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Gynecologic Brachytherapy: Cervical Cancer

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Brachytherapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Cervical cancer is the 3rd most common malignancy in the world. Despite national trends of declining utilization, brachytherapy plays an integral role in the curative management of all locally-advanced and medically inoperable early-stage cervical cancer. Herein we review the practice implementation of brachytherapy critical to curing patients of cervical cancer, especially modern image-based high-dose rate brachytherapy.

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References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108

    Article  PubMed  Google Scholar 

  3. Lanciano RM, Won M, Coia LR, Hanks GE (1991) Pretreatment and treatment factors associated with improved outcomes in squamous cell carcinoma of the uterine cervix: a final report of the 1973 and 1978 patterns of care studies. Int J Radiat Oncol Biol Phys 20:667–676

    Article  CAS  PubMed  Google Scholar 

  4. Montana GS, Hanlon AL, Brickner TJ et al (1995) Carcinoma of the cervix: patterns of care studies: reviews of 1978, 1983, and 1988–1989 surveys. Int J Radiat Oncol Biol Phys 32:1481–1486

    Article  CAS  PubMed  Google Scholar 

  5. Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN (2013) Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys 87:111–119

    Article  PubMed  Google Scholar 

  6. Gill BS, Lin JF, Krivak TC et al (2014) National cancer data base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys 90:1083–1090

    Article  PubMed  Google Scholar 

  7. Landoni F, Maneo A, Colombo A et al (1997) Randomized study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 350:535–540

    Article  CAS  PubMed  Google Scholar 

  8. Hricak H, Gatsonis C, Coakley FV et al (2007) Early invasive cervical: CT and MRI imaging in preoperative evaluation – ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology 245:491–498

    Article  PubMed  Google Scholar 

  9. Mitchell DG, Snyder B, Coakley F et al (2006) Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol 24:5687–5694

    Article  PubMed  Google Scholar 

  10. Kidd EA, Sigel BA, Dehdashti F et al (2010) Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis. J Clin Oncol 28:2108–2113

    Article  PubMed  Google Scholar 

  11. Tsai CS, Lai CH, Chang TC et al (2010) A prospective randomized trial to study the impact of pretreatment FDG-PET for cervical cancer patients with MRI-detected positive pelvic but negative para-aortic lymphadenopathy. Int J Radiat Oncol Biol Phys 76:477–484

    Article  PubMed  Google Scholar 

  12. Grinsky T, Rey A, Roche B et al (1993) Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys 27:1051–1056

    Article  Google Scholar 

  13. Lanciano RM, Pajak TF, Matrz K et al (1993) The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys 25:391–397

    Article  CAS  PubMed  Google Scholar 

  14. Perez CA, Grigsby PW, Castro-Vita H et al (1995) Carcinoma of the uterine cervix: impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 32:1275–1288

    Article  CAS  PubMed  Google Scholar 

  15. Petereit DG, Sarkaria JN, Chappell R et al (1995) The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 32:1301–1307

    Article  CAS  PubMed  Google Scholar 

  16. Viswanathan AN, Thomadsen B, American Brachytherapy Society Cervical Cancer Recommendations Committee, American Brachytherapy Society (2012) American brachytherapy society guidelines for locally advanced carcinoma of the cervix: part I general principles. Brachytherapy 11:33–46

    Article  PubMed  Google Scholar 

  17. Dimopoulos JC, Kirisits C, Petric P et al (2006) The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: clinical feasibility and preliminary results. Int J Radiat Oncol Biol Phys 66:83–90

    Article  PubMed  Google Scholar 

  18. Kirisits C, Lang S, Dimopoulos J et al (2006) The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: design, application, treatment planning, and dosimteric results. Int J Radiat Oncol Biol Phys 65:624–630

    Article  PubMed  Google Scholar 

  19. Nomden CN, de Leeuw AA, Moerland MA et al (2012) Clinical use of the Utrecht applicator for combined intracavitary/interstitial brachytherapy treatment in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 82:1424–1430

    Article  PubMed  Google Scholar 

  20. Vargo JA, Beriwal S (2014) Image-based brachytherapy for cervical cancer. World J Clin Oncol 5:921–930

    Article  PubMed  PubMed Central  Google Scholar 

  21. Dimopoulos JC, Schard G, Berger D et al (2006) Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys 64:1380–1388

    Article  PubMed  Google Scholar 

  22. Viswanathan AN, Dimopoulos J, Kirisits C et al (2007) Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys 68:491–498

