Search

BACKGROUND: Small cell cancer involving the cervix and uterus is considered the same rare disease, but management is controversial and disparate. Patterns of care and outcomes in the United States are unclear. METHODS: Clinical data from patients with small cell cancer of the cervix and uterus were abstracted from the National Cancer Database (NCDB) from 2004–2014. Patients with missing clinical stage, incomplete follow up, or receiving treatment >90 days from diagnosis were excluded. RESULTS: There were 621 cervical and 95 uterine cancer patients treated from 2004–2014. Compared to patients with a cervix primary site, patients with a uterine primary site were older (median age 64 years vs. 47 years), more likely to present with distant metastatic disease (47% vs. 33%), less likely to receive any pelvic radiation (31% vs. 64%), less likely to receive brachytherapy (3% vs. 27%), more likely to have at least a total hysterectomy (58% vs 28%), and less likely to receive chemotherapy (74% vs. 88%), all p

Purpose It is unknown whether brachytherapy after external beam radiation (EBRT + BT) results in improved outcomes compared with EBRT alone for patients with inoperable vulvar cancer. The purpose of this study was to compare survival outcomes for patients who received these treatment modalities. Methods and Materials Data between 1973 and 2011 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients with Federation of International Gynecologists and Obstetricians stage I-IVA vulvar cancer treated with definitive EBRT + BT or EBRT alone were included. Patients with prior surgical resection were excluded. Disease-specific survival (DSS) and overall survival were compared using the Kaplan–Meier method and Cox proportional hazard models. Results A total of 649 patients were analyzed, of which 617 received EBRT alone and 32 received EBRT + BT. Median follow-up was 33 months in surviving patients. The use of brachytherapy declined from 16% of cases treated in 1973–1980 to 4% in 2001–2011 (p = 0.04). EBRT + BT vs. EBRT alone was not significantly associated with improved DSS (45% vs. 33% at 5 years) or overall survival (34% vs. 24% at 5 years) on univariate or multivariate analyses. On post hoc subgroup analyses, brachytherapy consolidation was associated with higher 5-year DSS in a composite subgroup that included patients with stage IVA disease, tumor >4 cm, or node-positive disease (52% vs. 27%, p = 0.02). Conclusions Utilization of BT consolidation with EBRT for vulvar cancer is declining in the United States. EBRT + BT is not associated with improved survival compared with EBRT alone in the overall group of patients. Certain subgroups of patients might benefit from brachytherapy, but this hypothesis requires validation in future studies.

Purpose As experience with the MammoSite device for accelerated partial breast irradiation (APBI) has increased, more centers are starting to use three-dimensional (3D) treatment planning to generate plans with multiple nonequally weighted dwell positions. This report presents the use of serial computed tomography (CT) imaging, in addition to planar or ultrasound imaging, for the quality assurance of an APBI treatment using the elliptical MammoSite. Methods and Materials CT images of a patient implanted with a 4 cm × 6 cm elliptical MammoSite balloon were acquired. A treatment plan using multiple, nonequally weighted dwells was generated and delivered on Day 1 of a 10-fraction, twice-daily treatment. Before morning treatments on Days 2–5, the patient was reimaged on CT. Treatment plans on repeat CTs were generated two ways: using the decay-corrected plan from Day 1 (unadapted) vs. modifying the plan to account for changes in implant geometry (adapted). Adapted and unadapted plans on repeat CTs were compared with one another, and to the Day 1 plan. Results The use of unadapted plans led to increased doses to normal tissues, particularly the skin. Adaptive planning on the repeat CTs was effective for maintaining acceptable dosimetry throughout treatment. Conclusions Serial CT imaging was shown to provide a useful tool for the quality assurance of an elliptical balloon implant during the course of treatment. Serial CT imaging, as opposed to planar or ultrasound imaging, was necessary to evaluate skin dose and to facilitate adaptation of the treatment plan to satisfy limits for skin dose.

