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

6/2018
vol. 10
 
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abstract:
Original paper

Risk factors for fistula formation after interstitial brachytherapy for locally advanced gynecological cancers involving vagina

Allen Yen, Zhen Tian, Brian Hrycushko, Kevin Albuquerque

J Contemp Brachytherapy 2018; 10, 6: 510–515
Online publish date: 2018/12/05
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Purpose
To determine risk factors for fistula formation after interstitial brachytherapy (ISBT) in patients with advanced gynecologic cancers.

Material and methods
We performed an Institutional Review Board (IRB) approved retrospective review of 44 patients treated with transperineal template-based ISBT from 2011 to 2017 at a major metropolitan county and university health system. All patients were treated with image-guided high-dose-rate ISBT. Statistical analysis was performed using the χ2 test to identify factors correlated with fistula formation. Survival and tumor control outcomes were calculated using Kaplan Meier analyses.

Results
Patients had a mean age of 53 years (range, 28-81 years), a mean external beam dose of 43.1 Gy (range, 42.5-51.3 Gy), and a mean brachytherapy dose of 22.8 Gy (range, 21.3-30 Gy). Two of 44 patients had fistulas that could be definitively attributed to therapy for a fistula rate of 4.5%. Six additional patients (13.6%) developed fistula after treatment with associated recurrent disease but were included in the causality analysis. We analyzed patient tumor and treatment factors, and on univariate analyses we found that age ≥ 60 years, Hispanic ethnicity, bladder involvement, rectal D2 cc ≥ 70 Gy, and whether patients had post-radiation biopsies were predictors for fistula formation. The 1-year overall survival (OS), progression-free survival (PFS), and local control (LC) were 85%, 58.5%, and 76.9%, respectively, with a mean follow-up time 23 months (range, 4.0-68.8 months).

Conclusions
We identified factors that predict fistula formation in patients with advanced gynecologic tumors treated with ISBT. These factors can be used to stratify patients into a high-risk group, with potential for modification of brachytherapy planning to reduce their risk of fistula formation.

keywords:

