Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients
Scarce data exist on concurrent chemotherapy in locally advanced cervical cancer (LACC) patients (pts) treated with image-guided adaptive brachytherapy (IGABT). We examined the effect of a number of chemotherapy cycles and their interaction with brachytherapy dose/volume parameters. Clinical records...
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doaj-a11c5d0d61814109b760690ed195489f2020-11-25T03:27:40ZengMDPI AGJournal of Clinical Medicine2077-03832020-06-0191653165310.3390/jcm9061653Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer PatientsAlexandre Escande0Mohamed Khettab1Sophie Bockel2Isabelle Dumas3Antoine Schernberg4Sebastien Gouy5Philippe Morice6Patricia Pautier7Eric Deutsch8Christine Haie-Meder9Cyrus Chargari10Brachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceRadiotherapy Department, Gustave Roussy, F-94800 Villejuif, FranceBrachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceBrachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceBrachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceSurgery Department, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceSurgery Department, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceMedical Oncology, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceRadiotherapy Department, Gustave Roussy, F-94800 Villejuif, FranceBrachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceBrachytherapy Unit, Gustave Roussy Cancer Campus, F-94800 Villejuif, FranceScarce data exist on concurrent chemotherapy in locally advanced cervical cancer (LACC) patients (pts) treated with image-guided adaptive brachytherapy (IGABT). We examined the effect of a number of chemotherapy cycles and their interaction with brachytherapy dose/volume parameters. Clinical records of 209 consecutive pts treated for a LACC were reviewed. Pts received CRT concurrently with cisplatin 40 mg/m² or carboplatin AUC2. An additional cycle could have been delivered during the pulse-dose rate (PDR)-IGABT. The impact of a number of chemotherapy cycles on outcome was examined, as well as the interactions with dose volume parameters. The number of cycles was four in 55 (26.3%) pts, five in 154 (73.7%) including 101 receiving the fifth cycle during IGABT. Median follow-up was 5.5 years. Pts receiving five cycles had a better outcome on all survival endpoints, including three year local control rate (93.9% vs. 77.2%; <i>p</i> < 0.05). In the subgroup, only pts with tumor FIGO (Fédération Internationale de Gynécologie Obstétrique) stage ≤IIB or with CTV<sub>HR</sub> > 25 cm<sup>3</sup> had a better outcome. Pts receiving four cycles with D<sub>90</sub>CTV<sub>HR</sub> > 80Gy<sub>EQD2</sub> had the same locoregional control–(LRC) as those receiving five cycles and achieving D<sub>90</sub>CTV<sub>HR</sub> ≤ 80 Gy<sub>EQD2</sub> (<i>p</i> = 0.75). An optimal propensity score matching the balance for the FIGO stage, CTV<sub>HR</sub> volume and D<sub>90</sub>CTV<sub>HR</sub> confirmed the effect, with the largest life expectancy benefit for locoregional failure-free survival (absolute gain: 1.5 years; <i>p</i> = 0.017). Long-term radiation-induced toxicity was not increased. Increasing the total number of cycles from 4 to 5 improved LFS, suggesting a place for systemic strategies aimed at in-field cooperation. Delivering an additional cycle at the time of brachytherapy did not increase morbidity and there permitted an increase in chemotherapy dose intensity.https://www.mdpi.com/2077-0383/9/6/1653locally advanced cervical cancerchemoradiationchemotherapyimage-guided adaptive brachytherapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alexandre Escande Mohamed Khettab Sophie Bockel Isabelle Dumas Antoine Schernberg Sebastien Gouy Philippe Morice Patricia Pautier Eric Deutsch Christine Haie-Meder Cyrus Chargari |
spellingShingle |
Alexandre Escande Mohamed Khettab Sophie Bockel Isabelle Dumas Antoine Schernberg Sebastien Gouy Philippe Morice Patricia Pautier Eric Deutsch Christine Haie-Meder Cyrus Chargari Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients Journal of Clinical Medicine locally advanced cervical cancer chemoradiation chemotherapy image-guided adaptive brachytherapy |
author_facet |
Alexandre Escande Mohamed Khettab Sophie Bockel Isabelle Dumas Antoine Schernberg Sebastien Gouy Philippe Morice Patricia Pautier Eric Deutsch Christine Haie-Meder Cyrus Chargari |
author_sort |
Alexandre Escande |
title |
Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients |
title_short |
Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients |
title_full |
Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients |
title_fullStr |
Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients |
title_full_unstemmed |
Interaction between the Number of Chemotherapy Cycles and Brachytherapy Dose/Volume Parameters in Locally Advanced Cervical Cancer Patients |
title_sort |
interaction between the number of chemotherapy cycles and brachytherapy dose/volume parameters in locally advanced cervical cancer patients |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-06-01 |
description |
Scarce data exist on concurrent chemotherapy in locally advanced cervical cancer (LACC) patients (pts) treated with image-guided adaptive brachytherapy (IGABT). We examined the effect of a number of chemotherapy cycles and their interaction with brachytherapy dose/volume parameters. Clinical records of 209 consecutive pts treated for a LACC were reviewed. Pts received CRT concurrently with cisplatin 40 mg/m² or carboplatin AUC2. An additional cycle could have been delivered during the pulse-dose rate (PDR)-IGABT. The impact of a number of chemotherapy cycles on outcome was examined, as well as the interactions with dose volume parameters. The number of cycles was four in 55 (26.3%) pts, five in 154 (73.7%) including 101 receiving the fifth cycle during IGABT. Median follow-up was 5.5 years. Pts receiving five cycles had a better outcome on all survival endpoints, including three year local control rate (93.9% vs. 77.2%; <i>p</i> < 0.05). In the subgroup, only pts with tumor FIGO (Fédération Internationale de Gynécologie Obstétrique) stage ≤IIB or with CTV<sub>HR</sub> > 25 cm<sup>3</sup> had a better outcome. Pts receiving four cycles with D<sub>90</sub>CTV<sub>HR</sub> > 80Gy<sub>EQD2</sub> had the same locoregional control–(LRC) as those receiving five cycles and achieving D<sub>90</sub>CTV<sub>HR</sub> ≤ 80 Gy<sub>EQD2</sub> (<i>p</i> = 0.75). An optimal propensity score matching the balance for the FIGO stage, CTV<sub>HR</sub> volume and D<sub>90</sub>CTV<sub>HR</sub> confirmed the effect, with the largest life expectancy benefit for locoregional failure-free survival (absolute gain: 1.5 years; <i>p</i> = 0.017). Long-term radiation-induced toxicity was not increased. Increasing the total number of cycles from 4 to 5 improved LFS, suggesting a place for systemic strategies aimed at in-field cooperation. Delivering an additional cycle at the time of brachytherapy did not increase morbidity and there permitted an increase in chemotherapy dose intensity. |
topic |
locally advanced cervical cancer chemoradiation chemotherapy image-guided adaptive brachytherapy |
url |
https://www.mdpi.com/2077-0383/9/6/1653 |
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