Cancer Research and Treatment

Original Articles

Gynecologic cancer

Image-Guided Versus Conventional Brachytherapy for Locally Advanced Cervical Cancer: Experience of Single Institution with the Same Practitioner and Time Period: Tae Hoon Lee, Kyung Su Kim, Hak Jae Kim, Chang Heon Choi, Seonghee Kang, Keun-Yong Eom, Chan Woo Wee, Yong Sang Song, Noh Hyun Park, Jae-Weon Kim, Hyun Hoon Chung, Hee Seung Kim, Maria Lee, Hyun-Cheol Kang; Cancer Res Treat. 2023;55(1):258-269. Published online August 10, 2022; DOI: https://doi.org/10.4143/crt.2022.418

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Purpose
This study aimed to compare treatment outcomes and toxicity profile between imaged-guided brachytherapy (IGBT) versus conventional brachytherapy (CBT) performed by the same practitioner during the same time period.
Materials and Methods
Medical records of 104 eligible patients who underwent brachytherapy for locally advanced cervical cancer were retrospectively reviewed. Fifty patients (48.1%) underwent IGBT, and 54 (51.9%) patients underwent CBT. All patients underwent concurrent chemoradiation with cisplatin. High-dose-rate intracavitary brachytherapy with dose prescription of 25-30 Gy in 4-6 fractions was performed for all patients. Late lower gastrointestinal (GI) and urinary toxicities occurred more than 3 months after the end of brachytherapy were included for comparative and dosimetric analyses.
Results
The median follow-up period was 18.33 months (range, 3.25 to 38.43 months). There were no differences in oncologic outcomes between the two groups. The IGBT group had lower rate of actuarial grade ≥ 3 toxicity than the CBT group (2-year, 4.5% vs. 25.7%; p=0.030). Cumulative equieffective D2cc of sigmoid colon was significantly correlated with grade ≥ 2 lower GI toxicity (p=0.033), while equieffective D2cc of rectum (p=0.055) and bladder (p=0.069) showed marginal significance with corresponding grade ≥ 2 toxicities in the IGBT group. Half of grade ≥ 3 lower GI toxicities impacted GI tract above the rectum. Optimal thresholds of cumulative D2cc of sigmoid colon and rectum were 69.7 Gy and 70.8 Gy, respectively, for grade ≥ 2 lower GI toxicity.
Conclusion
IGBT showed superior toxicity profile to CBT. Evaluating the dose to the GI tract above rectum by IGBT might prevent some toxicities.

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Dosimetric and Clinical Effects of Polyethylene Glycol Gel in Radical Concurrent Chemoradiation Therapy for Cervical Cancer: A Phase 3 Prospective Multicenter Randomized Controlled Trial
Yuxuan Wang, Xiang Zhang, Fangfang Wang, Wenjuan Chen, Xinping Cao, Yangyi Ou, Zhen Zhang, Guihao Ke, Zi Liu, Tao Wang, Peng Xie, Qiufen Guo, Wenxue Zhang, Jing Zhai, Guiling Li, Zhen Pan, Sen Hou, Zhanpeng Zhang, Yali Wang, Junfang Yan, Jie Qiu, Fuquan Z
International Journal of Radiation Oncology*Biology*Physics.2026; 124(2): 349. CrossRef
Image-Guided Adaptive Brachytherapy for Uterine Cancer: A Comprehensive Review
Yi-Ching Chen, Chi-Yuan Yeh
Cancers.2026; 18(4): 693. CrossRef
Cisplatin

Reactions Weekly.2023; 1947(1): 125. CrossRef
A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents
Farinaz Havaei, Francis Kobekyaa, Andy Ma, Maura MacPhee, Wei Zhang, Megan Kaulius, Bahar Ahmadi, Sheila Boamah, Adam Easterbrook, Amy Salmon
Healthcare.2023; 11(15): 2187. CrossRef

