Journal article
American Brachytherapy Society working group report on the patterns of care and a literature review of reirradiation for gynecologic cancers
Brachytherapy, v 19(2), pp 127-138
Mar 2020
PMID: 31917178
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Recurrences of previously irradiated gynecological malignancies are uncommon. Standardized management of these cases is not well established. We aim to provide an in-depth literature review and present current practice patterns among an international group of experienced practitioners in the reirradiation setting of gynecologic cancers.
An extensive literature search was performed and 35 articles were selected based on preset criteria. A 20-question online survey of 10 experts regarding their retreatment practices was also conducted.
The reviewed publications include a diverse group of patients, multiple treatment techniques, a range of total doses, local control, overall survival, and toxicity outcomes. Overall, local control ranged from 44% to 88% over 1–5 years with OS in the range of 39.5–82% at 2–5 years. Late G3–4 toxicity varied very broadly from 0% to 42.9%, with most papers reporting serious toxicities greater than 15%. The most common reirradiation technique utilized was brachytherapy. Some low-dose-rate data suggest improved outcomes with doses >50 Gy. The high-dose-rate data are more varied with some studies suggesting improved local control with doses >40 Gy. In general, a longer time interval between the first and second course of radiation as well as recurrences <2–4 cm tend to have improved outcomes.
Reirradiation with brachytherapy results in relatively reasonable local control and toxicities for women with recurrent gynecologic cancers. The appropriate dose for each case needs to be individualized given the heterogeneity of cases. Multidisciplinary management is critical to develop individualized plans and to clearly communicate potential side effects and expected treatment outcomes.
Reirradiation with brachytherapy is an acceptable effective organ preserving approach for recurrent gynecologic cancers with a reasonable local control and toxicity profile. Each case requires multidisciplinary management to develop an individualized approach. Monitoring for potential long-term toxicities is essential.
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Details
- Title
- American Brachytherapy Society working group report on the patterns of care and a literature review of reirradiation for gynecologic cancers
- Creators
- Alina Sturdza - Comprehensive Cancer Center ViennaAkila N. Viswanathan - Johns Hopkins MedicineBeth Erickson - Medical College of WisconsinCatheryn Yashar - University of California, San DiegoAndrew Bruggeman - University of California, San DiegoJonathan Feddock - Central Baptist HospitalAnn Klopp - The University of Texas MD Anderson Cancer CenterSushil Beriwal - UPMC Hillman Cancer CenterDavid Gaffney - University of UtahKathy Han - University of TorontoMitchell Kamrava - Cedars-Sinai Medical Center
- Publication Details
- Brachytherapy, v 19(2), pp 127-138
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000527851200001
- Scopus ID
- 2-s2.0-85077525134
- Other Identifier
- 991021897384404721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging