Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer

John A. Vargo, Hayeon Kim, Christopher J. Houser, Paniti Sukumvanich, Alexander B. Olawaiye, Joseph L. Kelley, Robert P. Edwards, John T. Comerci, Marilyn Huang, Madeleine Courtney-Brooks, Sushil Beriwal

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. Methods and Materials: A total of 41 patients with vaginal cancer (24% primary vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2. Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. Results: The median high-risk clinical target volume was 24.2cc (interquartile range [IQR], 12.6), with a median dose to 90% (D90) of 77.1Gy (IQR, 3.4). The median dose to 2cc (D2 cc) for the bladder, rectum, and sigmoid were 59.4Gy (IQR, 5.6), 58.2Gy (IQR, 4.1), and 52.3Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for vaginal, bladder, urethral, and gastrointestinal, respectively. Conclusions: Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.

Original languageEnglish (US)
Pages (from-to)9-15
Number of pages7
JournalBrachytherapy
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Vaginal Neoplasms
Brachytherapy
Urinary Bladder
Radiotherapy
Sigmoid Colon
Tumor Burden
Rectum
Disease-Free Survival
Recurrence
Drug Therapy
Therapeutics

Keywords

  • HDR
  • Image-based brachytherapy
  • IMRT
  • MRI
  • Multichannel cylinder
  • Vaginal cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Vargo, J. A., Kim, H., Houser, C. J., Sukumvanich, P., Olawaiye, A. B., Kelley, J. L., ... Beriwal, S. (2015). Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer. Brachytherapy, 14(1), 9-15. https://doi.org/10.1016/j.brachy.2014.10.001

Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer. / Vargo, John A.; Kim, Hayeon; Houser, Christopher J.; Sukumvanich, Paniti; Olawaiye, Alexander B.; Kelley, Joseph L.; Edwards, Robert P.; Comerci, John T.; Huang, Marilyn; Courtney-Brooks, Madeleine; Beriwal, Sushil.

In: Brachytherapy, Vol. 14, No. 1, 01.01.2015, p. 9-15.

Research output: Contribution to journalArticle

Vargo, JA, Kim, H, Houser, CJ, Sukumvanich, P, Olawaiye, AB, Kelley, JL, Edwards, RP, Comerci, JT, Huang, M, Courtney-Brooks, M & Beriwal, S 2015, 'Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer', Brachytherapy, vol. 14, no. 1, pp. 9-15. https://doi.org/10.1016/j.brachy.2014.10.001
Vargo JA, Kim H, Houser CJ, Sukumvanich P, Olawaiye AB, Kelley JL et al. Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer. Brachytherapy. 2015 Jan 1;14(1):9-15. https://doi.org/10.1016/j.brachy.2014.10.001
Vargo, John A. ; Kim, Hayeon ; Houser, Christopher J. ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Comerci, John T. ; Huang, Marilyn ; Courtney-Brooks, Madeleine ; Beriwal, Sushil. / Image-based multichannel vaginal cylinder brachytherapy for vaginalcancer. In: Brachytherapy. 2015 ; Vol. 14, No. 1. pp. 9-15.
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abstract = "Purpose: To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. Methods and Materials: A total of 41 patients with vaginal cancer (24{\%} primary vaginal and 76{\%} recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41{\%}) or MR-based planning (59{\%}) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2. Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. Results: The median high-risk clinical target volume was 24.2cc (interquartile range [IQR], 12.6), with a median dose to 90{\%} (D90) of 77.1Gy (IQR, 3.4). The median dose to 2cc (D2 cc) for the bladder, rectum, and sigmoid were 59.4Gy (IQR, 5.6), 58.2Gy (IQR, 4.1), and 52.3Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98{\%} of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93{\%}, 100{\%}, 81{\%}, 78{\%}, and 88{\%}, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4{\%} overall with 0{\%}, 0{\%}, 0{\%}, and 4{\%} for vaginal, bladder, urethral, and gastrointestinal, respectively. Conclusions: Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.",
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AU - Olawaiye, Alexander B.

AU - Kelley, Joseph L.

AU - Edwards, Robert P.

AU - Comerci, John T.

AU - Huang, Marilyn

AU - Courtney-Brooks, Madeleine

AU - Beriwal, Sushil

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N2 - Purpose: To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. Methods and Materials: A total of 41 patients with vaginal cancer (24% primary vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2. Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. Results: The median high-risk clinical target volume was 24.2cc (interquartile range [IQR], 12.6), with a median dose to 90% (D90) of 77.1Gy (IQR, 3.4). The median dose to 2cc (D2 cc) for the bladder, rectum, and sigmoid were 59.4Gy (IQR, 5.6), 58.2Gy (IQR, 4.1), and 52.3Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for vaginal, bladder, urethral, and gastrointestinal, respectively. Conclusions: Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.

AB - Purpose: To investigate the clinical feasibility and treatment outcomes of image-based high-dose-rate (HDR) brachytherapy using an intracavitary multichannel vaginal cylinder for the definitive treatment of vaginal cancers. Methods and Materials: A total of 41 patients with vaginal cancer (24% primary vaginal and 76% recurrence from other gynecologic primaries) treated with definitive radiotherapy ± chemotherapy including image-based HDR brachytherapy with a multichannel vaginal cylinder were included in the study. Image-based brachytherapy was completed using either CT- (41%) or MR-based planning (59%) with each fraction. The high-risk clinical target volume was defined based on the pre- and postexternal beam radiotherapy gross tumor volume. Doses were converted to equivalent dose of 2. Gy per fraction. Endpoints examined were dose-volume parameters and early clinical outcomes. Results: The median high-risk clinical target volume was 24.2cc (interquartile range [IQR], 12.6), with a median dose to 90% (D90) of 77.1Gy (IQR, 3.4). The median dose to 2cc (D2 cc) for the bladder, rectum, and sigmoid were 59.4Gy (IQR, 5.6), 58.2Gy (IQR, 4.1), and 52.3Gy (IQR, 5.5), respectively. After a median followup of 16 months (range, 3-35), complete clinical response was documented in 98% of the patients. The 2-year local, regional, and distant control; and disease-free and overall survival were 93%, 100%, 81%, 78%, and 88%, respectively. The 2-year actuarial rate of late Grade 3 or higher toxicity was 4% overall with 0%, 0%, 0%, and 4% for vaginal, bladder, urethral, and gastrointestinal, respectively. Conclusions: Image-based HDR brachytherapy using an intracavitary multichannel cylinder seems feasible in definitive vaginal cancer treatment. The described clinical implementation shows promising early clinical outcomes with high rates of local control and little toxicity, which should be validated with extended followup.

KW - HDR

KW - Image-based brachytherapy

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KW - MRI

KW - Multichannel cylinder

KW - Vaginal cancer

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