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Gynecologic Cancer

Early Metabolic Response Assessed Using ¹⁸F-FDG-PET/CT for Image-Guided Intracavitary Brachytherapy Can Better Predict Treatment Outcomes in Patients with Cervical Cancer: Nalee Kim, Won Park, Won Kyung Cho, Duk-Soo Bae, Byoung-Gie Kim, Jeong-Won Lee, Tae-Joong Kim, Chel Hun Choi, Yoo-Young Lee, Young Seok Cho; Cancer Res Treat. 2021;53(3):803-812. Published online December 9, 2020; DOI: https://doi.org/10.4143/crt.2020.1251

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Purpose
This study aimed to identify the prognostic value of early metabolic response assessed using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiation therapy (RT) for cervical cancer.
Materials and Methods
We identified 116 patients treated with definitive RT, including FDG-PET/CT–guided intracavitary brachytherapy, between 2009 and 2018. We calculated parameters including maximum (SUV_max) and mean standardized uptake values (SUV_mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for baseline FDG-PET/CT (PET_base) and image-guided brachytherapy planning FDG-PET/CT (PET_IGBT). Multivariable analyses of disease-free survival (DFS) and overall survival (OS) were performed.
Results
We observed a time-dependent decrease in PET parameters between PET_base and PET_IGBT; ΔSUV_max, ΔSUV_mean, ΔMTV, and ΔTLG were 65%, 61%, 78%, and 93%, respectively. With a median follow-up of 59.5 months, the 5-year DFS and OS rates were 66% and 79%, respectively. Multivariable analysis demonstrated that ΔSUV_max ≥ 50% was associated with favorable DFS (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.14 to 5.77) and OS (HR, 5.14; 95% CI, 1.55 to 17.01). Patients with ΔSUV_max ≥ 50% (n=87) showed better DFS and OS than those with ΔSUV_max < 50% (n=29) (DFS, 76% vs. 35%, p < 0.001; OS, 90% vs. 41%, p < 0.001, respectively). Adenocarcinoma was frequently observed in ΔSUV_max < 50% compared to ΔSUV_max ≥ 50% (27.6% vs. 10.3%, p=0.003). In addition, models incorporating metabolic parameters showed improved accuracy for predicting DFS (p=0.012) and OS (p=0.004) than models with clinicopathologic factors.
Conclusion
Changes in metabolic parameters, especially those in SUV_max by > 50%, can help improve survival outcome predictions for patients with cervical cancer treated with definitive RT.

Citations

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Poseidon’s Trident: “Divine” Intervention in Cervical Cancer Through Chemoradiation, Immunotherapy, and Antibody–Drug Conjugates
Yuting Sheng, Hunter E. Wujcik, Mark R. Wakefield, Yujiang Fang
Cancers.2026; 18(5): 774. CrossRef
Roadmap: medical physics technologies in brachytherapy
William Y Song, Michael Roumeliotis, Junghoon Lee, Aaron Fenster, Jessica Rodgers, Tiana Trumpour, Rachel M Glicksman, Alejandro Berlin, Åsa Carlsson Tedgren, Javier Vijande, Luc Beaulieu, Björn Morén, Sandra Meyers, Alexandra Rink, Yin Gao, Benjamin P Fa
Physics in Medicine & Biology.2025; 70(14): 14RM01. CrossRef
Personalized strategies for brachytherapy of cervix cancer
Guillaume Camprodon, Alexandra Gabro, Zineb El Ayachi, Supriya Chopra, Remi Nout, Philippe Maingon, Cyrus Chargari
Cancer/Radiothérapie.2024; 28(6-7): 610. CrossRef
Brachytherapy for cervical cancer: from intracavitary to interstitial technique
Xiaojing Yang, Hanru Ren, Zhen Li, Jie Fu
Frontiers in Oncology.2024;[Epub] CrossRef
Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer
Zhaoming Zhang, Ning Zhang, Guanghui Cheng
La radiologia medica.2023; 128(5): 588. CrossRef
MRI- and PET-Based Assessment of Radiological and Clinical Factors Associated With Cervical Cancer Response to External Beam Radiation Therapy
Arun G Paul, Steven Miller, Lance K Heilbrun, Daryn W Smith
Cureus.2022;[Epub] CrossRef

