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Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer
Journal of Contemporary Brachytherapy ( IF 1.4 ) Pub Date : 2023-08-30 , DOI: 10.5114/jcb.2023.130976 Kiattisa Sommat 1 , Swee Peng Yap 1 , Richard Ming Chert Yeo 1 , Hoon Seng Khoo Tan 1 , Yoke Lim Soong 1 , Jeffrey Kit Loong Tuan 1 , Iris Huili Sin 1
Journal of Contemporary Brachytherapy ( IF 1.4 ) Pub Date : 2023-08-30 , DOI: 10.5114/jcb.2023.130976 Kiattisa Sommat 1 , Swee Peng Yap 1 , Richard Ming Chert Yeo 1 , Hoon Seng Khoo Tan 1 , Yoke Lim Soong 1 , Jeffrey Kit Loong Tuan 1 , Iris Huili Sin 1
Affiliation
Purpose:
To report outcomes of using image-guided hybrid intra-cavitary/interstitial applicators under moderate sedation for locally advanced cervical cancer patients in our institution.
Material and methods:
A total of 69 fractions of brachytherapy with hybrid applicators were performed in 33 patients from January 2017 to April 2021. All patients underwent MRI pelvis 1 week pre-brachytherapy to determine suitability for interstitial brachytherapy and pre-plan needle placement. All insertion of applicators were performed under moderate sedation with midazolam and/or fentanyl. Fifty-eight (84.1%) fractions were planned with CT alone. Clinical outcomes, dose volume parameters, and toxicities were analyzed.
Results:
The median follow-up was 28 months. A total of 320 needles (median, 5 needles per fraction) were implanted, with a median insertion depth of 3 cm (range, 1.5-4 cm). The median high-risk clinical target volume (HR-CTV) during initial brachytherapy was 34.5 cc (range, 17.8-74.7 cc). The median total EQD2 D2cc of the rectum, bladder, sigmoid, and small intestine colon was 71.8 Gy, 81.5 Gy, 69 Gy, and 58.3 Gy, respectively. The 2-year local control and overall survival were 80.7% and 77.7%, respectively. Larger volume HR-CTV was significantly associated with worse local control (HR = 1.08, p = 0.005) and overall survival (HR = 1.04, p = 0.015). None of the patients required in-patient admission or blood transfusion post-procedure. Late grade 3 gastrointestinal and genitourinary toxicities were observed in 4 patients (12.2%).
Conclusions:
Hybrid applicators inserted under moderate sedation are feasible and safe. Image-guided interstitial brachytherapy with CT planning aided by MRI performed 1 week pre-brachytherapy is associated with favorable outcomes and modest toxicities.
中文翻译：
中度镇静下使用混合型间质和腔内施源器进行 MRI 辅助图像引导近距离放射治疗治疗局部晚期宫颈癌后的肿瘤学结果
目的：
报告在我们机构的局部晚期宫颈癌患者中度镇静下使用图像引导混合腔内/间质涂药器的结果。
材
_ 所有涂药器的插入均在咪达唑仑和/或芬太尼的中度镇静下进行。单独使用 CT 计划了 58 次 (84.1%) 分次。分析了临床结果、剂量体积参数和毒性。
结果：
中位随访时间为 28 个月。总共植入 320 根针（中位，每部分 5 根针），中位插入深度为 3 厘米（范围，1.5-4 厘米）。初始近距离放射治疗期间的中位高风险临床靶体积 (HR-CTV) 为 34.5 cc（范围，17.8-74.7 cc）。直肠、膀胱、乙状结肠和小肠结肠的中位总EQD 2 D 2cc分别为71.8 Gy、81.5 Gy、69 Gy 和58.3 Gy。2年局部控制率和总生存率分别为80.7%和77.7%。较大体积的 HR-CTV 与较差的局部控制（HR = 1.08， p = 0.005）和总生存率（HR = 1.04，p = 0.015）显着相关。术后没有患者需要住院或输血。4 名患者 (12.2%) 观察到晚期 3 级胃肠道和泌尿生殖毒性。
结论：
在中等镇静状态下插入混合施药器是可行且安全的。近距离放射治疗前 1 周进行的图像引导间质近距离放射治疗，采用 CT 规划并在 MRI 辅助下进行，可带来良好的结果和适度的毒性。
更新日期：2023-08-30
To report outcomes of using image-guided hybrid intra-cavitary/interstitial applicators under moderate sedation for locally advanced cervical cancer patients in our institution.
Material and methods:
A total of 69 fractions of brachytherapy with hybrid applicators were performed in 33 patients from January 2017 to April 2021. All patients underwent MRI pelvis 1 week pre-brachytherapy to determine suitability for interstitial brachytherapy and pre-plan needle placement. All insertion of applicators were performed under moderate sedation with midazolam and/or fentanyl. Fifty-eight (84.1%) fractions were planned with CT alone. Clinical outcomes, dose volume parameters, and toxicities were analyzed.
Results:
The median follow-up was 28 months. A total of 320 needles (median, 5 needles per fraction) were implanted, with a median insertion depth of 3 cm (range, 1.5-4 cm). The median high-risk clinical target volume (HR-CTV) during initial brachytherapy was 34.5 cc (range, 17.8-74.7 cc). The median total EQD2 D2cc of the rectum, bladder, sigmoid, and small intestine colon was 71.8 Gy, 81.5 Gy, 69 Gy, and 58.3 Gy, respectively. The 2-year local control and overall survival were 80.7% and 77.7%, respectively. Larger volume HR-CTV was significantly associated with worse local control (HR = 1.08, p = 0.005) and overall survival (HR = 1.04, p = 0.015). None of the patients required in-patient admission or blood transfusion post-procedure. Late grade 3 gastrointestinal and genitourinary toxicities were observed in 4 patients (12.2%).
Conclusions:
Hybrid applicators inserted under moderate sedation are feasible and safe. Image-guided interstitial brachytherapy with CT planning aided by MRI performed 1 week pre-brachytherapy is associated with favorable outcomes and modest toxicities.
中文翻译：
中度镇静下使用混合型间质和腔内施源器进行 MRI 辅助图像引导近距离放射治疗治疗局部晚期宫颈癌后的肿瘤学结果
目的：
报告在我们机构的局部晚期宫颈癌患者中度镇静下使用图像引导混合腔内/间质涂药器的结果。
材
_ 所有涂药器的插入均在咪达唑仑和/或芬太尼的中度镇静下进行。单独使用 CT 计划了 58 次 (84.1%) 分次。分析了临床结果、剂量体积参数和毒性。
结果：
中位随访时间为 28 个月。总共植入 320 根针（中位，每部分 5 根针），中位插入深度为 3 厘米（范围，1.5-4 厘米）。初始近距离放射治疗期间的中位高风险临床靶体积 (HR-CTV) 为 34.5 cc（范围，17.8-74.7 cc）。直肠、膀胱、乙状结肠和小肠结肠的中位总EQD 2 D 2cc分别为71.8 Gy、81.5 Gy、69 Gy 和58.3 Gy。2年局部控制率和总生存率分别为80.7%和77.7%。较大体积的 HR-CTV 与较差的局部控制（HR = 1.08， p = 0.005）和总生存率（HR = 1.04，p = 0.015）显着相关。术后没有患者需要住院或输血。4 名患者 (12.2%) 观察到晚期 3 级胃肠道和泌尿生殖毒性。
结论：
在中等镇静状态下插入混合施药器是可行且安全的。近距离放射治疗前 1 周进行的图像引导间质近距离放射治疗，采用 CT 规划并在 MRI 辅助下进行，可带来良好的结果和适度的毒性。
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