Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina
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...
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| Veröffentlicht in: | Gynecologic oncology 2018-08, Vol.150 (2), p.293-299 |
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| creator | Gebhardt, Brian J. Vargo, John A. Kim, Hayeon Houser, Christopher J. Glaser, Scott M. Sukumvanich, Paniti Olawaiye, Alexander B. Kelley, Joseph L. Edwards, Robert P. Comerci, John T. Courtney-Brooks, Madeleine Beriwal, Sushil |
| description | 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 |
| doi_str_mv | 10.1016/j.ygyno.2018.06.011 |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7409556</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0090825818309879</els_id><sourcerecordid>S0090825818309879</sourcerecordid><originalsourceid>FETCH-LOGICAL-c459t-180bd30be128705026882d20898bcdab473bc20c1446d5a3567bd0e914595ae73</originalsourceid><addsrcrecordid>eNp9kd1q3DAQhUVJabZpn6BQ9AJ2R7JlyxcJhJC2gUBv2muhn7FXiy0tsrPgmzx7tbttSG8KAglmvjOjcwj5xKBkwJovu3Id1hBLDkyW0JTA2BuyYdCJopGiuyAbgA4KyYW8JO_neQcAFTD-jlzyrjsesSHPD5MesDB6Rkenp3HxdqtDwJEe9OCDHqldRx8cJmqSttt12WLS-5X2MdH8pg57H_ziD0iXhHqZMCw09jSvhjaOcfCWTnr0Q9DBepypDyfuLP-BvO31OOPHP_cV-fX1_ufd9-Lxx7eHu9vHwtaiWwomwbgKDDIuWxDAGym54yA7aazTpm4rYzlYVteNE7oSTWscYMcyLTS21RW5Oevun8yEzuYlkx7VPvlJp1VF7dW_leC3aogH1dbZT9FkgeosYFOc54T9C8tAHeNQO3WKQx3jUNCoHEemPr8e-8L89T83XJ8bMH_-4DGpOZsULDqf0C7KRf_fAb8BUXqhVw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina</title><source>Elsevier ScienceDirect Journals</source><creator>Gebhardt, Brian J. ; Vargo, John A. ; Kim, Hayeon ; Houser, Christopher J. ; Glaser, Scott M. ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Comerci, John T. ; Courtney-Brooks, Madeleine ; Beriwal, Sushil</creator><creatorcontrib>Gebhardt, Brian J. ; Vargo, John A. ; Kim, Hayeon ; Houser, Christopher J. ; Glaser, Scott M. ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Comerci, John T. ; Courtney-Brooks, Madeleine ; Beriwal, Sushil</creatorcontrib><description>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.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2018.06.011</identifier><identifier>PMID: 29929925</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Brachytherapy ; Intracavitary ; Multi-channel vaginal cylinder ; Vaginal cancer</subject><ispartof>Gynecologic oncology, 2018-08, Vol.150 (2), p.293-299</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-180bd30be128705026882d20898bcdab473bc20c1446d5a3567bd0e914595ae73</citedby><cites>FETCH-LOGICAL-c459t-180bd30be128705026882d20898bcdab473bc20c1446d5a3567bd0e914595ae73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0090825818309879$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29929925$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gebhardt, Brian J.</creatorcontrib><creatorcontrib>Vargo, John A.</creatorcontrib><creatorcontrib>Kim, Hayeon</creatorcontrib><creatorcontrib>Houser, Christopher J.</creatorcontrib><creatorcontrib>Glaser, Scott M.</creatorcontrib><creatorcontrib>Sukumvanich, Paniti</creatorcontrib><creatorcontrib>Olawaiye, Alexander B.</creatorcontrib><creatorcontrib>Kelley, Joseph L.</creatorcontrib><creatorcontrib>Edwards, Robert P.</creatorcontrib><creatorcontrib>Comerci, John T.</creatorcontrib><creatorcontrib>Courtney-Brooks, Madeleine</creatorcontrib><creatorcontrib>Beriwal, Sushil</creatorcontrib><title>Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>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.