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Ruthenium-106 Brachytherapy with or without Additional Local Therapy Shows Favorable Outcome for Variable-Sized Choroidal Melanomas in Korean Patients: Yeona Cho, Jee Suk Chang, Jin Sook Yoon, Sung Chul Lee, Yong Bae Kim, Joo Ho Kim, Ki Chang Keum; Cancer Res Treat. 2018;50(1):138-147. Published online March 24, 2017; DOI: https://doi.org/10.4143/crt.2016.391

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Purpose
The purpose of this study was to report clinical outcomes of ruthenium-106 (¹⁰⁶Ru) brachytherapy with or without additional local therapy for choroidal melanomas in Korean patients.
Materials and Methods
A total of 88 patients diagnosed with choroidal melanomas were treated with ¹⁰⁶Ru brachytherapy between 2006 and 2012. Patients were divided into two groups according to their tumor height: a large group (≥ 6 mm, n=50) and a small group (< 6 mm, n=38). Most patients in the large group received combined therapy with local excision and/or transpupillary thermotherapy. In general, 85-95 Gy was administered to the apex of the tumor, while 100 Gy was administered to the point 2-6 mm from the outer surface of the sclera for patients undergoing combined therapy.
Results
The median follow-up duration was 30 months. The 3-year local control rate was significantly higher in the small group than in the large group (94% vs. 70%, p=0.047). The free from distant metastasis (FFDM) rate and the overall survival (OS) rate were also higher in patients in the small group (3-year FFDM, 97% vs. 76%; p=0.031 and 3-year OS, 97% vs. 72%; p=0.036). A total of 13 patients underwent enucleation. The eye-preservation rate was also higher in the small group (3-year eye-preservation rate, 94% vs. 70%; p=0.050), and tumor height was a significant prognostic factor for eye-preservation.
Conclusion
¹⁰⁶Ru brachytherapy showed favorable outcomes in small choroidal melanomas in Korean patients. Although additional local treatment could improve eye-preservation rate for large tumors, other strategies should be considered for disease control.

