Jinekolojik tümörlerde brakiterapideki güncel gelişmeler

Jinekolojik tümörlerin tedavisinde brakiterapi (BRT) çok önemli bir role sahiptir. BRT'nin en büyük avantajı tümörlü dokulara yük- sek doz radyoterapi uygularken çevre kritik dokuların korunabilmesidir. Endometriyum kanserinin tedavisinde cerrahi sonrasında erken evre hastalıkta tek başına, ileri evre hastalıkta ise eksternal radyoterapi ile birlikte kullanılabilmektedir. Serviks kanserinde ise seçilecek olan tedavi modalitesi hastalığın evresine bağlı olarak değişmektedir. BRT, eksternal radyoterapi ile birlikte erken evrelerde tek başına ya da cerrahiye adjuvan olarak uygulanabilirken lokal ileri evre hastalarda kemoradyoterapi primer tedavi modalitesi olarak kabul edilmiştir. Lokal ileri evre serviks kanserinde radyoterapinin küratif bir tedavi seçeneği olması intrakaviter BRT'nin sağladığı avantajlar doğrultusunda başarılabilmektedir. Jinekolojik tümörlerde üç boyutlu BRT son yıllarda giderek yaygınlaşan bir tedavi seçeneğidir. Üç-boyutlu BRT ile rektum ve mesane gibi kritik organlar daha iyi korunurken ve hedef hacime konformal bir doz dağılımı sağlanmaktadır. Görüntü kılavuzluğunda yapılan adaptif BRT jinekolojik tümörlerde son zamanlarda kullanılmaya başlanan ve bu hastaların tedavisinde önemli gelişmeler ve kolaylıklar sağlayan bir diğer yöntemdir

Current status of brachytherapy in gynecological tumors: Brachytherapy in gynecological tumors

Brachytherapy (BRT) has a very important role in the treatment of gynecological tumors. The most important advantage of brachyt- herapy is ability to apply higher doses to the tumors whereas sparing surrounding critical tissues. BRT can be used alone after surgery in and in conjunction with external beam radiotherapy in early stage and advanced stage endometrial cancer patients respectively. The treatment modality for cervical cancer depends on the stage of the disease. Radiotherapy is accepted as the primary treatment modality in locally advanced disease, whereas in early stage disease it is accepted as adjuvant treatment after surgery. Radiotherapy can be a curative treatment option in locally advanced cervical cancer patients in accordance with the advantages of intracavitary BRT. Three-dimensional BRT has becoming widely used in the treatment of gynecological tumors. Three-dimensional BRT provides conformal dose distribution to the target volume while sparing nearby organs including the rectum and the bladder. Image-guided adaptive brachytherapy, which has recently introduced to the treatments of gynecological malignancies, is another method that pro- vides significant improvements in the treatment of gynecological tumors

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Brenner DJ, Williamson JF: Physics and biology of brachytherapy. In: principles and practice of radiation oncology. 5. Baskı, Perez C.A ve Bradly L.W. sayfa 423-75, Lippincott Williams& Wilkins, Philadelphia-New York, 2008.
AAPM, Code of practice for brachytherapy physics: Report of the AAPM Radiation Therapy Committee Task Group no.56. Med Phys 1997;24:1557-98.
Pierquin P, Wilson JF, Chassagne D. Modern Brachytherapy. Ma- son Publishing USA, Inc. (1987).
Nag S, Owen JB, Ferman N et al. Survey of brachytherapy practice in the United States: a report of the Clinical Research Committe of the American Endocurietherapy Society.Int J Radiat Oncol Biol Phys 1995;31:103-7.
ICRU. Dose and volume specification for reporting intracavitary therapy in gynecology: Report 38. Bethesda MD. International Commission of Radiation Units and Measurements, 1985.
Grigsby PW, Perez CA, Camel HM et al. Stage II carcinoma of the endometrium: Results of therapy and prognostic factors. Int J Ra- diat Oncol Biol Phys 1985;11:1915.
Papavasilious C, Yiogarakis D, Pappa J et al. Treatment of cervical carcinoma by total hysterectomy and postoperative external irra- diation. Int. J radiat Oncol Biol Phys 1980;6:871-4.
Perkins PL, Chu AM, Jose B et al: Posthysterectomy megavoltage irradiation in the treatment of cervical carcinoma. Gynecol Oncol 1984;17:340-8.
Deeks Emma. Local Therapy in endometrial cancer: evidence based review. Current Opinion in Oncology 2007;19:512-5.
Shaeffer DT, Randall ME. Adjuvant radiotherapy in endometrial carcinoma. Oncologist 2005;10:623-31.
Kong A, Johnson N, Cornes P, et al. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database Syst Rev 2007:CD003916.
