An Asian multi-national, multi-institutional, retrospective study on image-guided brachytherapy in cervical adenocarcinoma and adenosquamous carcinoma

Noriyuki Okonogi; Naoya Murakami; Ken Ando; Masumi Murata; Kazutoshi Murata; Tomomi Aoshika; Shingo Kato; Anneyuko I Saito; Joo-Young Kim; Yasuo Yoshioka; Shuhei Sekii; Kayoko Tsujino; Chairat Lowanichkiattikul; Poompis Pattaranutaporn; Yuko Kaneyasu; Tomio Nakagawa; Miho Watanabe; Takashi Uno; Rei Umezawa; Keiichi Jingu; Ayae Kanemoto; Masaru Wakatsuki; Katsuyuki Shirai; Hiroshi Igaki; Tatsuya Ohno; Jun Itami

doi:10.5114/jcb.2022.119451

An Asian multi-national, multi-institutional, retrospective study on image-guided brachytherapy in cervical adenocarcinoma and adenosquamous carcinoma

J Contemp Brachytherapy. 2022 Aug;14(4):311-320. doi: 10.5114/jcb.2022.119451. Epub 2022 Aug 31.

Authors

Noriyuki Okonogi^#¹, Naoya Murakami^#², Ken Ando^#^{3

4}, Masumi Murata^#³, Kazutoshi Murata^#^{1

4}, Tomomi Aoshika^#⁵, Shingo Kato^#⁵, Anneyuko I Saito^#⁶, Joo-Young Kim^#⁷, Yasuo Yoshioka^#⁸, Shuhei Sekii^#^{9

10}, Kayoko Tsujino^#⁹, Chairat Lowanichkiattikul^#¹¹, Poompis Pattaranutaporn^#¹¹, Yuko Kaneyasu^#¹², Tomio Nakagawa^#¹², Miho Watanabe^#¹³, Takashi Uno^#¹³, Rei Umezawa^#¹⁴, Keiichi Jingu^#¹⁴, Ayae Kanemoto^#¹⁵, Masaru Wakatsuki^#^{1

16}, Katsuyuki Shirai^#¹⁶, Hiroshi Igaki^#², Tatsuya Ohno^#⁴, Jun Itami^#²

Affiliations

¹ QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba City, Chiba, Japan.
² Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
³ Department of Radiation Oncology, Gunma Prefectural Cancer Center, Ota City, Gunma, Japan.
⁴ Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi City, Gunma, Japan.
⁵ Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan.
⁶ Department of Radiation Oncology, Juntendo University Faculty of Medicine, Tokyo, Japan.
⁷ Department of Radiation Oncology, National Cancer Center, Ilsandong, Goyang Gyeonggi, Korea.
⁸ Radiation Oncology Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan.
⁹ Department of Radiation Oncology, Hyogo Cancer Center, Akashi City, Hyogo, Japan.
¹⁰ Department of Radiation Therapy, Kita-Harima Medical Center, Ono City, Hyogo, Japan.
¹¹ Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rajataewe, Bangkok, Thailand.
¹² Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan.
¹³ Department of Radiology, Chiba University Hospital, Chuo-ku, Chiba City, Chiba, Japan.
¹⁴ Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan.
¹⁵ Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan.
¹⁶ Department of Radiology, Jichi Medical University Hospital, Shimotsuke City, Tochigi, Japan.

^# Contributed equally.

Abstract

Purpose: There are limited reports on outcomes of three-dimensional image-guided brachytherapy (3D-IGBT) for cervical adenocarcinoma in Asia. In a multi-institutional retrospective study, we assessed the clinical outcomes of three-dimensional image-guided brachytherapy for cervical adenocarcinoma or adenosquamous carcinoma (CA/CAC) in Asian countries.

Material and methods: Patients who had undergone definitive radiation therapy/concurrent chemoradiotherapy for untreated cervical cancer between 2000 and 2016 were registered. Those who had undergone 3D-IGBT for histologically proven CA/CAC were included. Data on patients' characteristics and treatment were collected, including tumor reduction rate (defined as a percentage of reduction in tumor size before brachytherapy compared with that at diagnosis) and high-risk clinical target volume D₉₀. Overall survival (OS), local control (LC), and progression-free survival (PFS) rates were calculated using Kaplan-Meier method. Late toxicities were assessed using common terminology criteria for adverse events version 4.0.

Results: Anonymized data of 498 patients were collected. Of the 498 patients, 36 patients met inclusion criteria. The median follow-up period was 39 months. The 3-year OS, LC, and PFS rates were 68.4%, 68.5%, and 44.4%, respectively. After treatment, five patients had tumor re-growth without complete disappearance of the tumor. Two patients developed grade 3 vaginal toxicity or grade 4 rectal toxicity; none developed other severe late toxicities. A tumor reduction rate of > 26.3% was the only significant factor in multivariate analyses, and was associated with significantly better OS (p = 0.018), LC (p = 0.022), and PFS (p = 0.013). There were no significant trends in local control or dose to high-risk clinical target volume D₉₀.

Conclusions: LC rate of CA/CAC was insufficient despite 3D-IGBT. Meanwhile, tumor reduction rate was associated with LC, OS, and PFS rates. Therefore, CA/CAC may require a different treatment strategy than that applied in cervical squamous cell carcinoma.

Keywords: brachytherapy; chemoradiotherapy; radiotherapy; uterine cervical neoplasms.