Citations

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Advances in mechanisms and challenges in clinical translation of synergistic nanomaterial-based therapies for melanoma
Yibo Zhang, Xilin Liu, Guangzhi Wu
Frontiers in Cell and Developmental Biology.2025;[Epub] CrossRef
Outcomes of Stereotactic Body Radiation Therapy for Large Uveal Melanoma: A Retrospective Analysis of Asian Population
Jong Won Park, Seowoong Jun, Ki Chang Keum, Christopher Seungkyu Lee, Kyung Hwan Kim
Cancer Research and Treatment.2025; 57(4): 1218. CrossRef
Carbon Ion Versus Photon-based Stereotactic Ablative Radiation Therapy for Patients with Choroidal Melanoma
Jina Kim, Masaru Wakatsuki, Shuri Aoki, Jong Won Park, Nao Kobayashi, Ki Chang Keum, Hirokazu Makishima, Christopher Seungkyu Lee, Hitoshi Ishikawa, Kyung Hwan Kim
Advances in Radiation Oncology.2025; 10(12): 101915. CrossRef
Incidence, risk factors and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma
Viktor T. Gill, Gustav Stålhammar
Heliyon.2024; 10(1): e23447. CrossRef
Brachytherapy With 15- Versus 20-mm Ruthenium 106 Plaques Without Verification of Plaque Position Is Associated With Local Tumor Recurrence and Death in Posterior Uveal Melanoma
Gustav Stålhammar
International Journal of Radiation Oncology*Biology*Physics.2023; 117(5): 1125. CrossRef
The Role of Ruthenium Compounds in Neurologic Diseases: A Minireview
Fátima Virgínia Gama Justi, Gabriella Araújo Matos, Juan de Sá Roriz Caminha, Cássia Rodrigues Roque, Edinilton Muniz Carvalho, Márcio Wilker Soares Campelo, Ludmila Belayev, Luiz Gonzaga de França Lopes, Reinaldo Barreto Oriá
The Journal of Pharmacology and Experimental Therapeutics.2022; 380(1): 47. CrossRef
Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy
Gilda Cennamo, Daniela Montorio, Luca D’ Andrea, Antonio Farella, Elide Matano, Mario Giuliano, Raffaele Liuzzi, Maria Angelica Breve, Sabino De Placido, Giovanni Cennamo
Frontiers in Oncology.2022;[Epub] CrossRef
Uveal Melanoma: A Review of the Literature and Personal Experiences
Yong Joon Kim, Christopher Seungkyu Lee, Sung Chul Lee
Journal of Retina.2021; 6(2): 65. CrossRef
Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma
Daniel Lorenzo, María Ochoa, Josep Maria Piulats, Cristina Gutiérrez, Luis Arias, Jaume Català, María Grau, Judith Peñafiel, Estefanía Cobos, Pere Garcia-Bru, Marcos Javier Rubio, Noel Padrón-Pérez, Bruno Dias, Joan Pera, Josep Maria Caminal
Cancer Research and Treatment.2018; 50(4): 1130. CrossRef

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Body Mass Index and Doses at Organs at Risk in a Mediterranean Population Treated with Postoperative Vaginal Cuff Brachytherapy: Sebastia Sabater, Meritxell Arenas, Roberto Berenguer, Ignacio Andres, Esther Jimenez-Jimenez, Ana Martos, Jesus Fernandez-Lopez, Mar Sevillano, Angeles Rovirosa; Cancer Res Treat. 2015;47(3):473-479. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2014.115

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Purpose
Association between body mass index (BMI) and doses in organs at risk during postoperative vaginal cuff brachytherapy (VCB) treatment has not been evaluated. The aim of this study was to analyse the impact of BMI on the dose delivered to bladder and rectum during high-dose-rate VCB using computed tomography (CT) scans at every fraction.
Materials and Methods
A retrospective analysis of 220 planning CT sets derived from 59 patients was conducted. Every planning CT was re-segmented and re-planned under the same parameters. Rectum and bladder dose-volume histogram values (D0.1cc, D1cc, and D2cc) were extracted and evaluated. The mean values for all applications per patient were calculated and correlated with BMI, as well as other factors influencing rectal and bladder doses. Multiple regression analysis performed to model organ at risk dose-volume parameters.
Results
According to World Health Organization (WHO), 6.8% of patients were normal, 35.6% were overweight, and 57.6% were class I obese. Median rectal doses were 133.5%, 110.9%, and 99.3% for D0.1cc, D1cc, and D2cc, respectively. The corresponding median bladder doses were 96.2%, 80.6%, and 73.3%, respectively. BMI did not show significant association with rectal doses. However, BMI did show a significant association with evaluated bladder dose metrics (D0.1cc, r=–0.366, p=0.004; D1cc, r=–0.454, p < 0.001; D2cc, r=–0.451, p < 0.001). BMI was retained in the multivariate regression models (D0.1cc, p=0.004; D1cc, p < 0.001; D2cc, p=0.001).
Conclusion
In this group of Mediterranean, overweight, and moderately obese patients, BMI showed association with lower bladder dose values, but not with rectal doses.