</description><subject>Brachytherapy</subject><subject>Intracavitary</subject><subject>Multi-channel vaginal cylinder</subject><subject>Vaginal cancer</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kd1q3DAQhUVJabZpn6BQ9AJ2R7JlyxcJhJC2gUBv2muhn7FXiy0tsrPgmzx7tbttSG8KAglmvjOjcwj5xKBkwJovu3Id1hBLDkyW0JTA2BuyYdCJopGiuyAbgA4KyYW8JO_neQcAFTD-jlzyrjsesSHPD5MesDB6Rkenp3HxdqtDwJEe9OCDHqldRx8cJmqSttt12WLS-5X2MdH8pg57H_ziD0iXhHqZMCw09jSvhjaOcfCWTnr0Q9DBepypDyfuLP-BvO31OOPHP_cV-fX1_ufd9-Lxx7eHu9vHwtaiWwomwbgKDDIuWxDAGym54yA7aazTpm4rYzlYVteNE7oSTWscYMcyLTS21RW5Oevun8yEzuYlkx7VPvlJp1VF7dW_leC3aogH1dbZT9FkgeosYFOc54T9C8tAHeNQO3WKQx3jUNCoHEemPr8e-8L89T83XJ8bMH_-4DGpOZsULDqf0C7KRf_fAb8BUXqhVw</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Gebhardt, Brian J.</creator><creator>Vargo, John A.</creator><creator>Kim, Hayeon</creator><creator>Houser, Christopher J.</creator><creator>Glaser, Scott M.</creator><creator>Sukumvanich, Paniti</creator><creator>Olawaiye, Alexander B.</creator><creator>Kelley, Joseph L.</creator><creator>Edwards, Robert P.</creator><creator>Comerci, John T.</creator><creator>Courtney-Brooks, Madeleine</creator><creator>Beriwal, Sushil</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>201808</creationdate><title>Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina</title><author>Gebhardt, Brian J. ; Vargo, John A. ; Kim, Hayeon ; Houser, Christopher J. ; Glaser, Scott M. ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Comerci, John T. ; Courtney-Brooks, Madeleine ; Beriwal, Sushil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-180bd30be128705026882d20898bcdab473bc20c1446d5a3567bd0e914595ae73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Brachytherapy</topic><topic>Intracavitary</topic><topic>Multi-channel vaginal cylinder</topic><topic>Vaginal cancer</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gebhardt, Brian J.</creatorcontrib><creatorcontrib>Vargo, John A.</creatorcontrib><creatorcontrib>Kim, Hayeon</creatorcontrib><creatorcontrib>Houser, Christopher J.</creatorcontrib><creatorcontrib>Glaser, Scott M.</creatorcontrib><creatorcontrib>Sukumvanich, Paniti</creatorcontrib><creatorcontrib>Olawaiye, Alexander B.</creatorcontrib><creatorcontrib>Kelley, Joseph L.</creatorcontrib><creatorcontrib>Edwards, Robert P.</creatorcontrib><creatorcontrib>Comerci, John T.</creatorcontrib><creatorcontrib>Courtney-Brooks, Madeleine</creatorcontrib><creatorcontrib>Beriwal, Sushil</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gebhardt, Brian J.</au><au>Vargo, John A.</au><au>Kim, Hayeon</au><au>Houser, Christopher J.</au><au>Glaser, Scott M.</au><au>Sukumvanich, Paniti</au><au>Olawaiye, Alexander B.</au><au>Kelley, Joseph L.</au><au>Edwards, Robert P.</au><au>Comerci, John T.</au><au>Courtney-Brooks, Madeleine</au><au>Beriwal, Sushil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2018-08</date><risdate>2018</risdate><volume>150</volume><issue>2</issue><spage>293</spage><epage>299</epage><pages>293-299</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29929925</pmid><doi>10.1016/j.ygyno.2018.06.011</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Brachytherapy Intracavitary Multi-channel vaginal cylinder Vaginal cancer |
| title | Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina |
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