brachytherapy, fistula, vagina cancer

references:
Marth C, Landoni F, Mahner S et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28: 72-83.
Board, P.D.Q.A.T.E. Vaginal Cancer Treatment (PDQ(R)): Health Professional Version, in PDQ Cancer Information Summaries. National Cancer Institute (US): Bethesda (MD). 2002.
Board, P.D.Q.A.T.E. Endometrial Cancer Treatment (PDQ(R)): Health Professional Version: in PDQ Cancer Information Summaries. National Cancer Institute (US): Bethesda (MD). 2002.
Glaser SM, Beriwal S. Brachytherapy for malignancies of the vagina in the 3D era. J Contemp Brachytherapy 2015; 7: 312-318.
Viswanathan AN, Cormack R, Rawal B, Lee H. Increasing brachytherapy dose predicts survival for interstitial and tandem-based radiation for stage IIIB cervical cancer. Int J Gynecol Cancer 2009; 19: 1402-1406.
Viswanathan AN, Moughan J, Small W Jr et al. The quality of cervical cancer brachytherapy implantation and the impact on local recurrence and disease-free survival in radiation therapy oncology group prospective trials 0116 and 0128. Int J Gynecol Cancer 2012; 22: 123-131.
Monk BJ, Tewari K, Burger RA et al. A comparison of intracavitary versus interstitial irradiation in the treatment of cervical cancer. Gynecol Oncol 1997; 67: 241-247.
Beriwal S, Demanes DJ, Erickson B et al. American Brachytherapy Society consensus guidelines for interstitial brachytherapy for vaginal cancer. Brachytherapy 2012; 11: 68-75.
Kannan N, Beriwal S, Kim H et al. High-dose-rate interstitial computed tomography–based brachytherapy for the treatment of cervical cancer: Early results. Brachytherapy 2012; 11: 408-412.
Banerjee R, Kamrava M. Brachytherapy in the treatment of cervical cancer: a review. Int J Womens Health 2014; 6: 555-564.
Manuel M, Cho L, Catalano P et al. Outcomes with Image-based Interstitial Brachytherapy for Vaginal Cancer. Radiother Oncol 2016; 120: 486-492.
Umezawa R, Murakami N, Nakamura S et al. Image-guided interstitial high-dose-rate brachytherapy for locally recurrent uterine cervical cancer: A single-institution study. Brachy­therapy 2018; 17: 368-376.
Sekii S, Murakami N, Kato T et al. Outcomes of salvage high-dose-rate brachytherapy with or without external beam radiotherapy for isolated vaginal recurrence of endometrial cancer. J Contemp Brachytherapy 2017; 9: 209-215.
Syed AM, Puthawala AA, Abdelaziz NN et al. Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2002; 54: 67-78.
Hughes-Davies L, Silver B, Kapp DS. Parametrial interstitial brachytherapy for advanced or recurrent pelvic malignancy: the Harvard/Stanford experience. Gynecol Oncol 1995; 58: 24-27.
Lee LJ, Viswanathan AN. Predictors of toxicity after image-guided high-dose-rate interstitial brachytherapy for gynecologic cancer. Int J Radiat Oncol Biol Phys 2012; 84: 1192-1197.
Moore KN, Gold MA, McMeekin DS et al. Vesicovaginal fistula formation in patients with Stage IVA cervical carcinoma. Gynecol Oncol 2007; 106: 498-501.
Denlinger N, Bixel NN, Salani K et al. Interstitial Brachytherapy for Locally Advanced Cervical Cancer. Int J Womens Health Wellness 2015; 1: 1.
Lebioda A. Rectovaginal fistula risk doses in patients with cervical cancer. Rep Pract Oncol Radiother 2004; 9: 37-43.
Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995; 31: 1213-1236.
Georg P, Lang S, Dimopoulos JC et al. Dose-volume histogram parameters and late side effects in magnetic resonance image-guided adaptive cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys 2011; 79: 356-362.
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.
Biewenga P, Mutsaerts MA, Stalpers LJ et al. Can we predict vesicovaginal or rectovaginal fistula formation in patients with stage IVA cervical cancer? Int J Gynecol Cancer 2010; 20: 471-475.
Viswanathan AN, Cormack R, Holloway CL et al. Magnetic resonance-guided interstitial therapy for vaginal recurrence of endometrial cancer. Int J Radiat Oncol Biol Phys 2006; 66: 91-99.
Kasibhatla M, Clough RW, Montana GS et al. Predictors of severe gastrointestinal toxicity after external beam radiotherapy and interstitial brachytherapy for advanced or recurrent gynecologic malignancies. Int J Radiat Oncol Biol Phys 2006; 65: 398-403.
Zelga P, Tchórzewski M, Zelga M et al. Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies-new patients, old problem? Lagenbecks Arch Surg 2017; 402: 1079-1088.
Eifel PJ, Levenback C, Wharton JT, Oswald MJ. Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1995; 32: 1289-1300.
Sun R, Koubaa I, Limkin EJ et al. Locally advanced cervical cancer with bladder invasion: clinical outcomes and predictive factors for vesicovaginal fistulae. Oncotarget 2018; 9: 9299-9310.
Sun R, Mazeron R, Koubaa I et al. OC-0366: Cervical cancer with bladder invasion: outcomes and vesicovaginal fistula prognostic factors. Radiother Oncol 2017; 123: S196-S197.
Hata M, Koike I, Miyagi E et al. Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas. Oncotarget 2017; 8: 112855-112866.
Feddock J, Randall M, Kudrimoti M et al. Impact of post-radiation biopsies on development of fistulae in patients with cervical cancer. Gynecol Oncol 2014; 133: 263-267.
Murakami N, Kasamatsu T, Sumi M et al. Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies. Radiat Oncol 2014; 9: 31.
 
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