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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2022
vol. 14
 
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abstract:
Original paper

Combined intra-cavitary and interstitial image-guided adaptative brachytherapy for cervical stump carcinomas: technical and clinical results of six patients

Florent Guillemin
1
,
Anne-Agathe Serre
1
,
Frédéric Gassa
1
,
Fabrice Lorchel
2
,
Magali Sandt
1
,
Frédéric Lafay
1
,
Julien Charret
3
,
Corinne Rannou
4
,
Pascal Pommier
1

  1. Department of Radiotherapy, Centre Léon Bérard, Lyon, France
  2. Department of Radiotherapy, University Hospital, Pierre Bénite, France
  3. Department of Radiotherapy, Institut de Cancérologie de Bourgogne, Chalon-sur-Saône, France
  4. Department of Radiology, Centre Léon Bérard, Lyon, France
J Contemp Brachytherapy 2022; 14, 3: 248-252
DOI: https://doi.org/10.5114/jcb.2022.116434
Online publish date: 2022/05/26
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Purpose
According to European guidelines for cervix cancers, the management of cervical stump cancers should follow recommendations for patients without previous sub-total hysterectomy, but may require adaptation of radiotherapy modalities, especially brachytherapy (BT). However, data with modern BT technics are very scarce.

Material and methods
From May 2013 to March 2020, 6 patients (age range, 71-88 years) with cervical stump squamous cell carcinoma (previously treated by sub-total hysterectomy) have been treated with external beam radiotherapy (intensity-modulated radiation therapy – IMRT, 45 Gy in 25 fractions, 5 patients, or 50.4 Gy in 28 fractions, 1 patient), with concomitant chemotherapy in 2 patients, followed by image-guided adaptive brachytherapy with pulsed-dose-rate in 5 patients or high-dose-rate in 1 patient. We used Utrecht BT applicator (Elekta®), with the implant of interstitial needles within the parametrium (unilaterally in 3 and bilaterally in 3 patients), and/or within the residual cervix (3 patients). Dosimetry was based on GEC-ESTRO recommendations.

Results
The median high-risk (HR) and intermediate-risk (IR) clinical target volumes (CTV ) were 14.5 cc (range, 12-35 cc) and 40 cc (range, 31-62 cc), respectively. The median dose (D90) delivered to HR and IR CTVs were 81.2 (range, 78.2-89.8) and 68.95 (range, 64.3-72.3) Gy EQD2, respectively. With a 26.5 months median follow-up (range, 10-92 months), we did not observe any local or distant recurrence. No grade 2 or more acute or late toxicities were reported.

Conclusions
Cervix brachytherapy with Utrecht applicator using interstitial needle is safe and effective in cervical stump cancer patients.

keywords:

brachytherapy, MRI, image-guided adaptive brachytherapy, cervical stump cancer

  
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