Nout RA, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endo- metrial cancer: First results of the randomized PORTEC-2 Trial. J Clin Oncol 2009;27:3547-56.
Aalders J, Abeler V, Kostad P et al. Postoperative external irradia- tion and prognostic parameters in stage I endometrial carcinoma: Clinical and histopathologic study of 540 patients. Obstet Gynecol 1980;56:419-27.
Creutzberg CL, van Putten WL, Koper PC et al. The morbidity of treatment for patients with stage I endometrial cancer: Re- sults from a randomised trial. Int. J Radiot Oncol Biol Pyhs 2001; 51:1246-1255.
Orton J, Blake P et al. Adjuvant external beam radiotherapy (EBRT) in the treatment of endometrial cancer. Results of the ran- domised MRC ASTEC and NCIC CTG EN 5 trial. J Clin Oncol 25:275s, 2007 (suppl;abstr 5504).
Creutzberg CL, van Putten WL, Koper PC et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre randomised tri- al-PORTEC Study Group: Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000;355:1404-11.
Keys HM, Roberts JA, Brunetto VL et al. A phase III trial of sur- gery with or without adjunctive external pelvic radiotherapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92:744-51.
Blake P, Swart AM, Orton J et al. Adjuvant external beam radio- therapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomized trials): pooled trial results, system- atic review, and meta-analysis. Lancet 2009;373: 137-46.
Yavas G, Dogan NU, Yavas C, Benzer N, Yuce D, Celik C. Pro- spective assessment of quality of life and psychological distress in patients with gynecologic malignancy: a 1-year prospective study. Int J Gynecol Cancer 2012;22:1096-101
Silverberg SG, Loffe OB. Pathology of cervical cancer. Cancer J 2003;9:335-47.
Morris M, Eifel PJ, Lu J et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Eng J Med 1999;340:1137-43.
Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339- 48.
Eifel PJ, Moughan J, Owen J et al. Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: Patterns of care study. Int J radiat Oncol Biol Phys 1999;43:351-8.
Rose PG, Bundy BN, Watkins EB et al. Concurrent cisplatin-based chemotherapy and radiotherapy for locally advanced cervical can- cer. N Engl J Med 1999;340:1144-53.
Perez CA, Kao MS. Radiation therapy alone or combined with sur- gery in barrel shaped cervix (stages IB, IIa, IIB). Int. J Radiat Oncol Biol Phys 1985;11:1903-9.
Hanks G, Herring DF, Kramer S. Patterns of care outcome stud- ies. Results of the national practice in cancer of the cervix. Cancer 1983;51:959-67.
Horiot JC, Pigneux J, Pourquier H et al. Radiotherapy alone in carcinoma of the intact uterine cervix according to GH Fletcher guidelines: A French cooperative study of 1388 cases. Int. J Radiat Oncol Biol Pyhs 1988;14:605-611.
Perez CA, Kuske RR, Camel HM et al. Analysis of pelvic tumor control and impact on survival in carcinoma of the uterine cer- vix treated with radiotherapy alone. Int J radiat Oncol Biol Phys 1988;14:613-21.
Coia L, Won M, Lanciano R, Marcial VA, Martz K, Hanks G. The patterns of care outcome study for cancer of the uterine cervix. Results of the Second National Practice Survey. Cancer 1990;66:2451-6.
Lanciano RM, Won M, Coia LR et al. Pretreatment and treatment factors associated with improved outcome in squamous cell carci- noma of the uterine cervix: a final report of the 1973 and 1978 pat- terns of care studies. Int J Radiat Oncol Biol Phys 1991;20:667-76.
Montana GS, Fowler WC, Varra MA et al. Carcinoma of the cer- vix, stage III: results of radiation therapy. Cancer 1986;57:148-54.
Perez CA, Breaux S, Madoc-Jones H, et al. Radiation therapy alone in the treatment of carcinoma of the uterine cervix: analysis of tu- mor recurrence. Cancer 1983;51:1393-402.
Lorvidhaya V, Tonusin A, Changwiwit W et al. High-dose rate afterloading brachytherapy in carcinoma of the cervix: an experi- ence of 1992 patients. Int J radiat Oncol Biol Phys 2000;46:1185- 91.
Lowrey GC, Mendenhall WM, Million RR. Stage IB or IIA-B carcinoma of the intact uterine cervix treated with irradiation: a multivariate analysis. Int J Radiat Oncol Biol Phys 1992;24:205-10.
Perez CA, Grigsby PW, Castro-Vita H et al. Carcinoma of the uter- ine cervix. I. impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Ra- diat Oncol Biol Phys 1995;32:1275-88.
Petereit DG, Sarkaria JN, Hartmann TJ et al. Adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Pyhs 1995;32:1301-7.
