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Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results
by
Terlizzi, Mario
, Chargari, Cyrus
, Martelli, Hélène
, Minard, Véronique
, Guérin, Florent
, Haie-Meder, Christine
, Espenel, Sophie
in
Adenocarcinoma
/ Brachytherapy
/ Cancer
/ Catheters
/ Cervix
/ Chemotherapy
/ Dosimetry
/ Fertility
/ General anesthesia
/ Genital tract
/ Gynecology
/ Life Sciences
/ Magnetic resonance imaging
/ Medical imaging
/ Medical prognosis
/ Medical records
/ Metastases
/ Optimization
/ Ovaries
/ Patients
/ Pediatrics
/ Planning
/ Radiation therapy
/ Rhabdomyosarcoma
/ Stenosis
/ Surgery
/ Toxicity
/ Tumors
/ Vagina
2022
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Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results
by
Terlizzi, Mario
, Chargari, Cyrus
, Martelli, Hélène
, Minard, Véronique
, Guérin, Florent
, Haie-Meder, Christine
, Espenel, Sophie
in
Adenocarcinoma
/ Brachytherapy
/ Cancer
/ Catheters
/ Cervix
/ Chemotherapy
/ Dosimetry
/ Fertility
/ General anesthesia
/ Genital tract
/ Gynecology
/ Life Sciences
/ Magnetic resonance imaging
/ Medical imaging
/ Medical prognosis
/ Medical records
/ Metastases
/ Optimization
/ Ovaries
/ Patients
/ Pediatrics
/ Planning
/ Radiation therapy
/ Rhabdomyosarcoma
/ Stenosis
/ Surgery
/ Toxicity
/ Tumors
/ Vagina
2022
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Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results
by
Terlizzi, Mario
, Chargari, Cyrus
, Martelli, Hélène
, Minard, Véronique
, Guérin, Florent
, Haie-Meder, Christine
, Espenel, Sophie
in
Adenocarcinoma
/ Brachytherapy
/ Cancer
/ Catheters
/ Cervix
/ Chemotherapy
/ Dosimetry
/ Fertility
/ General anesthesia
/ Genital tract
/ Gynecology
/ Life Sciences
/ Magnetic resonance imaging
/ Medical imaging
/ Medical prognosis
/ Medical records
/ Metastases
/ Optimization
/ Ovaries
/ Patients
/ Pediatrics
/ Planning
/ Radiation therapy
/ Rhabdomyosarcoma
/ Stenosis
/ Surgery
/ Toxicity
/ Tumors
/ Vagina
2022
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Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results
Journal Article
Implementation of Image-Guided Brachytherapy for Pediatric Vaginal Cancers: Feasibility and Early Clinical Results
2022
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Overview
Background: Brachytherapy (BT) has a major role in pediatric cancers of the lower genital tract, as part of a multimodal organ conservative strategy. Scarce data are available on the location of image-guided BT. Methods: Medical records of all consecutive girls treated in our center between 2005 and 2020 for a vaginal tumor with exclusive image-guided PDR-BT were retrospectively examined, with a focus on treatment parameters, patient compliance, and clinical outcome, including analysis of local control, survival and late toxicity rates. Results: Twenty-six patients were identified, with a median age of 25 months. Histological types were rhabdomyosarcoma, malignant germ cell tumor (MGCT) and clear cell adenocarcinoma in 18 (69%), 7 (27%) and 1 (4%) patients, respectively. Ten (33%) patients had prior surgery and 25 (96%) received chemotherapy prior to BT. The median prescribed dose was 60 Gy through pulses of 0.42 Gy. Global compliance was satisfactory, but three (12%) patients required replanning because of applicator displacement. After a median follow-up of 47.5 months, one patient with MGCT referred for salvage treatment of a local recurrence had a local and metastatic relapse. The local control rate probability was 96% at the last follow-up. Late toxicity rates ≥ grade 2 and ≥ grade 3 were reported in 23% and 11%, respectively, with gynecological toxicities being the most frequent side effect. Two patients required dilatation for vaginal stenosis. Conclusions: PDR-BT allowed similar local control compared to the historical low-dose rate technique. An indirect comparison suggests fewer treatment-related toxicities by integrating image guidance and optimization capabilities, but longer follow-up is necessary. Due to the rarity of the disease and the technical aspects of BT in these very young patients, referral to specialized high-volume centers is recommended.
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