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Qian S, Ye L, Tian YH, Wang LG, Huang ZP, Li F, Hou B, Song N, Chen J, Liu Y, Liu X, Zhou T. Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervical cancer: a retrospective clinical study. CHINESE JOURNAL OF CANCER 2017; 36:24. [PMID: 28245859 PMCID: PMC5331714 DOI: 10.1186/s40880-017-0191-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/16/2017] [Indexed: 01/02/2023]
Abstract
Background Cervical cancer is the sixth most common cancer in Chinese women. A standard treatment modality for cervical cancer is the combination of surgery, chemotherapy, external-beam radiotherapy and intracavitary brachytherapy. The aim of this study was to retrospectively assess the long-term treatment outcomes of patients with cervical cancer who were treated with californium-252 neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy. Methods We retrospectively analyzed the medical records of 150 patients with primary stages IB-IVB cervical cancer who received neutron brachytherapy combined with external-beam radiotherapy concurrently with cisplatin chemotherapy. All patients were followed up. Using an actuarial analysis, patient outcomes and treatment-related adverse effects were evaluated and compared. Results The median overall survival (OS) was 33.2 months. The 3-year progression-free survival rates for patients with stages I–II, III, and IV diseases were 81.0% (68/84), 65.0% (39/60), and 0% (0/6), respectively; the 3-year OS rates were 90.5% (76/84), 85.0% (51/60), and 16.7% (1/6), respectively. Vaginal bleeding was controlled within the median time of 4.0 days. One month after treatment, 97.3% of patients achieved short-term local control. The local recurrence rates for patients with stages I–II, III, and IV disease were 4.8% (4/84), 11.7% (7/60), and 33.3% (2/6), respectively, and the occurrence rates of distant metastasis were 16.7% (14/84), 25.0% (15/60), and 100.0% (6/6), respectively. Cancer stage, tumor size, and lymph node metastasis were identified as prognostic risk factors, but only lymph node metastasis was found to be an independent prognostic factor. The most common adverse effects during treatment were grades 1 and 2 irradiation-related proctitis and radiocystitis. Conclusion For patients with cervical cancer, neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long-term survival rates with tolerable adverse effects.
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Affiliation(s)
- Shen Qian
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China.
| | - Ling Ye
- Department of Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, P. R. China
| | - Yun-Hong Tian
- Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, 510095, P. R. China
| | - Li-Gen Wang
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Zuo-Ping Huang
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Feng Li
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Bing Hou
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Ni Song
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Juan Chen
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Xiao Liu
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China
| | - Tao Zhou
- Department of Oncology, Armed Police Hospital of Guangdong Affiliated with Guangzhou Medical University, No. 268 of Yanling Road, Tianhe District, Guangzhou, 510507, Guangdong, P. R. China.
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Huang MW, Zhang JG, Zheng L, Liu SM, Yu GY. Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:662-667. [PMID: 27422928 PMCID: PMC5137284 DOI: 10.1093/jrr/rrw033] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/30/2015] [Accepted: 02/11/2016] [Indexed: 06/06/2023]
Abstract
To transfer the preplan for the head and neck brachytherapy to the clinical implantation procedure, a preplan-based 3D-printed individual template for needle insertion guidance had previously been designed and used. The accuracy of needle insertion using this kind template was assessed in vivo In the study, 25 patients with head and neck tumors were implanted with 125I radioactive seeds under the guidance of the 3D-printed individual template. Patients were divided into four groups based on the site of needle insertion: the parotid and masseter region group (nine patients); the maxillary and paranasal region group (eight patients); the submandibular and upper neck area group (five patients); and the retromandibular region group (six patients). The distance and angular deviations between the preplanned and placed needles were compared, and the complications and time required for needle insertion were assessed. The mean entrance point distance deviation for all 619 needles was 1.18 ± 0.81 mm, varying from 0.857 ± 0.545 to 1.930 ± 0.843 mm at different sites. The mean angular deviation was 2.08 ± 1.07 degrees, varying from 1.85 ± 0.93 to 2.73 ± 1.18 degrees at different sites. All needles were manually inserted to their preplanned positions in a single attempt, and the mean time to insert one needle was 7.5 s. No anatomical complications related to inaccurately placed implants were observed. Using the 3D-printed individual template for the implantation of 125I radioactive seeds in the head and neck region can accurately transfer a CT-based preplan to the brachytherapy needle insertion procedure. Moreover, the addition of individual template guidance can reduce the time required for implantation and minimize the damage to normal tissues.
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Affiliation(s)
- Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing100081, P. R. China
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Dimopoulos JCA, Schirl G, Baldinger A, Helbich TH, Pötter R. MRI assessment of cervical cancer for adaptive radiotherapy. Strahlenther Onkol 2009; 185:282-7. [PMID: 19440666 DOI: 10.1007/s00066-009-1918-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the importance of the information obtained from MRI for adaptive cervix cancer radiotherapy. PATIENTS AND METHODS 49 patients with cervix cancer, treated by external-beam radiotherapy (EBRT) and MRI-assisted high-dose-rate brachytherapy +/- concomitant cisplatin, underwent MRI at diagnosis and at the time of brachytherapy fractions. 190 MRI examinations were performed. Pretreatment scans were correlated with clinical examination (CE) findings. Measurements in 3-D of the tumor extension and also of the distance from the tumor to the pelvic side wall were performed using both MRI and CE. The tumor volume regression induced initially by EBRT and the subsequent regression after each brachytherapy fraction were assessed. RESULTS MRI and CE showed 92% agreement in overall parametrial staging and 73% agreement in terms of vaginal involvement. There was, however, disagreement in parametrial side (right/left) classification in 25% of the parametria examined. These were patients with unilateral displacement of the cervix and contralateral invasion of the parametrium. The mean tumor volume on the pretreatment MRI scan (GTVD) was 61 cm(3). At the time of the four brachytherapy fractions the mean was 16 cm(3), 10 cm(3), 9 cm(3), and 8 cm(3), defined as the GTVBT plus the gray zones in the parametria. CONCLUSION CE and MRI findings agree well in terms of overall staging. The clinical assessment of side-specific parametrial invasion improved when having access to the additional knowledge obtained from MRI. The greatest decrease in tumor volume occurs during EBRT, whereas tumor regression between the first and subsequent brachytherapy fractions is minor.
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