Citations

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Influence of Body Mass Index on Dosimetric Outcomes in CT-Based Interstitial Brachytherapy for Gynecological Malignancies
Sahana Srinivasan, Johan Sunny, Dilson Lobo, Srikant N, Athiyamaan MS, Sourjya Banerjee, Abhishek Krishna, Paul Simon, Challapalli Srinivas
F1000Research.2026; 15: 795. CrossRef
Investigating the Influence of Body Mass Index on Organs at Risk Doses for Adjuvant High-Dose-Rate Vaginal Cuff Brachytherapy in Patients with Early-Stage Endometrial Carcinoma: A Single-Center Experience
Alexandra Timea Kirsch-Mangu, Diana Cristina Pop, Alexandru Țipcu, Andrei-Rareș Avasi, Claudia Ordeanu, Ovidiu Florin Coza, Alexandru Irimie
Diagnostics.2025; 15(7): 795. CrossRef
Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?
Yaowen Zhang, Faegheh Noorian, Rosa Abellana, José Rochera, Antonio Herreros, Gabriela Antelo, Valentina Lancellotta, Luca Tagliaferri, Qian Han, Aureli Torne, Angeles Rovirosa
Clinical and Translational Oncology.2023; 25(6): 1748. CrossRef
Dose and secondary cancer-risk estimation of patients undergoing high dose rate intracavitary gynaecological brachytherapy
Chris Osam Doudoo, Prince Kwabena Gyekye, Geoffrey Emi-Reynolds, Simon Adu, David Okoh Kpeglo, Samuel Nii Adu Tagoe, Kofi Agyiri
Journal of Medical Imaging and Radiation Sciences.2023; 54(2): 335. CrossRef
Influence of body habitus on dose parameters of nodal levels III to IV irradiation for breast cancer: comparison of 3 techniques
Sebastia Sabater, Marina Gascon, Manuel Gutierrez-Perez, Roberto Berenguer, Ellen M. Donovan, Emma J. Harris, Meritxell Arenas
Medical Dosimetry.2018; 43(4): 328. CrossRef
Does postoperative irradiation improve survival in early-stage endometrial cancer?
Sebastia Sabater, Ignacio Andres, Veronica Lopez-Honrubia, Maria Magdalena Marti-Laosa, Susana Castro-Larefors, Roberto Berenguer, Esther Jimenez-Jimenez, Marimar Sevillano, Angeles Rovirosa, Meritxell Arenas
Brachytherapy.2018; 17(6): 912. CrossRef
Body mass index and outcomes of endometrial and ovarian cancer patients
Anke Smits, Alberto Lopes, Ruud Bekkers, Leon Massuger, Khadra Galaal
Expert Review of Quality of Life in Cancer Care.2016; 1(3): 221. CrossRef

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High-Dose-Rate Brachytherapy for the Treatment of Vaginal Intraepithelial Neoplasia: Jin Ho Song, Joo Hwan Lee, Jong Hoon Lee, Jong Sup Park, Sook Hee Hong, Hong Seok Jang, Yeon Sil Kim, Byung Ock Choi, Sei Chul Yoon; Cancer Res Treat. 2014;46(1):74-80. Published online January 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.1.74

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PURPOSE
Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy.
MATERIALS AND METHODS
We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa.
RESULTS
Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097).
CONCLUSION
HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

