Editorial

4 pages, 211 KiB

Open AccessEditorial

Interventional Radiotherapy in Gynecological Cancer

by Angeles Rovirosa, Meritxell Arenas and Luca Tagliaferri

Cancers 2023, 15(19), 4804; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15194804 - 29 Sep 2023

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This special issue of “Cancers” explores unusual and very particular aspects of interventional radiotherapy (brachytherapy) in gynecological cancer [...] Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

Research

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16 pages, 11979 KiB

Open AccessArticle

Role of Brachytherapy in the Postoperative Management of Endometrial Cancer: Decision-Making Analysis among Experienced European Radiation Oncologists

by Markus Glatzer, Kari Tanderup, Angeles Rovirosa, Lars Fokdal, Claudia Ordeanu, Luca Tagliaferri, Cyrus Chargari, Vratislav Strnad, Johannes Athanasios Dimopoulos, Barbara Šegedin, Rachel Cooper, Esten Søndrol Nakken, Primoz Petric, Elzbieta van der Steen-Banasik, Kristina Lössl, Ina M. Jürgenliemk-Schulz, Peter Niehoff, Ruth S. Hermansson, Remi A. Nout, Paul Martin Putora, Ludwig Plasswilm and Nikolaos Tselis Show full author list Hide full author list

Cancers 2022, 14(4), 906; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14040906 - 11 Feb 2022

Cited by 5 | Viewed by 3379

Abstract

Background: There are various society-specific guidelines addressing adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC). However, these recommendations are not uniform. Against this background, clinicians need to make decisions despite gaps between best scientific evidence and clinical practice. We explored factors influencing [...] Read more.

Background: There are various society-specific guidelines addressing adjuvant brachytherapy (BT) after surgery for endometrial cancer (EC). However, these recommendations are not uniform. Against this background, clinicians need to make decisions despite gaps between best scientific evidence and clinical practice. We explored factors influencing decision-making for adjuvant BT in clinical routine among experienced European radiation oncologists in the field of gynaecological radiotherapy (RT). We also investigated the dose and technique of BT. Methods: Nineteen European experts for gynaecological BT selected by the Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology provided their decision criteria and technique for postoperative RT in EC. The decision criteria were captured and converted into decision trees, and consensus and dissent were evaluated based on the objective consensus methodology. Results: The decision criteria used by the experts were tumour extension, grading, nodal status, lymphovascular invasion, and cervical stroma/vaginal invasion (yes/no). No expert recommended adjuvant BT for pT1a G1-2 EC without substantial LVSI. Eighty-four percent of experts recommended BT for pT1a G3 EC without substantial LVSI. Up to 74% of experts used adjuvant BT for pT1b LVSI-negative and pT2 G1–2 LVSI-negative disease. For 74–84% of experts, EBRT + BT was the treatment of choice for nodal-positive pT2 disease and for pT3 EC with cervical/vaginal invasion. For all other tumour stages, there was no clear consensus for adjuvant treatment. Four experts already used molecular markers for decision-making. Sixty-five percent of experts recommended fractionation regimens of 3 × 7 Gy or 4 × 5 Gy for BT as monotherapy and 2 × 5 Gy for combination with EBRT. The most commonly used applicator for BT was a vaginal cylinder; 82% recommended image-guided BT. Conclusions: There was a clear trend towards adjuvant BT for stage IA G3, stage IB, and stage II G1–2 LVSI-negative EC. Likewise, there was a non-uniform pattern for BT dose prescription but a clear trend towards 3D image-based BT. Finally, molecular characteristics were already used in daily decision-making by some experts under the pretext that upcoming trials will bring more clarity to this topic. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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12 pages, 1796 KiB

Open AccessArticle

EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma

by Yaowen Zhang, Balbino Fornes, Gabriela Gómez, Irene Bentoldrà, Clara Carmona, Antonio Herreros, Sebastià Sabater, Inmaculada Nicolás, Yan Li, Joan Sánchez, Albert Biete, Aureli Torné, Carlos Ascaso and Ángeles Rovirosa

Cancers 2020, 12(10), 3059; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12103059 - 20 Oct 2020

Cited by 7 | Viewed by 2475

Abstract

Background: To evaluate whether EQD2_{(α/β = 3Gy)} at 2 cm³ of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, [...] Read more.

