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CT-Guided Pelvic Lymph Nodal Brachytherapy.

Hiroaki Kunogi1, I-Chow Hsu2, Nanae Yamaguchi1

  • 1Department of Radiation Oncology, Juntendo University, Tokyo, Japan.

Frontiers in Oncology
|March 8, 2021
PubMed
Summary

Computed tomography (CT)-guided high dose rate (HDR) brachytherapy effectively treats bulky pelvic nodal metastases in cervical and endometrial cancers, demonstrating excellent local control and good tolerance for patients.

Keywords:
CT guidancegynecological malignanciesinterstitial brachytherapynodal brachytherapypelvic lymph node

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Bulky pelvic nodal metastases pose a significant challenge in treating advanced cervical and endometrial cancers.
  • Definitive radiotherapy often requires precise targeting of these nodal volumes.

Purpose of the Study:

  • To report the initial experience with computed tomography (CT)-guided interstitial high dose rate (HDR) brachytherapy for bulky pelvic nodal metastases.
  • To evaluate the safety and efficacy of this technique as part of definitive radiotherapy.

Main Methods:

  • 14 patients with cervical/endometrial cancer and bulky pelvic nodes received nodal interstitial brachytherapy boost between February 2015 and April 2019.
  • Dosimetry of the lymph nodal target volume and small bowel were analyzed.
  • Treatment-related toxicities were assessed using Common Terminology Criteria for Adverse Events version 4.0.

Main Results:

  • The median follow-up was 26 months, with a 2-year pelvic control estimate of 90%.
  • Local recurrence occurred in only 7% of patients.
  • One patient experienced grade 3 bladder bleeding; no patient had grade ≥2 gastrointestinal toxicity.
  • Nodal target volume received a significantly higher dose (D90%) compared to the small bowel dose.

Conclusions:

  • CT-guided interstitial HDR brachytherapy is well-tolerated in patients with bulky pelvic nodes.
  • This technique provides excellent local control for cervical and endometrial cancer patients.
  • It represents a valuable therapeutic option for unresected bulky pelvic nodes.