Citations

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Treatment of cervical/vaginal intra-epithelial neoplasia with high–dose-rate brachytherapy: a multi-center retrospective analysis
Dong-Yun Kim, Choong-Won Lee, Wonguen Jung, Hyun-Cheol Kang, Eunji Kim, Won Il Jang, Kyung Su Kim
International Journal of Gynecological Cancer.2026; 36(4): 104466. CrossRef
High-dose-rate vaginal brachytherapy for treatment of recurrent high-grade vaginal intraepithelial neoplasia
Jacopo Di Muzio, Niccolò Gallio, Valeria Chiofalo, Mario Preti, Fulvio Borella, Elena Casetta, Stefano Cosma, Alberto Revelli, Paola Cassoni, Umberto Ricardi
La radiologia medica.2026; 131(7): 1261. CrossRef
Image-guided interventional radiotherapy (modern brachytherapy) for treatment of vaginal intraepithelial neoplasia: single-institution experience and systematic literature review and meta-analysis
V. Lancellotta, A. P. Solazzo, B. Fionda, G. Garganese, S. M. Fragomeni, A. Federico, M. C. La Milia, P. Dragonetti, E. Rosa, L. Bannoni, M. De Angeli, S. Russi, S. Laurino, A. G. Morganti, R. P. De Vincenzo, G. Macchia, M. A. Gambacorta, R. Iezzi, L. Tag
Strahlentherapie und Onkologie.2026;[Epub] CrossRef
Natural History of Primary Vaginal Intraepithelial Neoplasia With and Without Treatment: A Systematic Review and Meta-Analysis
Ugo Indraccolo, Chiara Borghi, Marta Mattei Gentili, Gennaro Scutiero, Emanuele Caselli, Alessandro Favilli
Clinical and Experimental Obstetrics & Gynecology.2025;[Epub] CrossRef
Analysis of the clinical efficacy of HIFU in the treatment of low-grade vaginal intraepithelial neoplasia
Jingxi Zhang, Xiang Li, Mengyu Chen, Biyao Jiang, Shiying Wu, Weiwei Hu, Juan Tao, Fang Xiao, Songshu Xiao
International Journal of Hyperthermia.2025;[Epub] CrossRef
Is robotic-assisted vaginectomy a better choice in vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery?
Yana Liu, Meng Mao, Jing Bai, Mingbo Cai, Qian Wang, Hanlin Fu, Mengling Zhao, Chunfang Wang, Lulu Si, Ruixia Guo
BMC Women's Health.2024;[Epub] CrossRef
Advances in the Treatment of High-Grade Stump Vaginal Intraepithelial Neoplasia after Total Hysterectomy
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Advances in Clinical Medicine.2024; 14(04): 1555. CrossRef
Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies
Jiahui Wei, Yumei Wu
Archives of Gynecology and Obstetrics.2024; 310(1): 1. CrossRef
Non-Excisional therapeutic modalities in vaginal intraepithelial neoplasia
Gonçalo Freitas, Antónia Costa
European Journal of Obstetrics & Gynecology and Reproductive Biology.2023; 284: 175. CrossRef
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus State
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Y.Y. Zhang, R. Xia, D. Chen, X. Zhang
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Hyun‐Woong Cho, Jin Hwa Hong, Jae Kwan Lee
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Mikel Gorostidi, Arantza Lekuona, Arantxa Juaristi, Glauco Baiocchi
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Argirios Rountis, Vasilios Pergialiotis, Paraskevi Tsetsa, Alexandros Rodolakis, Dimitrios Haidopoulos
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Effect of Cyclophosphamide Treatment on Central and Effector Memory T Cells in Mice
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Ju Hyun Youn, Min Ah Lee, Woong Ju, Seoung Cheol Kim, Yun Hwan Kim
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Agnieszka Zolciak-Siwinska, Ewelina Gruszczynska, Joanna Jonska-Gmyrek, Anna Kulik, Wojciech Michalski
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Assessment of Tumor Regression by Consecutive Pelvic Magnetic Resonance Imaging and Dose Modification during High-Dose-Rate Brachytherapy for Carcinoma of the Uterine Cervix: Taek-Keun Nam, Byung-Sik Nah, Ho-Sun Choi, Woong-Ki Chung, Sung-Ja Ahn, Seok-Mo Kim, Ju-Young Song, Mi-Seon Yoon; Cancer Res Treat. 2005;37(3):157-164. Published online June 30, 2005; DOI: https://doi.org/10.4143/crt.2005.37.3.157

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Purpose

To assess tumor regression, as determined by pelvic magnetic resonance imaging (MRI), and evaluate the efficacies and toxicities of the interim brachytherapy (BT) modification method, according to tumor regression during multi-fractionated high-dose-rate (HDR) BT for uterine cervical cancer.

