Phase II trial of image-based high-dose-rate interstitial brachytherapy for previously irradiated gynecologic cancer
Martínez-Monge R(1), Cambeiro M(2), Rodríguez-Ruiz ME(2), Olarte A(2), Ramos LI(2), Villafranca E(3), Bascón N(4), Jurado M(5).
(1) Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
(2) Department of Radiation Oncology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Navarre, Spain.
(3) Department of Radiation Oncology, Hospital de Navarra, Pamplona, Navarre, Spain.
(4) Department of Radiation Oncology, Hospital Clínico Universitario, Zaragoza, Spain.
(5) Department of Gynaecology, University of Navarra, Pamplona, Navarre, Spain.
To report the disease-free Grade ≥3 complication-free survival of a Phase II protocol of reirradiation with high-dose-rate (HDR) interstitial brachytherapy (ITB) in previously irradiated gynecologic cancer.
METHODS AND MATERIALS:
Fifteen patients with previously irradiated cervical (n = 6), endometrial (n = 6), and vulvovaginal tumors (n = 3) were treated with HDR-ITB alone to a median dose of 38 Gy in 8 b.i.d. fractions over 4 consecutive days. Prior treatments included surgery (n = 12; 80%), external irradiation (n = 15; 100%), and brachytherapy (n = 9; 60%). Average clinical target volume Size was 60.9 cc (range, 14.8-165.3 cc), and median time to reirradiation was 3.9 years (range, 0.4-22.7 years).
With a median followup of 2.8 years (range, 1.2-9.2 years), 3 patients (20.0%) developed Grade ≥3 toxicity consisting of Grade 3 intestinal obstruction (n = 1), Grade 4 rectovesical fistula (n = 1), and Grade 5 intestinal obstruction (n = 1). Six patients remain alive and without evidence of disease at last followup. Two patients are alive with disease progression, and 7 patients have died, 4 of them from disease progression and 3 from other causes. The 2-year disease-free Grade ≥3 complication-free survival was 40%.
HDR-ITB alone is a reasonable salvage treatment option in a significant number of patients with previously irradiated gynecologic tumors.
CITA DEL ARTÍCULO Brachytherapy. 2014 May-Jun;13(3):219-24. doi: 10.1016/j.brachy.2014.01.008.