaya
Gupta, Sudeep
Ghadi, Yogesh
Menachery, Siji
Swamidas, Jamema
Gurram, Lavanya
Shrivastava, Shyam Kishore
author_sort Mittal, Prachi
collection PubMed
description PURPOSE: Recent guidelines recommend magnetic resonance imaging–based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with chemoradiation and point A–based brachytherapy (BT) using x-ray– or computed tomography–based planning. METHODS: Patients treated between January 2014 and December 2015 were included. Patients underwent x-ray– or computed tomography–based BT planning with an aim to deliver equivalent doses in 2 Gy (EQD2) > 84 Gy(10) to point A while minimizing maximum dose received by rectum or bladder to a point or 2 cc volume to < 75 Gy EQD2 and < 90 Gy EQD2, respectively(.) The impact of known prognostic factors was evaluated. RESULTS: A total of 339 patients were evaluated. Median age was 52 (32 to 81) years; 52% of patients had stage IB2 to IIB and 48% had stage III to IVA disease. There was 85% compliance with chemoradiation, and 87% of patients received four or more cycles. Median point A dose was 84 (64.8 to 89.7) Gy. The median rectal and bladder doses were 73.5 (69.6 to 78.4) Gy(3) and 83 (73.2 to 90.0) Gy(3), respectively. At a median follow-up of 28 (4 to 45) months, the 3-year local, disease-free, and overall survival for stage IB to IIB disease was 94.1%, 83.3%, and 82.7%, respectively. The corresponding rates for stage III to IVA were 85.1%, 60.7%, and 69.6%. Grade III to IV proctitis and cystitis were observed in 4.7% and 0% of patients, respectively. CONCLUSION: This audit demonstrates good 3-year outcomes that are comparable to published MRBT series. Conventional BT with selective use of interstitial needles and MRBT should continue as standard procedures until level-I evidence for MRBT becomes available.
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spelling pubmed-62235102018-11-13 Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy? Mittal, Prachi Chopra, Supriya Pant, Sidharth Mahantshetty, Umesh Engineer, Reena Ghosh, Jaya Gupta, Sudeep Ghadi, Yogesh Menachery, Siji Swamidas, Jamema Gurram, Lavanya Shrivastava, Shyam Kishore J Glob Oncol Original Reports PURPOSE: Recent guidelines recommend magnetic resonance imaging–based brachytherapy (MRBT) for locally advanced cervical cancer. However, its implementation is challenging within the developing world. This article reports the outcomes of patients with locally advanced cervical cancer treated with chemoradiation and point A–based brachytherapy (BT) using x-ray– or computed tomography–based planning. METHODS: Patients treated between January 2014 and December 2015 were included. Patients underwent x-ray– or computed tomography–based BT planning with an aim to deliver equivalent doses in 2 Gy (EQD2) > 84 Gy(10) to point A while minimizing maximum dose received by rectum or bladder to a point or 2 cc volume to < 75 Gy EQD2 and < 90 Gy EQD2, respectively(.) The impact of known prognostic factors was evaluated. RESULTS: A total of 339 patients were evaluated. Median age was 52 (32 to 81) years; 52% of patients had stage IB2 to IIB and 48% had stage III to IVA disease. There was 85% compliance with chemoradiation, and 87% of patients received four or more cycles. Median point A dose was 84 (64.8 to 89.7) Gy. The median rectal and bladder doses were 73.5 (69.6 to 78.4) Gy(3) and 83 (73.2 to 90.0) Gy(3), respectively. At a median follow-up of 28 (4 to 45) months, the 3-year local, disease-free, and overall survival for stage IB to IIB disease was 94.1%, 83.3%, and 82.7%, respectively. The corresponding rates for stage III to IVA were 85.1%, 60.7%, and 69.6%. Grade III to IV proctitis and cystitis were observed in 4.7% and 0% of patients, respectively. CONCLUSION: This audit demonstrates good 3-year outcomes that are comparable to published MRBT series. Conventional BT with selective use of interstitial needles and MRBT should continue as standard procedures until level-I evidence for MRBT becomes available. American Society of Clinical Oncology 2018-06-21 /pmc/articles/PMC6223510/ /pubmed/30085892 http://dx.doi.org/10.1200/JGO.18.00028 Text en © 2018 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/
spellingShingle Original Reports
Mittal, Prachi
Chopra, Supriya
Pant, Sidharth
Mahantshetty, Umesh
Engineer, Reena
Ghosh, Jaya
Gupta, Sudeep
Ghadi, Yogesh
Menachery, Siji
Swamidas, Jamema
Gurram, Lavanya
Shrivastava, Shyam Kishore
Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title_full Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title_fullStr Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title_full_unstemmed Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title_short Standard Chemoradiation and Conventional Brachytherapy for Locally Advanced Cervical Cancer: Is It Still Applicable in the Era of Magnetic Resonance–Based Brachytherapy?
title_sort standard chemoradiation and conventional brachytherapy for locally advanced cervical cancer: is it still applicable in the era of magnetic resonance–based brachytherapy?
topic Original Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223510/
https://www.ncbi.nlm.nih.gov/pubmed/30085892
http://dx.doi.org/10.1200/JGO.18.00028
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