Materials and Methods

Consecutive MRI studies were performed pre-radiotherapy (RT), pre-BT and during interfraction of BT (inter-BT) in 69 patients with cervical cancer. External beam radiotherapy (EBRT) was performed, using a 10 MV X-ray, in daily fraction of 1.8 Gy with 4-fields, 5 d/wk. Radiation was delivered up to 50.4 Gy, with midline shielding at around 30.6 Gy. Of all 69 patients, 50 received modified interim BT after checking the inter-BT MRI. The BT was delivered in two sessions; the first was composed of several 5 Gy fractions to point A, twice weekly, using three channel applicators. According to the three measured orthogonal diameters of the regressed tumor, based on inter-BT MR images, the initial BT plan was modified, with the second session consisting of a few fractions of less than 5 Gy to point A, using a cervical cylinder applicator.

Results

The numbers of patients in FIGO stages Ib, IIa, IIb and IIIb+IVa were 19 (27.5%), 18 (26.1%), 27 (39.2%) and 5 (7.2%), respectively. Our treatment characteristics were comparable to those from the literatures with respect to the biologically effective dose (BED) to point A, rectum and bladder as reference points. In the regression analysis a significant correlation was observed between tumor regression and the cumulative dose to point A on the follow-up MRI. Nearly 80% regression of the initial tumor volume occurred after 30.6 Gy of EBRT, and this increased to 90% after an additional 25 Gy in 5 fractions of BT, which corresponds to 73.6 Gy of cumulative BED₁₀ to point A. The median total fraction number, and those at the first and second sessions of BT were 8 (5~10), 5 (3~7) and 3 (1~5), respectively. The median follow-up time was 53 months (range, 9~66 months). The 4-year disease-free survival rate of all patients was 86.8%. Six (8.7%) patients developed pelvic failures, but major late complications developed in only two (2.9%).

Conclusion

Our study shows that effective tumor control, equivalent survival and low rates of major complications can be achieved by modifying the fraction size during BT according to tumor regression, as determined by consecutive MR images. We recommend checking the follow-up MRI at a cumulative BED₁₀ of around 65 Gy to point A, with the initial BT modified at a final booster BT session.

Citations

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Correlations of UICC tumor stage and tumor regression on T2-weighted MRI sequences during definitive radiotherapy of cervical cancer
Florian Arend, Markus Oechsner, Clara B. Weidenbächer, Stephanie E. Combs, Kai J. Borm, Marciana N. Duma
Tumori Journal.2021; 107(2): 139. CrossRef
Target volume changes through high-dose-rate brachytherapy for cervical cancer when evaluated on high resolution (3.0 Tesla) magnetic resonance imaging
Wenqing Sun, Sudershan K. Bhatia, Geraldine M. Jacobson, Ryan T. Flynn, Yusung Kim
Practical Radiation Oncology.2012; 2(4): e101. CrossRef
Metabolic Response of Lymph Nodes Immediately After RT Is Related With Survival Outcome of Patients With Pelvic Node-Positive Cervical Cancer Using Consecutive [18F]fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography
Mee Sun Yoon, Sung-Ja Ahn, Byung-Sik Nah, Woong-Ki Chung, Ho-Chun Song, Su Woong Yoo, Ju-Young Song, Jae-Uk Jeong, Taek-Keun Nam
International Journal of Radiation Oncology*Biology*Physics.2012; 84(4): e491. CrossRef

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Radical Radiotherapy for Locally Advanced Cancer of Uterine Cervix: Jeung Eun Lee, Seung Jae Huh, Won Park, Do Hoon Lim, Yong Chan Ahn, Chang Soo Park, Byoung Gie Kim, Duk Soo Bae, Je Ho Lee, Chong Taik Park, Tae Jin Kim, Kyung Taek Lim, Hwan Wook Chung, Ki Heon Lee, Jae Uk Shim; Cancer Res Treat. 2004;36(4):222-227. Published online August 31, 2004; DOI: https://doi.org/10.4143/crt.2004.36.4.222

Abstract PDF PubReader ePub

Purpose

This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy.

