eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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SCImago Journal & Country Rank

4/2022
vol. 14
 
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abstract:
Original paper

An Asian multi-national, multi-institutional, retrospective study on image-guided brachytherapy in cervical adenocarcinoma and adenosquamous carcinoma

Noriyuki Okonogi
1
,
Naoya Murakami
2
,
Ken Ando
3, 4
,
Masumi Murata
3
,
Kazutoshi Murata
1, 4
,
Tomomi Aoshika
5
,
Shingo Kato
5
,
Anneyuko I Saito
6
,
Joo-Young Kim
7
,
Yasuo Yoshioka
8
,
Shuhei Sekii
9, 10
,
Kayoko Tsujino
9
,
Chairat Lowanichkiattikul
11
,
Poompis Pattaranutaporn
11
,
Yuko Kaneyasu
12
,
Tomio Nakagawa
12
,
Miho Watanabe
13
,
Takashi Uno
13
,
Rei Umezawa
14
,
Keiichi Jingu
14
,
Ayae Kanemoto
15
,
Masaru Wakatsuki
1, 16
,
Katsuyuki Shirai
16
,
Hiroshi Igaki
2
,
Tatsuya Ohno
4
,
Jun Itami
2

1.
QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba City, Chiba, Japan
2.
Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
3.
Department of Radiation Oncology, Gunma Prefectural Cancer Center, Ota City, Gunma, Japan
4.
Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi City, Gunma, Japan
5.
Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
6.
Department of Radiation Oncology, Juntendo University Faculty of Medicine, Tokyo, Japan
7.
Department of Radiation Oncology, National Cancer Center, Ilsandong, Goyang Gyeonggi, Korea
8.
Radiation Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
9.
Department of Radiation Oncology, Hyogo Cancer Center, Akashi City, Hyogo, Japan
10.
Department of Radiation Therapy, Kita-Harima Medical Center, Ono City, Hyogo, Japan
11.
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rajataewe, Bangkok, Thailand
12.
Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
13.
Department of Radiology, Chiba University Hospital, Chuo-ku, Chiba City, Chiba, Japan
14.
Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
15.
Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
16.
Department of Radiology, Jichi Medical University Hospital, Shimotsuke City, Tochigi, Japan
J Contemp Brachytherapy 2022; 14, 4: 311–320
Online publish date: 2022/08/31
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Purpose
There are limited reports on outcomes of three-dimensional image-guided brachytherapy (3D-IGBT) for cervical adenocarcinoma in Asia. In a multi-institutional retrospective study, we assessed the clinical outcomes of three-dimensional image-guided brachytherapy for cervical adenocarcinoma or adenosquamous carcinoma (CA/CAC) in Asian countries.

Material and methods
Patients who had undergone definitive radiation therapy/concurrent chemoradiotherapy for untreated cervical cancer between 2000 and 2016 were registered. Those who had undergone 3D-IGBT for histologically proven CA/CAC were included. Data on patients’ characteristics and treatment were collected, including tumor reduction rate (defined as a percentage of reduction in tumor size before brachytherapy compared with that at diagnosis) and high-risk clinical target volume D90. Overall survival (OS), local control (LC), and progression-free survival (PFS) rates were calculated using Kaplan-Meier method. Late toxicities were assessed using common terminology criteria for adverse events version 4.0.

Results
Anonymized data of 498 patients were collected. Of the 498 patients, 36 patients met inclusion criteria. The median follow-up period was 39 months. The 3-year OS, LC, and PFS rates were 68.4%, 68.5%, and 44.4%, respectively. After treatment, five patients had tumor re-growth without complete disappearance of the tumor. Two patients developed grade 3 vaginal toxicity or grade 4 rectal toxicity; none developed other severe late toxicities. A tumor reduction rate of > 26.3% was the only significant factor in multivariate analyses, and was associated with significantly better OS (p = 0.018), LC (p = 0.022), and PFS (p = 0.013). There were no significant trends in local control or dose to high-risk clinical target volume D90.

Conclusions
LC rate of CA/CAC was insufficient despite 3D-IGBT. Meanwhile, tumor reduction rate was associated with LC, OS, and PFS rates. Therefore, CA/CAC may require a different treatment strategy than that applied in cervical squamous cell carcinoma.

keywords:

uterine cervical neoplasms, radiotherapy, chemoradiotherapy, brachytherapy

 
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