TY - JOUR
T1 - Inversely and adaptively planned interstitial brachytherapy
T2 - A single implant approach
AU - Hanania, Alexander N.
AU - Myers, Pamela
AU - Yoder, Alison K.
AU - Bulut, Ahmet
AU - Henry Yu, Z.
AU - Eraj, Salman
AU - Bowers, John
AU - Bonnen, Mark D.
AU - Echeverria, Alfredo
AU - Hall, Tracilyn R.
AU - Anderson, Matthew L.
AU - Ludwig, Michelle
N1 - Funding Information:
Harris Health System (Ben Taub and Lyndon B. Johnson Hospitals) Department of Gynecology Oncology, MDACC (Lois Ramondetta MD, Kathleen Schmeler MD). The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Objective: To evaluate the efficacy, feasibility and safety of image-based, inversely and adaptively planned high-dose rate interstitial brachytherapy (HDR-ISBT) to treat advanced primary or recurrent gynecologic malignancy in a single implant, three-consecutive-day regimen. Methods: Clinical demographics and outcome data were abstracted from all patients with primary and recurrent gynecologic malignancies who received HDR-ISBT boost from 2014 to 2017. Treatment consisted of a single implant (~7 Gy × 4 fractions) of interstitial needles using the Syed-Neblett template over a three-day hospital admission. CT-based (3D) simulation with inverse and adaptive planning was utilized for each fraction. MR prior to and MR immediately after external beam therapy were fused for HDR-ISBT target delineation. Results: Forty women with an overall median follow-up of 18 months (range: 6–54 months) received an HDR-ISBT boost. Of the 30 primary cases (83% cervix, 10% vaginal, 7% uterine), 44% had organ invasion (bladder, rectal or both) on MRI. Median coverage and dose are reported (V100: 98%, HR-CTV EQD2: 85.1 Gy, D90: 92 Gy). A significant association existed between rectal doses exceeding GEC-ESTRO recommendations (D2cc < 75 Gy) and the development of grade 3 gastrointestinal toxicity with a relative risk of 1.4 [1.1–1.8] (p =.046). Actuarial two-year overall survival (OS), local control (LC) and progression-free survival (PFS) were 81%, 81% and 64%, respectively. Conclusions: A four fraction, inversely and adaptively planned, single-implant approach of image-based HDR-ISBT provides excellent coverage, minimal toxicity and effective local control in patients with advanced and recurrent disease.
AB - Objective: To evaluate the efficacy, feasibility and safety of image-based, inversely and adaptively planned high-dose rate interstitial brachytherapy (HDR-ISBT) to treat advanced primary or recurrent gynecologic malignancy in a single implant, three-consecutive-day regimen. Methods: Clinical demographics and outcome data were abstracted from all patients with primary and recurrent gynecologic malignancies who received HDR-ISBT boost from 2014 to 2017. Treatment consisted of a single implant (~7 Gy × 4 fractions) of interstitial needles using the Syed-Neblett template over a three-day hospital admission. CT-based (3D) simulation with inverse and adaptive planning was utilized for each fraction. MR prior to and MR immediately after external beam therapy were fused for HDR-ISBT target delineation. Results: Forty women with an overall median follow-up of 18 months (range: 6–54 months) received an HDR-ISBT boost. Of the 30 primary cases (83% cervix, 10% vaginal, 7% uterine), 44% had organ invasion (bladder, rectal or both) on MRI. Median coverage and dose are reported (V100: 98%, HR-CTV EQD2: 85.1 Gy, D90: 92 Gy). A significant association existed between rectal doses exceeding GEC-ESTRO recommendations (D2cc < 75 Gy) and the development of grade 3 gastrointestinal toxicity with a relative risk of 1.4 [1.1–1.8] (p =.046). Actuarial two-year overall survival (OS), local control (LC) and progression-free survival (PFS) were 81%, 81% and 64%, respectively. Conclusions: A four fraction, inversely and adaptively planned, single-implant approach of image-based HDR-ISBT provides excellent coverage, minimal toxicity and effective local control in patients with advanced and recurrent disease.
KW - Adaptive planning recurrent
KW - Advanced
KW - Gynecologic
KW - High dose rate (HDR)
KW - Image based
KW - Interstitial brachytherapy (ISBT)
UR - http://www.scopus.com/inward/record.url?scp=85056731652&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056731652&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2018.11.020
DO - 10.1016/j.ygyno.2018.11.020
M3 - Article
C2 - 30449720
AN - SCOPUS:85056731652
VL - 152
SP - 353
EP - 360
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 2
ER -