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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| Format: | Article |
| Language: | English |
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MDPI AG
2020-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/6/1653 |
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| author | Alexandre Escande Mohamed Khettab Sophie Bockel Isabelle Dumas Antoine Schernberg Sebastien Gouy Philippe Morice Patricia Pautier Eric Deutsch Christine Haie-Meder Cyrus Chargari |
| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T19:27:56Z |
| format | Article |
| id | doaj.art-a11c5d0d61814109b760690ed195489f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T19:27:56Z |
| publishDate | 2020-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a11c5d0d61814109b760690ed195489f2023-11-20T02:25:30ZengMDPI AGJournal of Clinical Medicine2077-03832020-06-0196165310.3390/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 |
| 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 |
| title | 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_short | 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 |
| 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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