    Article  PubMed  Google Scholar 

  23. Viswanathan AN, Erickson B, Gaffney DK et al (2014) Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 90:320–328

    Article  PubMed  PubMed Central  Google Scholar 

  24. Beriwal S, Kim H, Coon D et al (2009) Single magnetic resonance imaging vs magnetic resonance imaging/computed tomography planning in cervical cancer brachytherapy. Clin Oncol (R Coll Radiol) 21:483–487

    Article  CAS  Google Scholar 

  25. Beriwal S, Kannan N, Kim H et al (2011) Three-dimensional high dose rate intracavitary image-guided brachytherapy for the treatment of cervical cancer using a hybrid magnetic resonance imaging/computed tomography approach: feasibility and early results. Clin Oncol (R Coll Radiol) 23:685–690

    Article  CAS  Google Scholar 

  26. Nesvacil N, Pötter R, Sturdza A et al (2013) Adaptive image guided brachytherapy for cervical cancer: a combined MRI-/CT-planning technique with MRI only at first fraction. Radiother Oncol 107:75–81

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tan LT, Coles CE, Hart C et al (2009) Clinical impact of computed tomography-based image-guided brachytherapy for cervix cancer using the tandem-ring applicator – the Addenbrooke’s experience. Clin Oncol (R Coll Radiol) 21:175–182

    Article  CAS  Google Scholar 

  28. Mahantshetty U, Khanna N, Swamidas J et al (2012) Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol 102:130–134

    Article  PubMed  Google Scholar 

  29. Van Dyk S, Narayan K, Fisher R et al (2009) Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound. Int J Radiat Oncol Biol Phys 75:64–70

    Article  PubMed  Google Scholar 

  30. Haie-Meder C, Pötter R, Van Limbergen E et al (2005) Recommendations from gynecological (GYN) GEC-ESTRO working group (I): concepts and terms in 3D image based treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 74:235–245

    Article  PubMed  Google Scholar 

  31. Lee LJ, Das IJ, Higgins SA et al (2012) American brachytherapy society consensus guidelines for locally advanced carcinoma of the cervix: Part III low-dose-rate and pulsed-dose-rate brachytherapy. Brachytherapy 11:53–57

    Article  PubMed  Google Scholar 

  32. Nag S, Cardenes H, Chang S et al (2004) Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma: report from image-guided brachytherapy working group. Int J Radiat Oncol Biol Phys 60:1160–1172

    Article  PubMed  Google Scholar 

  33. Pötter R, Haie-Meder C, Van Limbergen E et al (2006) Recommendations from gynecological (GYN) GEC-ESTRO working group (II): concepts and terms in 3D image based treatment planning in cervix cancer brachytherapy-3D dose volumes parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 78:67–77

    Article  PubMed  Google Scholar 

  34. Viswanathan AN, Beriwal S, De Los Santos JF et al (2012) American brachytherapy society consensus guidelines for locally advanced carcinoma of the cervix: part II high-dose-rate brachytherapy. Brachytherapy 11:47–52

    Article  PubMed  PubMed Central  Google Scholar 

  35. Georg P, Kirisits C, Goldner G et al (2009) 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 91:173–180

    Article  PubMed  Google Scholar 

  36. Georg P, Pötter R, Georg D et al (2012) Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy. Int J Radiat Oncol Biol Phys 82:653–657

    Article  PubMed  Google Scholar 

  37. Koom WS, Sohn DK, Kim JY et al (2007) Computed tomography-based high-dose-rate intracavitary brachytherapy for uterine cervical cancer: preliminary demonstration of correlation between dose-volume parameters and rectal mucosal changes observed by flexible sigmoidoscopy. Int J Radiat Oncol Biol Phys 68:1446–1454

    Article  PubMed  Google Scholar 

  38. Dimopoulos JC, Lang S, Kirisits C et al (2009) Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys 75:56–63

    Article  PubMed  Google Scholar 

  39. Gill BS, Kim H, Houser CJ et al (2015) MRI-guided high dose rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience. Int J Radiat Oncol Biol Phys 91(3):540–547

    Article  PubMed  Google Scholar 

  40. Viswanathan A, Cormack R, Rawal B et al (2009) Increasing brachytherapy dose predicts survival for interstitial and tandem-based radiation for stage IIIB cervical cancer. Int J Gynecol Cancer 19:1402–1406

    Article  PubMed  Google Scholar 

  41. Martinez A, Cox RS, Edmundson GK (1984) A multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies. Int J Radiat Oncol Biol Phys 10:297–305

    Article  CAS  PubMed  Google Scholar 

  42. Syed A, Putjawala AA, Neblett D et al (1986) Transperineal interstitial intracavitary “Syed-Neblett” applicator in the treatment of carcinoma of the uterine cervix. Endocuriether hypertherm Oncol 2:1–13

    Google Scholar 

  43. Popowski Y, Hiltbrand E, Joliat D et al (2004) Open magnetic resonance imaging using titanium-zirconium needles: improved accuracy for interstitial brachytherapy implants? Int J Radiat Oncol Biol Phys 47:759–765

    Article  Google Scholar 

  44. Fokdal L, Tanderup K, Nielsen SK et al (2011) Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept. Radiother Oncol 100:473–479

    Article  PubMed  Google Scholar 

  45. Lee LJ, Damato AL, Viswanathan AN (2013) Clinical outcomes of high-dose-rate interstitial gynecologic brachytherapy using real-time CT guidance. Brachytherapy 12:303–310

    Article  PubMed  Google Scholar 

  46. Stock RG, Chan K, Terk M et al (1997) A new technique for performing Syed-Neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance. Int J Radiat Oncol Biol Phys 37:819–825

    Article  CAS  PubMed  Google Scholar 

  47. Viswanathan AN, Szymonifka J, Tempany-Afdhal CM et al (2013) A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy. Brachytherapy 12:240–247

    Article  PubMed  Google Scholar 

  48. Shah AP, Strauss JB, Gielda BT et al (2010) Toxicity associated with bowel or bladder puncture during gynecologic interstitial brachytherapy. Int J Radiat Oncol Biol Phys 77:171–179

    Article  PubMed  Google Scholar 

  49. Eisbruch A, Johnston CM, Martel MK et al (1998) Customized gynecologic interstitial implants: CT-based planning, dose evaluation, and optimization aided by laparotomy. Int J Radiat Oncol Biol Phys 40:1087–1093

    Article  CAS  PubMed  Google Scholar 

  50. Erickson B, Albano K, Gillin M (1996) CT-guided interstitial implantation of gynecologic malignancies. Int J Radiat Oncol Biol Phys 36:699–709

    Article  CAS  PubMed  Google Scholar 

  51. Erickson B, Albano K, Gillin M (1996) Magnetic resonance imaging following interstitial implantation of pelvic malignancies. Radiat Oncol Invest 2:298–300

    Google Scholar 

  52. Brenner DJ, Hall EJ (1991) Conditions for the equivalence of continuous to pulsed low dose rate brachytherapy. Int J Radiat Oncol Biol Phys 20:181–190

    Article  CAS  PubMed  Google Scholar 

  53. Fraass B, Doppke M, Hunt G et al (1998) American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: quality assurance for clinical radiotherapy treatment planning. Med Phys 25:1773–1829

    Article  CAS  PubMed  Google Scholar 

  54. Glasgow GP, Bourland JD, Grigsby PW et al (1993) Remote afterloading technology: a report of AAPM Task Group No. 41. American Institute of Physics, New York

    Google Scholar 

  55. Kubo HD, Glasgow GP, Pethel TD et al (1998) High dose-rate brachytherapy treatment delivery: a report of the AAPM Radiation Therapy Committee Task Group No. 59. Med Phys 25:375–403

    Article  CAS  PubMed  Google Scholar 

  56. Nath R, Anderson LL, Meli JA et al (1997) Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No. 56. Med Phys 24:1557–1598

    Article  CAS  PubMed  Google Scholar 

  57. Thomadsen BR, Erickson BA, Eifel PJ et al (2014) A review of safety, quality management, and practice guidelines for high-dose-rate brachytherapy: executive summary. Pract Radiat Oncol 4:65–70

    Article  PubMed  Google Scholar 

  58. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration (2008) Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 26:5802–5812

    Article  PubMed Central  Google Scholar 

  59. Charra-Brunaud C, Harter V, Delannes M et al (2012) Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol 103:305–313

    Article  PubMed  Google Scholar 

  60. Haie-Meder C, Chargari C, Rey A et al (2009) DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI-based low dose rate brachytherapy followed by surgery. Radiother Oncol 93:316–321

    Article  PubMed  Google Scholar 

  61. Kang HC, Shin KH, Park SY et al (2010) 3D CT-based high-dose-rate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control. Radiother Oncol 97:507–513