Background: To evaluate whether EQD2_{(α/β = 3Gy)} at 2 cm³ of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, 43p were included in this study. BT was administered: 3-fractions of 6Gy in 37p and 2-fractions of 7.5Gy in 6p. The dose was prescribed at a depth of 5 mm from the applicator surface with dose-point optimization based on distance. The active treatment length was 2.5 cm. CTV-D90 and the dose to the most exposed 2 cm³ of the vagina was calculated for each patient. Late toxicity of the bladder and rectum was assessed using Radiation Therapy Oncology Group (RTOG) criteria, and vaginal toxicity by objective Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) (LENT-SOMA) criteria. Statistics: frequency tables, mean, median, range, standard deviation, and box plot. Results: The median follow-up was 51 months (12–68). 20 p (46.5%) and 2 p (4.7%) developed G1 and G2 vaginal complications, respectively. Only 1/2 p-G2 receiving EQD2_{(α/β = 3Gy)} at 2 cm³ >68Gy presented vaginal shortening and 18/20 p-G1 received doses < 68Gy. Conclusions: PECp receiving exclusive brachytherapy with doses < 68Gy EQD2_{(α/β = 3Gy)} at 2 cm² of the vagina presented only G0–G1 vaginal toxicity, except for one with bleeding telangiectasias. Larger prospective studies are necessary to confirm the present results. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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Review

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11 pages, 1457 KiB

Open AccessReview

Is There a Place for Brachytherapy in Vulvar Cancer? A Narrative Review

by Sofia Cordoba, Abel Cordoba, Beatriz Gil, Raquel Benlloch, Silvia Rodriguez, Dina Najjari-Jamal, Sofía Santana, Lucie Bresson, Cristina de la Fuente and Jesús Romero

Cancers 2023, 15(23), 5581; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15235581 - 25 Nov 2023

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Abstract

Vulvar cancer is a relatively rare neoplasm. The essential treatment is surgery for the primary tumour. However, postoperative recurrence rates are high, even in early-stage disease when tumour-free surgical margins are achieved or in the absence of associated risk factors (lymph node metastases, [...] Read more.

Vulvar cancer is a relatively rare neoplasm. The essential treatment is surgery for the primary tumour. However, postoperative recurrence rates are high, even in early-stage disease when tumour-free surgical margins are achieved or in the absence of associated risk factors (lymph node metastases, deep stromal invasion or invasion of the lymphatic vascular space). Radiotherapy plays an important role in the treatment of vulvar cancer. Adjuvant treatment after surgery as well as primary treatment of locally advanced vulvar cancer (LAVC) is composed of two key radiotherapy treatment scenarios, external beam radiation therapy (EBRT) either combined or not combined with brachytherapy (BT). In a recurrence setting, where surgery is not an option, BT alone or in combination with EBRT can be used. Compared to EBRT, BT has the radiobiological potential to improve dose to the target volume, minimise the dose to organs at risk, and facilitate hypofractionated-accelerated treatment. This narrative review presents recent data on the role of BT in the treatment of primary and/or recurrent vulvar cancer, including radiobiological, clinical, and therapeutic aspects. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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18 pages, 839 KiB

Open AccessFeature PaperReview

The Use of 3D Printing Technology in Gynaecological Brachytherapy—A Narrative Review

by Barbara Segedin, Manja Kobav and Helena Barbara Zobec Logar

Cancers 2023, 15(16), 4165; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15164165 - 18 Aug 2023

Cited by 2 | Viewed by 1467

Abstract

Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy [...] Read more.

Radiation therapy, including image-guided adaptive brachytherapy based on magnetic resonance imaging, is the standard of care in locally advanced cervical and vaginal cancer and part of the treatment in other primary and recurrent gynaecological tumours. Tumour control probability increases with dose and brachytherapy is the optimal technique to increase the dose to the target volume while maintaining dose constraints to organs at risk. The use of interstitial needles is now one of the quality indicators for cervical cancer brachytherapy and needles should optimally be used in ≥60% of patients. Commercially available applicators sometimes cannot be used because of anatomical barriers or do not allow adequate target volume coverage due to tumour size or topography. Over the last five to ten years, 3D printing has been increasingly used for manufacturing of customised applicators in brachytherapy, with gynaecological tumours being the most common indication. We present the rationale, techniques and current clinical evidence for the use of 3D-printed applicators in gynaecological brachytherapy. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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15 pages, 298 KiB

Open AccessReview

Review on Treatment Planning Systems for Cervix Brachytherapy (Interventional Radiotherapy): Some Desirable and Convenient Practical Aspects to Be Implemented from Radiation Oncologist and Medical Physics Perspectives

by Antonio Otal, Francisco Celada, Jose Chimeno, Javier Vijande, Santiago Pellejero, Maria-Jose Perez-Calatayud, Elena Villafranca, Naiara Fuentemilla, Francisco Blazquez, Silvia Rodriguez and Jose Perez-Calatayud

Cancers 2022, 14(14), 3467; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14143467 - 17 Jul 2022

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Abstract

Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used [...] Read more.

Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used by commercially available treatment planning systems (TPSs) in exclusive magnetic resonance imaging-based (MRI) cervix BT with interstitial component treatments. Practical aspects and improvements to be implemented into the TPSs are discussed. This review is based on the clinical expertise of a group of radiation oncologists and medical physicists and on interactive demos provided by the software manufacturers. The TPS versions considered include all the new tools currently in development for future commercial releases. The specialists from the supplier companies were asked to propose solutions to some of the challenges often encountered in a clinical environment through a questionnaire. The results include not only such answers but also comments by the authors that, in their opinion, could help solve the challenges covered in these questions. This study summarizes the possibilities offered nowadays by commercial TPSs, highlighting the absence of some useful tools that would notably improve the planning of MR-based interstitial component cervix brachytherapy. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

Other

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22 pages, 2990 KiB

Open AccessSystematic Review

Image-Guided Brachytherapy for Salvage Reirradiation: A Systematic Review

by Sophie Bockel, Sophie Espenel, Roger Sun, Isabelle Dumas, Sébastien Gouy, Philippe Morice and Cyrus Chargari

Cancers 2021, 13(6), 1226; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13061226 - 11 Mar 2021

Cited by 13 | Viewed by 2805

Abstract

Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for [...] Read more.

Background: Local recurrence in gynecological malignancies occurring in a previously irradiated field is a challenging clinical issue. The most frequent curative-intent treatment is salvage surgery. Reirradiation, using three-dimensional image-guided brachytherapy (3D-IGBT), might be a suitable alternative. We reviewed recent literature concerning 3D-IGBT for reirradiation in the context of local recurrences from gynecological malignancies. Methods: We conducted a large-scale literature research, and 15 original studies, responding to our research criteria, were finally selected. Results: Local control rates ranged from 44% to 71.4% at 2–5 years, and overall survival rates ranged from 39.5% to 78% at 2–5 years. Grade ≥3 toxicities ranged from 1.7% to 50%, with only one study reporting a grade 5 event. Results in terms of outcome and toxicities were highly variable depending on studies. Several studies suggested that local control could be improved with 2 Gy equivalent doses >40 Gy. Conclusion: IGBT appears to be a feasible alternative to salvage surgery in inoperable patients or patients refusing surgery, with an acceptable outcome for patients who have no other curative therapeutic options, however at a high cost of long-term grade ≥3 toxicities in some studies. We recommend that patients with local recurrence from gynecologic neoplasm occurring in previously irradiated fields should be referred to highly experienced expert centers. Centralization of data and large-scale multicentric international prospective trials are warranted. Efforts should be made to improve local control while limiting the risk of toxicities. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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9 pages, 283 KiB

Open AccessCommentary

Quality Assurance in Modern Gynecological HDR-Brachytherapy (Interventional Radiotherapy): Clinical Considerations and Comments

by Tamer Soror, Frank-André Siebert, Valentina Lancellotta, Elisa Placidi, Bruno Fionda, Luca Tagliaferri and György Kovács

Cancers 2021, 13(4), 912; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13040912 - 22 Feb 2021

Cited by 5 | Viewed by 2622

Abstract

The use of brachytherapy (interventional radiotherapy) in the treatment of gynecological cancers is a crucial element in both definitive and adjuvant settings. The recent developments in high-dose rate remote afterloaders, modern applicators, treatment-planning software, image guidance, and dose monitoring systems have led to [...] Read more.

The use of brachytherapy (interventional radiotherapy) in the treatment of gynecological cancers is a crucial element in both definitive and adjuvant settings. The recent developments in high-dose rate remote afterloaders, modern applicators, treatment-planning software, image guidance, and dose monitoring systems have led to improvement in the local control rates and in some cases improved the survival rates. The development of these highly advanced and complicated treatment modalities has been accompanied by challenges, which have made the existence of quality assurance protocols a must to ensure the integrity of the treatment process. Quality assurance aims at standardizing the technical and clinical procedures involved in the treatment of patients, which could eventually decrease the source of uncertainties whether technical (source/equipment related) or clinical. This commentary review sheds light (from a clinical point of view) on some potential sources of uncertainties associated with the use of modern brachytherapy in the treatment of gynecological cancers. Full article

(This article belongs to the Special Issue Interventional Radiotherapy in Gynecological Cancer)

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