Nag S, Erickson B, Thomadsen B, et al. The American Brachyther- apy Society recommendations for high-dose-rate brachyther- apy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000;48:201-11.
Erickson BA. Intracavitary applications in the treatment of cancer of the cervix, part II: High dose rate techniques. J Brachyther Int 1997;13:271-87.
Abitbol AA, Houdek P, Schwade JG et al. Ring applicator with rectal retractor: Applicability to HDR barchytherpay of cervical cancer. Selectron Brachyther J 1990;4:68-9.
Wollin M, Kagan AR, Olch et al. Comparison of the ring applicator and th Fletcher applicator for HDR gynaecological brachytherapy. Selectron Brachyther J 1991;2(Suppl):25-7.
Akine Y, Tokita N, Ongino T et al. Dose equivalence for high- dose rate to low dose rate intracavitary irradiation in the treat- ment of cancer of the uterine cervix. Int J Radiat Oncol Biol Phys 1990;19:1511-4.
Arai T, Nakano T, Morita S et al. High-dose-rate remote afterload- ing intracavitary radiation therapy for cancer of the uterine cervix. Cancer 1992;69:175-80.
Cikaric S. Radiation therapy of cervical carcinoma using either HDR or LDR afterloading: comparison of 5-year results and com- plications. Strahlenther Onkol 1988;82:119-22.
Fu KK, Phillips TL. High-dose rate vs low-dose rate intracavitary brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 1990;19:791-6.
Orton CG, Seyedsadr M, Somnay A. Comparison of high and low dose rate remote after loading for cervix cancer and the impor- tance of fractionation. Int J Radiat Oncol Biol Phys 1991;21:1425- 34.
Patel FD, Sharma SC, Nergi PS et al. Low dose rate vs HDR brachytherapy in the treatment of carcinoma of the uterine cervix: a clinical trial. Int J Radiat Oncol Biol Phys 1994;28:335-41.
Sarkaria JN, Petereit DG, Stitt JA et al. A comparison of the ef- ficacy and complication rates of low-dose rate vs high-dose rate brachytherapy in the treatment of uterine cervical carcinoma. Int J Radiat Oncol Biol Phys 1994;30:75-82.
Teshima T, Inoue T, Ikeda H et al. High-dose rate and low-dose rate intracavitary brachytherapy for carcinoma of the uterine cer- vix. Cancer 1993;72:2409-14.
Petereit DG, Pearcey R. Literature analysis of high dose rate brachytherapy fractionation schedules in the treatment of cervi- cal cancer: Is there an optimal fractionation schedule? Int J Radiat Oncol Biol Phys 1995;31:103-7.
Orton CG. High and low dose rate brachytherapy for cervical can- cer. Acta Oncol 1998;37:117-25.
Jemal A, Murray T, Samyels A et al. Cancer statistics. CA Cancer J Clin 2003;53:5-26.
Beriwal S, Heron DE, Mogus R et al. High-dose rate barchtherapy (HDRB) for primary or recurrent cancer i the vagina. Radiation Oncol 2008;3:7-10.
Vaginal Cancer. In Beyzadeoglu M, Ozyigit G, Ebruli G. Basic Ra- diation Oncology. Springer New York 2010 p: 445-53.
Schwarz G. An evaluation of the Manchester system of treatment of carcinoma of the cervix. Am J Roentgenol Radium Ther Nucl Med 1969;105:579-85.
Nag S. Controversies and new developments in gynecologic brachytherapy: image based intracavitary brachytherapy for cervi- cal carcinoma. Seminars in Radiation Oncol 2006;16:164-7.
Heie-Meder C, Pötter R, Van Limbergen E, et al. Recommenda- tions from Gynaecological (GYN) GEC ESTRO Working Group (I): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005;74: 235-45
Potter R, Haie-Meder C, Van Limbergen E, et al. Recommenda- tions from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and as- pects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006;78:67-77.
Dimopoulos JCA, Schirl G, Baldinger A, Helbich TH, Pötter R. MRI assessment of cervical cancer for adaptive radiotherapy. Strahlentherapie und Onkologie 2009;185:282-7.
Beadle B, Jhingran A, Salehpour M, et al. Tumor regression and organ motion during the course of chemoradiation for cervical cancer: implications for treatment planning and use of IMRT. Int J Radiat Oncol Biol Phys 2006;66:Suppl3-44.
Dogan NU, Yavas G, Yavas C, et al. Comparison of "sandwich che- mo-radiotherapy" and six cycles of chemotherapy followed by ad- juvant radiotherapy in patients with stage IIIC endometrial cancer: a single center experience. Arch Gynecol Obstet 2013;288:845-50.