Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer

Kari Tanderup; Lars Ulrik Fokdal; Alina Sturdza; Christine Haie-Meder; Renaud Mazeron; Erik van Limbergen; Ina Jürgenliemk-Schulz; Primoz Petric; Peter Hoskin; Wolfgang Dörr; Søren M Bentzen; Christian Kirisits; Jacob Christian Lindegaard; Richard Pötter

doi:10.1016/j.radonc.2016.05.014

Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer

Kari Tanderup, Lars Ulrik Fokdal, Alina Sturdza, Christine Haie-Meder, Renaud Mazeron, Erik van Limbergen, Ina Jürgenliemk-Schulz, Primoz Petric, Peter Hoskin, Wolfgang Dörr, Søren M Bentzen, Christian Kirisits, Jacob Christian Lindegaard, Richard Pötter

Division of Cancer Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND PURPOSE: Currently, there is no consensus on dose prescription in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. The purpose of this study was to provide evidence based recommendations for tumor dose prescription based on results from a multi-center patient series (retroEMBRACE).

MATERIALS AND METHODS: This study analyzed 488 locally advanced cervical cancer patients treated with external beam radiotherapy±chemotherapy combined with IGABT. Brachytherapy contouring and reporting was according to ICRU/GEC-ESTRO recommendations. The Cox Proportional Hazards model was applied to analyze the effect on local control of dose-volume metrics as well as overall treatment time (OTT), dose rate, chemotherapy, and tumor histology.

RESULTS: With a median follow up of 46months, 43 local failures were observed. Dose (D90) to the High Risk Clinical Target Volume (CTVHR) (p=0.022, HR=0.967 per Gy) was significant for local control, whereas increasing CTVHR volume (p=0.004, HR=1.017 per cm3), and longer OTT (p=0.004, HR=1.023 per day) were associated with worse local control. Histology (p=0.084), chemotherapy (p=0.49) and dose rate (p=1.00) did not have significant impact on local control. Separate analyses according to stage of disease showed that dose to CTVHR, residual gross tumor volume (GTVres), and Intermediate Risk CTV (CTVIR) has significant impact on local control.

CONCLUSION: CTVHR dose of ⩾85Gy (D90) delivered in 7weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR. CTVIR and GTVres dose of ⩾60Gy and ⩾95Gy (D98) leads to similar local control. A dose of 5Gy (CTVHR) is required to compensate an increase of OTT by one week. Increased CTVHR volume by 10cm3 requires additional 5Gy for equivalent local control.

Original language	English
Pages (from-to)	441-446
Number of pages	6
Journal	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume	120
Issue number	3
DOIs	https://doi.org/10.1016/j.radonc.2016.05.014
Publication status	Published - 1 Sept 2016

Keywords

Adult
Aged
Aged, 80 and over
Brachytherapy/methods
Chemoradiotherapy/methods
Dose Fractionation, Radiation
Evidence-Based Medicine/methods
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Neoplasm Staging
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted/methods
Radiotherapy, Image-Guided/methods
Time Factors
Treatment Outcome
Uterine Cervical Neoplasms/diagnostic imaging
Young Adult

Research Beacons, Institutes and Platforms

Manchester Cancer Research Centre

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.radonc.2016.05.014

Cite this

Tanderup, K., Fokdal, L. U., Sturdza, A., Haie-Meder, C., Mazeron, R., van Limbergen, E., Jürgenliemk-Schulz, I., Petric, P., Hoskin, P., Dörr, W., Bentzen, S. M., Kirisits, C., Lindegaard, J. C., & Pötter, R. (2016). Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 120(3), 441-446. https://doi.org/10.1016/j.radonc.2016.05.014

Tanderup, Kari ; Fokdal, Lars Ulrik ; Sturdza, Alina et al. / Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. In: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2016 ; Vol. 120, No. 3. pp. 441-446.

