Ester Jääskeläinen

Clinical outcome of high-dose-rate interstitial brachytherapy in vulvar cancer: A single institutional experience

The aim was to evaluate the toxicities and survival of patients with inoperable vulvar cancer treated using brachytherapy (BT). Patients treated at Kuopio University Hospital, Finland, during years 2007-2022 were retrospectively analyzed. Twenty-seven patients with vulvar cancer received high-dose-rate (HDR) interstitial brachytherapy (BT), most of them after external beam radiotherapy (EBRT). Nineteen had primary locally advanced vulvar cancer, and 8 had recurrent cancer. The mean EBRT prescription dose was 48.5 Gy (39-60 Gy) in 13-33 fractions. Eighteen patients (67%) had cisplatin as a radiosensitizer. EBRT was followed by BT (16-36 Gy in 3-8 fractions). The mean HR-CTV (high-risk clinical target volume) D90 EBRT + BT dose was 71.2 Gy (EQD₂). The mean follow-up time was 30 months. The 2-year progression-free survival (PFS) was 41% in the primary cancer group and 38% in the recurrence group. The 2-year overall survival (OS) was 56% and 63%, respectively. There were 12/19 (63%) recurrences in the primary cancer group. In the recurrent cancer group, 4 out of 8 (50%) patients had a subsequent recurrence. 7/27 (26%) patients suffered from grade 3-4 late toxicities. Before EBRT, the median size of the tumors was 3.8 cm. Patients with a tumor ≥ 3.8 cm had significantly worse OS than patients with tumors <3.8 cm, 45 months and 54 months, respectively (p = 0.022). The use of radiosensitizing chemotherapy also predicted better overall survival (p = 0.037). Definitive radiation therapy, including EBRT and BT, is a potential option in the management of inoperable vulvar cancer. To avoid toxicities, the proper radiation doses are to be found.

MRI-guided brachytherapy for locally advanced cervical cancer: Program initiation, learning curve and dose delivery results in Kuopio University Hospital

Image guided adaptive brachytherapy, the standard treatment for locally advanced cervical cancer (LACC), is a complex medical procedure that requires an experienced multidisciplinary team. The aims of this analysis were to assess (1) the learning curve of brachytherapy team, (2) dose-volume parameters, (3) the use of an interstitial component, and (4) the overall treatment time (OTT). Our study cohort comprised 117 LACC patients treated in Kuopio University Hospital with magnetic resonance imaging guided intracavitary (IC) or combined intracavitary/interstitial (IC/IS) high dose rate brachytherapy during 2009-2018. Target volumes and organs at risk (OAR) were contoured according to ICRU/GEC-ESTRO recommendations. Treatment plans were optimized individually without using standard loading patterns. Mean dose to 90% of the high-risk clinical target volume (HR-CTV D90) improved after the first 15 patients, however the team's learning curve to reliably fulfill the main planning aim (PA) of 85 Gy required a total 43 patients and more than 10 patients annually. Significant difference was detected between IC and IC/IS brachytherapy in achieving the PA of HR-CTV D90. Especially, HR-CTV volumes >30 cm Brachytherapy requires good experience of multidisciplinary team and the continuous development of the program to fulfill PA and to avoid OTT prolongation. The use of IS needles is safe and improves the fulfillment of PA to target volume.