    Article  PubMed  Google Scholar 

  62. Kharofa J, Morrow N, Kelly T et al (2014) 3-T MRI-based adaptive brachytherapy for cervix cancer: treatment technique and initial clinical outcomes. Brachytherapy 13:319–325

    Article  PubMed  Google Scholar 

  63. Lindegaard JC, Fokdal LU, Nielsen SK et al (2013) MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective. Acta Oncol 52:1510–1519

    Article  CAS  PubMed  Google Scholar 

  64. Narayan K, van Dyk S, Bernshaw D et al (2009) Comparative study of LDR (Manchester system) and HDR image-guided conformal brachytherapy of cervical cancer: patterns of failure, late complications, and survival. Int J Radiat Oncol Biol Phys 74:1529–1535

    Article  PubMed  Google Scholar 

  65. Pötter R, Georg P, Dimopoulos JC et al (2011) Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 100:116–123

    Article  PubMed  PubMed Central  Google Scholar 

  66. Rijkmans EC, Nout RA, Rutten IH et al (2014) Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy. Gynecol Oncol 135:231–238

    Article  CAS  PubMed  Google Scholar 

  67. Tharavichitkul E, Chakrabandhu S, Wanwilairat S et al (2013) Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience. Gynecol Oncol 130:81–85

    Article  PubMed  Google Scholar 

  68. Narayanan P, Nobbenhuis M, Reynolds KM et al (2009) Fistulas in malignant gynecologic disease: etiology, imaging, and management. Radiographics 29:1073–1083

    Article  PubMed  Google Scholar 

  69. Anderson JR, Spence RA, Parks TG et al (1984) Rectovaginal fistulae following radiation treatment for cervical carcinoma. Ulster Med J 53:84–87

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Feddock J, Randall M, Kudrimoti M et al (2014) Impact of post-radiation biopsies on development of fistulae in patients with cervical cancer. Gynecol Oncol 133:263–267

    Article  PubMed  Google Scholar 

  71. Angioli R, Penalver M, Muzi L et al (2003) Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 48:295–304

    Article  PubMed  Google Scholar 

  72. Jao SW, Beart RW, Gunderson LL (1986) Surgical treatment of radiation injuries of the colon and rectum. Am J Surg 151:272–277

    Article  CAS  PubMed  Google Scholar 

  73. Chun M, Kang S, Kil HJ et al (2004) Rectal bleeding and its management after irradiation for uterine cervical cancer. Int J Radiat Oncol Biol Phys 58:98–105

    Article  PubMed  Google Scholar 

  74. Colwell JC, Goldberg M (2000) A review of radiation proctitis in the treatment of prostate cancer. J Wound Ostomy Continence Nurs 27:179–187

    CAS  PubMed  Google Scholar 

  75. Kochhar R, Patel F, Dhar A et al (1991) Radiation-induced proctosigmoiditis: prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 36:103–107

    Article  CAS  PubMed  Google Scholar 

  76. Kochhar R, Sriram PV, Sharma SC et al (1999) Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 44:973–978

    Article  CAS  PubMed  Google Scholar 

  77. Shipley WU, Zietman AL, Hanks GE et al (1994) Treatment related sequelae following external beam radiation for prostate cancer: a review with an update in patients with stages T1 and T2 tumor. J Urol 152:1799–1805

    CAS  PubMed  Google Scholar 

  78. Teshima T, Hanks GE, Hanlon AL et al (1997) Rectal bleeding after conformal 3D treatment of prostate cancer: time to occurrence, response to treatment and duration of morbidity. Int J Radiat Oncol Biol Phys 39:77–83

    Article  CAS  PubMed  Google Scholar 

  79. Jensen DM, Machicado GA, Cheng S et al (1997) Randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointest Endosc 45:20–25

    Article  CAS  PubMed  Google Scholar 

  80. Viggiano TR, Zighelboim J, Ahlquist DA et al (1993) Endoscopic Nd: YAG laser coagulation of bleeding from radiation proctopathy. Gastrointest Endosc 39:513–517

    Article  CAS  PubMed  Google Scholar 

  81. Kirchheiner K, Nout RA, Tanderup K et al (2014) Manifestation pattern of early-late vaginal morbidity after definitive radiation (chemo) therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys 89:88–95

    Article  PubMed  Google Scholar 

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Vargo, J.A., Viswanathan, A.N., Erickson, B.A., Beriwal, S. (2016). Gynecologic Brachytherapy: Cervical Cancer. In: Montemaggi, P., Trombetta, M., Brady, L. (eds) Brachytherapy. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-319-26791-3_15

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