SBRT of gynecological cancerStereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer
Section snippets
Material and methods
Between 1997 and 2007, 19 patients have been treated with radiotherapy for an isolated pelvic tumor recurrence of cervical cancer (n = 12) or endometrial cancer (n = 7). A summary of the patient and treatment characteristics is shown in Table 1. Patients had been treated surgically at primary diagnosis of cancer (n = 18) and six of these patients had received adjuvant radiotherapy (vaginal brachytherapy only n = 4; combined external beam radiotherapy [EBRT] and vaginal brachytherapy n = 1; EBRT n = 1).
Results
Median EQD2 to the recurrent tumor was 68.8 Gy (range 40–75 Gy) considering the conventionally fractionated series and the dose at the PTV margin of the SBRT boost. If the dose in the isocenter of the SBRT boost is considered as treatment dose, median EQD2 to the recurrent tumor was 82.8 Gy (range 62.2–93.8 Gy). Due to steep dose gradients at the PTV margin, the dose at the isocenter is usually a better estimate of the dose actually delivered to the CTV (Fig. 1). Note that vaginal brachytherapy was
Discussion
Pelvic recurrences after primary surgical treatment of gynaecological cancers are solitary without synchronous systemic progression in about 50% of patients [31]. Radiotherapy treatment is potentially curable in these patients and several prognostic factors have been identified.
Recurrent cancer extending to the pelvic wall is a significant negative prognostic factor for survival. The largest study by Jain et al. reported 5-year overall survival rates of 42% and 20% after radiotherapy for
Conclusions
SBRT for local dose escalation to the residual tumor after conventionally fractionated radiotherapy of the whole pelvis results in high rates of local control in an unfavourable patient collective, where large size of the recurrent tumor and/or location at the pelvic wall makes vaginal brachytherapy alone inappropriate for boost irradiation. The favourable outcome in terms of local control was associated with a 25% rate of late toxicity > grade II and survival was limited due to metastatic
References (33)
- et al.
A prospective surgical pathological study of stage I squamous carcinoma of the cervix: a gynecologic oncology group study
Gynecol Oncol
(1989) - et al.
Image-guided radiotherapy for cervix cancer: high-tech external beam therapy versus high-tech brachytherapy
Int J Radiat Oncol Biol Phys
(2008) - et al.
Correlation of dose–volume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy
Radiother Oncol
(2009) - et al.
Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis
Lancet
(2001) - et al.
Magnitude and clinical relevance of translational and rotational patient setup errors: a cone-beam CT study
Int J Radiat Oncol Biol Phys
(2006) - et al.
Dose–response relationship for image-guided stereotactic body radiotherapy of pulmonary tumors: relevance of 4D dose calculation
Int J Radiat Oncol Biol Phys
(2009) - et al.
Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery
Radiother Oncol
(2008) - et al.
Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma
Gynecol Oncol
(1998) - et al.
Radiotherapy for centrally recurrent cervical cancer of the vaginal stump following hysterectomy
Gynecol Oncol
(1997) - et al.
Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer
Clin Oncol (R Coll Radiol)
(2007)
Treatment of locoregional recurrence of carcinoma of the cervix by radiotherapy after primary surgery
Gynecol Oncol
Clinical aspects and prognosis of pelvic recurrence of cervical carcinoma
Int J Gynaecol Obstet
The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: design, application, treatment planning, and dosimetric results
Int J Radiat Oncol Biol Phys
Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer
Int J Radiat Oncol Biol Phys
Fractionated stereotactic radiotherapy boost for gynecologic tumors: an alternative to brachytherapy?
Int J Radiat Oncol Biol Phys
Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer
Radiother Oncol
Cited by (70)
Stereotactic Body Radiation Therapy for Gynecologic Malignancies: A Case-Based Radiosurgery Society Practice Review
2023, Practical Radiation OncologyStereotactic body radiotherapy for pelvic boost in gynecological cancer patients with local recurrence or unsuitable for intracavitary brachytherapy
2021, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :Pelvic exenteration is considered as an optimal form of surgery for central recurrence after primary or adjuvant RT, but for patients with recurrent tumors at periphery, radiotherapy-based treatment is always suggested. By using SBRT technique, previous studies showed that the IFRFS ranged from 65% to 82.5% [10–13]. However, the application of EBRT was heterogeneous in these studies.
Stereotactic body radiation therapy (SBRT) in recurrent, persistent or oligometastatic gynecological cancers
2020, Gynecologic OncologyCitation Excerpt :It is unclear why ovarian, cervical and uterine primaries (as shown in Fig. 2A) and non-adenocarcinoma histology had superior local control (Table 1). These correlations have not been reported in gynecological malignancies previously and could be due to differences in tumor biology, frequency of previous radiation use and systemic therapy utilization [14,15,35,36,38]. While these findings are hypothesis-generating, prospective studies are needed to confirm these.
A Phase II Trial of Stereotactic Ablative Radiation Therapy as a Boost for Locally Advanced Cervical Cancer
2020, International Journal of Radiation Oncology Biology PhysicsPelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review
2017, Radiotherapy and OncologyCitation Excerpt :The timing of the other grade 3 event was not reported (neuropathy) [20]. Six grade 4 events were also reported in definitely re-irradiated patients including five late events (small bowel ileus in a patient previously treated with EBRT and vaginal brachytherapy [8], intestino-vaginal fistula in a patient previously irradiated with vaginal brachytherapy who received conventionally fractionated re-irradiation then SABR [8], haemorrhagic cystitis requiring surgery [17] and two episodes of recto-vaginal fistulation in patients previously treated with pelvic surgery and whole pelvis external beam radiotherapy [18]). The timing of the sixth grade 4 event was not reported (small bowel perforation [20]).