1. 3D image-guided interstitial brachytherapy for primary vaginal cancer: A multi-institutional experience.
- Author
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Goodman CD, Mendez LC, Velker V, Weiss Y, Leung E, Louie AV, Warner A, Hajdok G, and D'Souza DP
- Subjects
- Aged, Female, Humans, Imaging, Three-Dimensional methods, Lymphatic Metastasis, Middle Aged, Neoplasm Staging, Radiotherapy Planning, Computer-Assisted methods, Retrospective Studies, Vaginal Neoplasms pathology, Brachytherapy methods, Radiotherapy, Image-Guided methods, Vaginal Neoplasms diagnostic imaging, Vaginal Neoplasms radiotherapy
- Abstract
Purpose/objectives: High dose rate (HDR) interstitial brachytherapy (ISBT) boost is integral for definitive radiation treatment of primary vaginal cancer. Technological advances with CT or MRI guidance provide improved precision and ability to treat more extensively invasive tumors over historical techniques, but reported experience is limited. We sought to provide updated outcome and toxicity data for women with primary vaginal cancer undergoing treatment with a modern ISBT technique., Material/methods: Databases of primary vaginal carcinoma patients treated at two Canadian academic cancer institutions were combined including patient, tumor and treatment characteristics, and survival outcomes and toxicity data. Descriptive statistics, survival estimates based on the Kaplan-Meier method, and univariable/multivariable Cox proportional hazards regression analyses are reported., Results: Between 2002 and 2017, 67 women with primary vaginal cancer were treated with 3D HDR ISBT. FIGO stage distribution was I (22.4%), II (50.8%), III (17.9%), IVa (9.0%). All patients received external beam radiotherapy and HDR ISBT of 500-750 cGy per fraction over 2-4 fractions. Median follow-up was 2.68 years (95% confidence interval: 2.04-6.04). Cumulative rate of grade 3-4 genitourinary/gastrointestinal toxicity was 10.4%. Four patients developed vaginal fistula. Progression-free survival at 2 and 3 years was 73.5% and 66.4% for all patients, 78.3% and 75.0% for stage I-II and 61.6% and 46.2% for stage III-IVa, respectively (log-rank p = 0.252)., Conclusions: Use of 3D image-guided HDR ISBT boost was safe and resulted in improved survival outcomes compared to historical rates in this series of primary vaginal cancer patients. Prospective study is warranted to better define clinical and dosimetric predictors of local control., Competing Interests: Declaration of Competing Interest AVL has received honoraria unrelated to this work, from Varian Medical Systems, RefleXion and AstraZeneca., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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