OBJECTIVE: To evaluate recurrence patterns and overall survival in patients treated with adju- vant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. METHODS/MATERIALS: The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. RESULTS: Median patient age was 59 years (range, 42e87 years). All tumors were of endome- trioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival (p 5 0.510) or freedom from vaginal (p 5 0.840), distant (p 5 0.133), or any recurrence (p 5 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or re- currences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. CONCLUSIONS: VB alone results in excellent local control for patients with Stage II endome- trial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy. 2015 American Brachy

Purpose To evaluate outpatient-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) in the treatment of gynecologic malignancies. Methods and Materials Between December 2006 and July 2012, 50 patients were treated with twice-daily outpatient-based HDR iridium-192 ISBT at our institution. Thirty-two patients had vaginal cancers, 13 vulvar, 3 urethral, and 2 cervical cancers. The most common histologies were squamous cell carcinoma (58%) and endometrioid adenocarcinoma (26%). Twenty-six patients were treated with definitive radiation therapy with or without platinum-based chemotherapy, 16 were treated for recurrent disease, 5 were treated in the postoperative setting, and 3 were treated palliatively. Forty patients received external beam radiation therapy before ISBT. Results Median followup was 13.7 months. Median interstitial dose was 18 Gy in 2.25 Gy twice-daily fractions prescribed to the implant volume. Median external beam dose was 50.4 Gy in 1.8 Gy daily fractions prescribed to the primary disease site. Eight patients (16%) were seen in the emergency room or were admitted to the hospital during treatment. Six patients (17%) experienced significant complications after treatment (3 ulcerations at the primary site, 1 vaginal necrosis, 1 vaginal abscess, and 1 patient with urinary obstruction). Larger volume encompassing 100% of the prescribed dose was correlated with significant complications on multivariate analysis ( p = 0.039). Actuarial local control at 1 year was 72%, with univariate analysis demonstrating worse local control for nonendometrioid adenocarcinoma compared with squamous cell carcinoma (20% vs. 84%, p = 0.044). Conclusions Outpatient-based HDR ISBT is feasible and safe, with toxicity and local control rates consistent with historical outcomes.

to have recurrence either local or metastatic. Initial data were obtained for 85 women. Treatment data: There was a significant relationship between the average baseline scores and patient age (P 50:037) for the vagina scale score and also for sexual dysfunction (P 50:038). There was no significant relationship for vagina scores and stage of disease (P 5 0:054) or for sexual dysfunction and stage P 50:44. There was a significant relationship between the maximum vagina scores at baseline and age (P 50:039), but not for stage of disease (P 5 0:077). For sexual dysfunction maximum scores there was no significant association with age (P 50:095) or disease stage. (P 50:31). Nineteen of the 85 patients had prior treatment with surgery and both their average vagina scores (P 50:025) and maximum vagina (P 50:045) scoreswere significantly lower than those for non-surgically treated patients. Similarly for sexual dysfunction scores,the averages scores (P 50:042) for those patients who had prior surgery were lower than those who had no surgery and the maximum score was significantly different (P 50:027). Statistical analysis of data: The mean subjective sexual function and satisfaction score was highest (0.4601) in patients in which gap between treatment and interview was 11 years and maximum score was highest (0.94) in same group. Average subjective LENT SOMA score was highest in patients who were interviewed after 11 years of treatment in comparison to other patients. The objective mean score VG (Vagina) was highest (0.6444) in patients who were interviewed after 11 years of treatment and maximum score (0.80) was highest (0.80) in patients in which gap between treatment and interview was 10 years. Average objective LENT SOMA score was highest in patients who were interviewed after 11 years of treatment in comparison to other patients (p value0.693). Average overall LENT SOMA score was highest in patients in which gap between treatment and interview was 11 years. (p value0.705) Conclusions: The LENT SOMA system was acceptable and feasible to use and gave us an insight into the morbidity in our patients. Since it is one of few studies in India on late morbidity in treated patients of carcinoma uterine cervix, it is an important step in comparing our data with the Western literature. It will also help us to develop effective management plans to reduce the post treatment symptoms and improve quality of life in patients of carcinoma uterine cervix.