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Journal of Contemporary Brachytherapy
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1/2019
vol. 11
 
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abstract:
Original paper

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction

Naoya Murakami, Satoshi Shima, Tairo Kashihara, Nikolaos Tselis, Tomoyasu Kato, Yoshiaki Takagawa, Koji Masui, Ken Yoshida, Kana Takahashi, Koji Inaba, Kae Okuma, Hiroshi Igaki, Yuko Nakayama, Jun Itami

J Contemp Brachytherapy 2019; 11, 1: 1–7
Online publish date: 2019/01/29
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Purpose
The purpose of this study was to report our initial experience of hyaluronic acid gel injection (HGI) in the vesicovaginal septum (VVS) for bladder dose reduction in brachytherapy (BT) for uterine cervical carcinoma.

Material and methods
Between September 2016 and May 2018, 15 uterine cervical cancer patients received HGI in the VVS as a part of their definitive radiotherapy (RT) treatment consisting of external beam radiation therapy (EBRT) with additional BT. Of those, 9 patients received BT both with and without HGI, and remaining 6 patients were excluded because these 6 patients received HGI in the VVS for all BT fractions. All 9 patients received HGI in the rectovaginal septum. For these patients, the dosimetric parameters bladder D2cc, HR-CTV D90, and rectum D2cc were selected, and two groups were generated (BT with vs. without HGI in the VVS) for dosimetric comparison.

Results
The median cumulative EQD2 for HR-CTV, rectum D2cc, and bladder D2cc for the 9 patients were 73.3, 52.8, and 67.1, respectively. While no statistical difference could be detected for rectal dose reduction, bladder dose was significantly less in the group with HGI in the VVS compared to that without (449 cGy [range, 416-566, 1SD = 66.1] vs. 569 cGy [range, 449-647, 1SD = 59.5], p = 0.033), with no compromising of target coverage. Although it did not reach statistically significance, there was a trend toward better HR-CTV D90 in the group with HGI compared to that without HGI in the VVS (713 cGy vs. 706 cGy, p = 0.085). No severe bleeding, hematuria, bladder wall injury, or urethral injury requiring hospitalization was experienced in association with HGI in the VVS.

Conclusions
HGI in the VVS can be performed safely and can effectively reduce the bladder dose in BT for uterine cervical cancer patients.

keywords:

uterine cervical cancer, brachytherapy, gel spacer injection, bladder dose, vesicovaginal septum

references:
Tod M, Meredith WJ. Treatment of cancer of the cervix uteri, a revised Manchester method. Br J Radiol 1953; 26: 252-257.
Whitney CW, Sause W, Bundy BN et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999; 17: 1339-1348.
Rose PG, Bundy BN, Watkins EB et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999; 340: 1144-1153.
Morris M, Eifel PJ, Lu J et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999; 340: 1137-1143.
Landoni F, Maneo A, Colombo A et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350: 535-540.
Han K, Milosevic M, Fyles A et al. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys 2013; 87: 111-119.
Mayadev J, Klapheke A, Yashar C et al. Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. Gynecol Oncol 2018; 150: 73-78.
Georg P, Potter R, Georg D et al. Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy. Int J Radiat Oncol Biol Phys 2012; 82: 653-657.
Pötter R, Haie-Meder C, Van Limbergen E et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78: 67-77.
Mazeron R, Fokdal LU, Kirchheiner K et al. Dose-volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study. Radiother Oncol 2016; 120: 412-419.
Viswanathan AN, Beriwal S, De Los Santos JF et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy. Brachytherapy 2012; 11: 47-52.
Kishi K, Iida T, Ojima T et al. Esophageal gel-shifting technique facilitating eradicative boost or reirradiation to upper mediastinal targets of recurrent nerve lymph node without damaging esophagus. J Radiat Res 2013; 54: 748-754.
Kishi K, Mabuchi Y, Sonomura T et al. Eradicative brachytherapy with hyaluronate gel injection into pararectal space in treatment of bulky vaginal stump recurrence of uterine cancer. J Radiat Res 2012; 53: 601-607.
Kishi K, Sonomura T, Shirai S et al. Brachytherapy reirradiation with hyaluronate gel injection of paraaortic lymphnode metastasis of pancreatic cancer: paravertebral approach – a technical report with a case. J Radiat Res 2011; 52: 840-844.
Kishi K, Sonomura T, Shirai S et al. Critical organ preservation in reirradiation brachytherapy by injectable spacer. Int J Radiat Oncol Biol Phys 2009; 75: 587-594.
Mariados N, Sylvester J, Shah D et al. Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2015; 92: 971-977.
Hamstra DA, Mariados N, Sylvester J et al. Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial. Int J Radiat Oncol Biol Phys 2017; 97: 976-985.
Murakami N, Kasamatsu T, Wakita A et al. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer. BMC Cancer 2014; 14: 447.
Kuroda Y, Murakami N, Morota M et al. Impact of concurrent chemotherapy on definitive radiotherapy for women with FIGO IIIb cervical cancer. J Radiat Res 2012; 53: 588-593.
Dale RG. The application of the linear-quadratic dose-effect equation to fractionated and protracted radiotherapy. Br J Radiol 1985; 58: 515-528.
Stuschke M, Thames HD. Fractionation sensitivities and dose-control relations of head and neck carcinomas: analysis of the randomized hyperfractionation trials. Radiother Oncol 1999; 51: 113-121.
Terry NH, Denekamp J. RBE values and repair for colo-rectal injury after caesium 137 gamma-ray and neutron irradiation. II. Fractionation up to ten doses. Br J Radiol 1984; 57: 617-629.
Sturdza A, Potter R, Fokdal LU et al. Image-guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol 2016; 120: 428-433.
Otahal B, Dolezel M, Cvek J et al. Dosimetric comparison of MRI-based HDR brachytherapy and stereotactic radiotherapy in patients with advanced cervical cancer: A virtual brachytherapy study. Rep Pract Oncol Radiother 2014; 19: 399-404.
Dang YZ, Li P, Li JP et al. The efficacy and late toxicities of computed tomography-based brachytherapy with intracavitary and interstitial technique in advanced cervical cancer. J Cancer 2018; 9: 1635-1641.
Sharma AD, Poddar J, Suryanarayan KU et al. Dosimetric analysis of the effects of the bladder volume on organs at risk (OAR) in high-dose-rate intracavitary brachytherapy in carcinoma cervix – an institutional study. J Contemp Brachytherapy 2018; 10: 26-31.
Damato AL, Kassick M, Viswanathan AN. Rectum and bladder spacing in cervical cancer brachytherapy using a novel injectable hydrogel compound. Brachytherapy 2017; 16: 949-955.
Viswanathan AN, Damoto AL, Nguyen PL. Novel use of a hydrogel spacer permits reirradiation in otherwise incurable recurrent gynecologic cancers. J Clin Oncol 2013; 31: e446-447.
Mazeron R, Maroun P, Castelnau-Marchand P et al. Pulsed-dose rate image-guided adaptive brachytherapy in cervical cancer: Dose-volume effect relationships for the rectum and bladder. Radiother Oncol 2015; 116: 226-232.
 
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