Fantine Giap

Predicting which patients may benefit from the hybrid intracavitary+interstitial needle (IC/IS) applicator for advanced cervical cancer: A dosimetric comparison and toxicity benefit analysis

The purpose of this study is to compare the predicted rate of local control and bladder and rectum toxicity rates for image-guided adaptive brachytherapy plans using a tandem and ovoid (T/O) applicator versus using a simulated hybrid intracavitary/interstitial tandem and ring applicator with needles (T/R + N) for patients with locally advanced cervical cancer (LACC). Patients with ≥ FIGO Stage IIB locally advanced cervical cancer treated with T/O from a single institution were included. Simulated treatment plans were created with a T/R + N applicator for the best high-risk clinical target volume (CTV) coverage and minimal dose to organs at risk. Three-year local control rate was estimated using published dose-volume effect relationships. Next, the high-risk CTV EQD2 D90 of T/R + N plans were calculated, and bladder and rectum toxicity rates were estimated. Analysis was performed in subpatient groups defined based on tumor volume and ratio of maximal and minimal tumor radii (RR) that reflects tumor shape asymmetry. Improvements in predicted local control rate for the T/R + N were 0.8, 4.1, 1.6, and 3.9% for groups with tumor volume <35 cc, ≥35 cc, RR < 2.0, and ≥2.0, respectively, with the latter three being statistically significant. Predicted reductions in Grade 2-4 toxicity rates of bladder and rectum were significant in all groups except bladder toxicity in tumor volume <35 cc, when T/R + N plans were normalized to the same CTV coverage as the T/O plans. Comparing unnormalized T/R + N plans and T/O plans, predicted toxicity reductions were significant in all groups except rectum toxicity in RR ≥ 2.0. Predicted reduction of toxicity rate was larger for patients with large tumor or large tumor RR, although some reductions were relatively small. Cases with large tumor (volume ≥35 cc) or large tumor asymmetry (RR ≥ 2.0) would probably benefit more from the use of hybrid applicators.

Understanding anxiety in patients receiving vaginal brachytherapy for low-grade early-stage endometrial cancer

Vaginal brachytherapy (VBT) is a standard treatment after hysterectomy for early-stage endometrial cancer. Despite only requiring a few treatments with minimal toxicity, many women have significant anxiety regarding VBT. This study was to assess and quantify anxiety in early-stage endometrial cancer patients receiving VBT and to evaluate correlations with clinicopathologic and demographic variables. A survey-based cohort study of patients ages 18-99 with stage I-II endometrioid endometrial cancer treated with adjuvant VBT after hysterectomy between 2014 and 2020 was performed to assess experience with VBT and related anxiety. Patients with recurrent disease were excluded. Assessments included: (1) qualitative questionnaire measuring anxiety and mood pre- and post-VBT, (2) clinical factors questionnaire measuring health status, (3) Hospital and Anxiety Depression Scale (HADS), and (4) demographics questionnaire. Pearson's chi-squared test was used to correlate demographics with anxiety. About 185 patients met inclusion criteria and of those, 75 completed all 4 surveys. Forty-nine patients (65%) reported anxiety or fear prior to receiving VBT, related to concerns of pain (40%), quality of life (27%), bladder/bowel function (24%). On univariate analysis, patients with a college degree or higher, income of ≥ $80,000, and HADS-Anxiety ≥ 8 were significantly more likely to experience anxiety with X A majority of patients experience anxiety prior to treatment with adjuvant VBT. It is important to increase the general knowledge surrounding VBT and to establish educational tools to reduce VBT related anxiety and fear.