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title = "Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer",

abstract = "BACKGROUND AND PURPOSE: Currently, there is no consensus on dose prescription in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. The purpose of this study was to provide evidence based recommendations for tumor dose prescription based on results from a multi-center patient series (retroEMBRACE).MATERIALS AND METHODS: This study analyzed 488 locally advanced cervical cancer patients treated with external beam radiotherapy±chemotherapy combined with IGABT. Brachytherapy contouring and reporting was according to ICRU/GEC-ESTRO recommendations. The Cox Proportional Hazards model was applied to analyze the effect on local control of dose-volume metrics as well as overall treatment time (OTT), dose rate, chemotherapy, and tumor histology.RESULTS: With a median follow up of 46months, 43 local failures were observed. Dose (D90) to the High Risk Clinical Target Volume (CTVHR) (p=0.022, HR=0.967 per Gy) was significant for local control, whereas increasing CTVHR volume (p=0.004, HR=1.017 per cm3), and longer OTT (p=0.004, HR=1.023 per day) were associated with worse local control. Histology (p=0.084), chemotherapy (p=0.49) and dose rate (p=1.00) did not have significant impact on local control. Separate analyses according to stage of disease showed that dose to CTVHR, residual gross tumor volume (GTVres), and Intermediate Risk CTV (CTVIR) has significant impact on local control.CONCLUSION: CTVHR dose of ⩾85Gy (D90) delivered in 7weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR. CTVIR and GTVres dose of ⩾60Gy and ⩾95Gy (D98) leads to similar local control. A dose of 5Gy (CTVHR) is required to compensate an increase of OTT by one week. Increased CTVHR volume by 10cm3 requires additional 5Gy for equivalent local control.",

keywords = "Adult, Aged, Aged, 80 and over, Brachytherapy/methods, Chemoradiotherapy/methods, Dose Fractionation, Radiation, Evidence-Based Medicine/methods, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Neoplasm Staging, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted/methods, Radiotherapy, Image-Guided/methods, Time Factors, Treatment Outcome, Uterine Cervical Neoplasms/diagnostic imaging, Young Adult",

author = "Kari Tanderup and Fokdal, {Lars Ulrik} and Alina Sturdza and Christine Haie-Meder and Renaud Mazeron and {van Limbergen}, Erik and Ina J{\"u}rgenliemk-Schulz and Primoz Petric and Peter Hoskin and Wolfgang D{\"o}rr and Bentzen, {S{\o}ren M} and Christian Kirisits and Lindegaard, {Jacob Christian} and Richard P{\"o}tter",

note = "Copyright {\textcopyright} 2016. Published by Elsevier Ireland Ltd.",

year = "2016",

month = sep,

day = "1",

doi = "10.1016/j.radonc.2016.05.014",

language = "English",

volume = "120",

pages = "441--446",

journal = "Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology",

issn = "0167-8140",

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}

Tanderup, K, Fokdal, LU, Sturdza, A, Haie-Meder, C, Mazeron, R, van Limbergen, E, Jürgenliemk-Schulz, I, Petric, P, Hoskin, P, Dörr, W, Bentzen, SM, Kirisits, C, Lindegaard, JC & Pötter, R 2016, 'Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer', Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, vol. 120, no. 3, pp. 441-446. https://doi.org/10.1016/j.radonc.2016.05.014

Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. / Tanderup, Kari; Fokdal, Lars Ulrik; Sturdza, Alina et al.
In: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Vol. 120, No. 3, 01.09.2016, p. 441-446.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer

AU - Tanderup, Kari

AU - Fokdal, Lars Ulrik

AU - Sturdza, Alina

AU - Haie-Meder, Christine

AU - Mazeron, Renaud

AU - van Limbergen, Erik

AU - Jürgenliemk-Schulz, Ina

AU - Petric, Primoz

AU - Hoskin, Peter

AU - Dörr, Wolfgang

AU - Bentzen, Søren M

AU - Kirisits, Christian

AU - Lindegaard, Jacob Christian

AU - Pötter, Richard

PY - 2016/9/1

Y1 - 2016/9/1

N2 - BACKGROUND AND PURPOSE: Currently, there is no consensus on dose prescription in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. The purpose of this study was to provide evidence based recommendations for tumor dose prescription based on results from a multi-center patient series (retroEMBRACE).MATERIALS AND METHODS: This study analyzed 488 locally advanced cervical cancer patients treated with external beam radiotherapy±chemotherapy combined with IGABT. Brachytherapy contouring and reporting was according to ICRU/GEC-ESTRO recommendations. The Cox Proportional Hazards model was applied to analyze the effect on local control of dose-volume metrics as well as overall treatment time (OTT), dose rate, chemotherapy, and tumor histology.RESULTS: With a median follow up of 46months, 43 local failures were observed. Dose (D90) to the High Risk Clinical Target Volume (CTVHR) (p=0.022, HR=0.967 per Gy) was significant for local control, whereas increasing CTVHR volume (p=0.004, HR=1.017 per cm3), and longer OTT (p=0.004, HR=1.023 per day) were associated with worse local control. Histology (p=0.084), chemotherapy (p=0.49) and dose rate (p=1.00) did not have significant impact on local control. Separate analyses according to stage of disease showed that dose to CTVHR, residual gross tumor volume (GTVres), and Intermediate Risk CTV (CTVIR) has significant impact on local control.CONCLUSION: CTVHR dose of ⩾85Gy (D90) delivered in 7weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR. CTVIR and GTVres dose of ⩾60Gy and ⩾95Gy (D98) leads to similar local control. A dose of 5Gy (CTVHR) is required to compensate an increase of OTT by one week. Increased CTVHR volume by 10cm3 requires additional 5Gy for equivalent local control.

AB - BACKGROUND AND PURPOSE: Currently, there is no consensus on dose prescription in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. The purpose of this study was to provide evidence based recommendations for tumor dose prescription based on results from a multi-center patient series (retroEMBRACE).MATERIALS AND METHODS: This study analyzed 488 locally advanced cervical cancer patients treated with external beam radiotherapy±chemotherapy combined with IGABT. Brachytherapy contouring and reporting was according to ICRU/GEC-ESTRO recommendations. The Cox Proportional Hazards model was applied to analyze the effect on local control of dose-volume metrics as well as overall treatment time (OTT), dose rate, chemotherapy, and tumor histology.RESULTS: With a median follow up of 46months, 43 local failures were observed. Dose (D90) to the High Risk Clinical Target Volume (CTVHR) (p=0.022, HR=0.967 per Gy) was significant for local control, whereas increasing CTVHR volume (p=0.004, HR=1.017 per cm3), and longer OTT (p=0.004, HR=1.023 per day) were associated with worse local control. Histology (p=0.084), chemotherapy (p=0.49) and dose rate (p=1.00) did not have significant impact on local control. Separate analyses according to stage of disease showed that dose to CTVHR, residual gross tumor volume (GTVres), and Intermediate Risk CTV (CTVIR) has significant impact on local control.CONCLUSION: CTVHR dose of ⩾85Gy (D90) delivered in 7weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR. CTVIR and GTVres dose of ⩾60Gy and ⩾95Gy (D98) leads to similar local control. A dose of 5Gy (CTVHR) is required to compensate an increase of OTT by one week. Increased CTVHR volume by 10cm3 requires additional 5Gy for equivalent local control.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Brachytherapy/methods

KW - Chemoradiotherapy/methods

KW - Dose Fractionation, Radiation

KW - Evidence-Based Medicine/methods

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Middle Aged

KW - Neoplasm Staging

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Radiotherapy, Image-Guided/methods

KW - Time Factors

KW - Treatment Outcome

KW - Uterine Cervical Neoplasms/diagnostic imaging

KW - Young Adult

U2 - 10.1016/j.radonc.2016.05.014

DO - 10.1016/j.radonc.2016.05.014

M3 - Article

C2 - 27350396

SN - 0167-8140

VL - 120

SP - 441

EP - 446

JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

IS - 3

ER -

Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E et al. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2016 Sept 1;120(3):441-446. doi: 10.1016/j.radonc.2016.05.014

Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer

Abstract

Keywords

Research Beacons, Institutes and Platforms

UN SDGs

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