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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2022
vol. 14
 
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abstract:
Original paper

Bevacizumab increases late toxicity in re-irradiation with image-guided high-dose-rate brachytherapy for gynecologic malignancies

Naoya Murakami
1
,
Kae Okuma
1
,
Hiroyuki Okamoto
2
,
Satoshi Nakamura
2
,
Tairo Kashihara
1
,
Tomoya Kaneda
1
,
Kana Takahashi
1
,
Koji Inaba
1
,
Hiroshi Igaki
1
,
Koji Masui
3
,
Ken Yoshida
4
,
Tomoyasu Kato
5
,
Jun Itami
1

  1. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
  2. Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
  3. Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
  4. Department of Radiology, Kansai Medical University Medical Center, Osaka, Japan
  5. Department of Gynecologic Oncology, National Cancer Center Hospital, Tokyo, Japan
J Contemp Brachytherapy 2022; 14, 1: 52–59
DOI: https://doi.org/10.5114/jcb.2022.113549
Online publish date: 2022/02/18
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Introduction
Patients with recurrent gynecologic malignancies having had pelvic irradiation, generally have limited salvage options. This study investigated patients with gynecologic malignancies, who had a history of pelvic irradiation and received salvage re-irradiation using image-guided high-dose-rate brachytherapy (IG-HDR-BT).

Material and methods
Patients with gynecologic malignancies, who had a history of previous irradiation and received re-irradiation using IG-HDR-BT for disease recurrences from June 2014 to March 2020 were included in this study.

Results
A total of 37 patients were included in this retrospective analysis. Primary tumor was uterine cervical cancer in 31 patients, endometrial cancer in 5 patients, and vaginal cancer in 1 patient. Median follow-up period of patients who were alive at the time of analysis was 15.4 months (range, 4.1-61.4 months). Two-year overall survival, progression-free survival, and local control were 68.9%, 49.3%, and 67.5%, respectively. Severe late toxicities ≥ grade 3, which were related to re-irradiation, were observed in 9 patients (24.3%). Usage of bevacizumab in the entire course of treatment was associated with development of late ≥ grade 3 fistula formation, bowel perforation, or vaginal ulcer (50% vs. 6.9%, p = 0.013). Tumor size ≥ 2.5 cm was associated with development of late ≥ grade 3 of rectum, bladder, or vaginal toxicities (0% vs. 28%, p = 0.047).

Conclusions
If the recurrent disease was found in small size and there was no history of bevacizumab usage, re-irradiation with IG-HDR-BT could be considered, even in patients with a previous history of pelvic irradiation.

keywords:

re-irradiation, image-guided high-dose-rate brachytherapy, gynecologic malignancies, bevacizumab, late toxicities

  
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