Materials and Methods

One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months).

Results

The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 60.2, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%).

Conclusion

The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.

Citations

Citations to this article as recorded by

Bilateral cervical cancer in a complete septate uterus with a double cervix and vagina: a case report
Li Wang, Zi Liu
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Pooled Analysis of external-beam RADiotherapy parameters in phase II and phase III trials in radiochemotherapy in Anal Cancer (PARADAC)
Eleonor Rivin del Campo, Oscar Matzinger, Karin Haustermans, Didier Peiffert, Robert Glynne-Jones, Kathryn A. Winter, Andre A. Konski, Jaffer A. Ajani, Jean-François Bosset, Jean-Michel Hannoun-Levi, Marc Puyraveau, A. Bapsi Chakravarthy, Helen Meadows, J
European Journal of Cancer.2019; 121: 130. CrossRef
Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer
Hyo Sook Bae, Yeon-Joo Kim, Myong Cheol Lim, Sang-Soo Seo, Sang-yoon Park, Sokbom Kang, Sun Ho Kim, Joo-Young Kim
International Journal of Gynecological Cancer.2016; 26(4): 737. CrossRef
High expression of mTOR is associated with radiation resistance in cervical cancer
Min-Kyu Kim, Tae-Joong Kim, Chang Ok Sung, Chel Hun Choi, Jeong-Won Lee, Byoung-Gie Kim, Duk-Soo Bae
Journal of Gynecologic Oncology.2010; 21(3): 181. CrossRef
Increased expression of pAKT is associated with radiation resistance in cervical cancer
T-J Kim, J-W Lee, S Y Song, J-J Choi, C H Choi, B-G Kim, J-H Lee, D-S Bae
British Journal of Cancer.2006; 94(11): 1678. CrossRef

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Limb - Conserving Surgery and Interstitial Brachytherapy Plus External Radiation Therapy in Extremity Soft Tissue Sarcoma: Yong Chan Ahn, Do Hoon Lim, Jai Gon Seo, Moon Kyung Kim, Hong Gyun Wu, Dae Young Kim, Seung Jae Huh; J Korean Cancer Assoc. 1998;30(3):599-607.

Abstract PDF: PURPOSE
In order to avoid functional disability that may be caused by radical excision or amputation in extremity soft tissue sarcomas, authors employed limb-conserving surgery together with extemal radiation therapy plus interstitial brachytherapy.
MATERIALS AND METHODS
From June 1995 to Febrary 1997, 10 extremity soft tissue sarcoma patients were treated with limb-conserving surgery and external radiation therapy plus interstitial brachytherapy. In six patients, whose histologic diagnoses were made at the time of surgery, wide or marginal excision and interstitial brachytherapy was done 4 weeks before postoperative external radiation therapy. In four patients whose histologic confinnations were done before definitive treatment, preoperative external radiation therapy was given 4 weeks before surgery and interstitial brachytherapy. The types of surgery were wide excision in five patients, and marginal excision in five patients. Gross or microscopic residual was left at the surgical resection margins in four patients. The brachytherapy dose ranged from 17.5 Gy to 24 Gy and external beam radiation did from 40 Gy to 45 Gy.
RESULTS
With the median follow-up duration of 21.5 months(range: 13 to 29 months); one local recurrence, and three new distant metastases were observed. There were three patients with wound complications attributable to the current treatment regimen.
CONCLUSION
Satisfactory local tumor control may be achievable with limb-conserving surgery and external radiation therapy plus brachytherapy in patients with extremity soft tissue sarcomas, while more caution should be used to avoid wound problems.

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