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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina
Gynecologic oncology, v 150(2), pp 293-299
Aug 2018
PMID: 29929925
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Brachytherapy is integral to vaginal cancer treatment and is typically delivered using an intracavitary single-channel vaginal cylinder (SCVC) or an interstitial brachytherapy (ISBT) applicator. Multi-channel vaginal cylinder (MCVC) applicators allow for improved organ-at-risk (OAR) sparing compared to SCVC while maintaining target coverage. We present clinical outcomes of patients treated with image-based high dose-rate (HDR) brachytherapy using a MCVC.
Sixty patients with vaginal cancer (27% primary vaginal and 73% recurrence from other primaries) were treated with combination external beam radiotherapy (EBRT) and image-based HDR brachytherapy utilizing a MCVC if residual disease thickness was 7 mm or less after EBRT. All pts received 3D image-based BT to a total equivalent dose of 70–80 Gy.
The median high-risk clinical target volume was 24.4 cm3 (interquartile range [IQR], 14.1), with a median dose to 90% of 77.2 Gy (IQR, 2.8). After a median follow-up of 45 months (range, 11–78), the 4-year local-regional control, distant control, DFS, and OS rates were 92.6%, 76.1%, 64.0%, and 67.2%, respectively. The 4-year LRC rates were similar between the primary vaginal (92%) and recurrent (93%) groups (p = 0.290). Pts with lymph node positive disease had a lower rate of distant control at 4 years (22.7% vs. 89.0%, p < 0.001). There were no Grade 3 or higher acute complications. The 4-year rate of late Grade 3 or higher toxicity was 2.7%.
Clinical outcomes of pts with primary and recurrent vaginal cancer treated definitively in a systematic manner with combination EBRT with image-guided HDR BT utilizing a MCVC applicator demonstrate high rates of local control and low rates of severe morbidity. The MCVC technique allows interstitial implantation to be avoided in select pts with ≤7 mm residual disease thickness following EBRT while maintaining excellent clinical outcomes with extended 4-year follow-up in this rare malignancy.
•Treatment of vaginal cancers with multi-channel cylinder produced high local control.•There were no severe acute complications and only 3% severe late morbidity.•Interstitial implantation can be avoided in select patients with good outcomes.
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Details
- Title
- Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina
- Creators
- Brian J. Gebhardt - UPMC Hillman Cancer CenterJohn A. Vargo - UPMC Hillman Cancer CenterHayeon Kim - UPMC Hillman Cancer CenterChristopher J. Houser - UPMC Hillman Cancer CenterScott M. Glaser - UPMC Hillman Cancer CenterPaniti Sukumvanich - UPMC Hillman Cancer CenterAlexander B. Olawaiye - UPMC Hillman Cancer CenterJoseph L. Kelley - UPMC Hillman Cancer CenterRobert P. Edwards - UPMC Hillman Cancer CenterJohn T. Comerci - UPMC Hillman Cancer CenterMadeleine Courtney-Brooks - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Gynecologic oncology, v 150(2), pp 293-299
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000442192200015
- Scopus ID
- 2-s2.0-85048711093
- Other Identifier
- 991021897271404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology