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Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in...
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Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in Genitourinary Cancer, Gynecologic Cancer, and Pelvic Sarcoma

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 November 2022) | Viewed by 14654

Special Issue Editor

Prof. Dr. Cyrus Chargari

E-Mail Website
Guest Editor
Radiotherapy, Gustave Roussy Institute, 94805 Villejuif, France
Interests: gynecological cancers; brachytherapy

Special Issue Information

Dear Colleagues,

Radiotherapy has an important place in the management of urogenital and gynecological tumors, either as an upfront treatment or as an adjuvant in patients treated with surgery and harboring risk factors for locoregional relapse (e.g., endometrial cancer, early stage cervical cancer, and prostate cancer). It is also used as a salvage treatment in patients who relapse despite a primary surgical procedure. The role of radiotherapy as an adjuvant or salvage treatment has evolved over the past years, with the implementation of modern technologies for improving the therapeutic index of radiotherapy/brachytherapy. This Thematic Issue aims at focusing on the place of radiotherapy/brachytherapy as an adjuvant or salvage treatment for genitourinary and gynecological, as well as for pelvic sarcoma.

Prof. Dr. Cyrus Chargari
Guest Editor

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Keywords

  • radiotherapy
  • brachytherapy
  • genitourinary cancer
  • gynecological cancer
  • pelvic sarcoma

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Published Papers (4 papers)

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Research

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14 pages, 750 KiB  
Article
Magnetic Resonance-Guided Reirradiation for Local Recurrence within the Prostate or in the Prostate Bed: One-Year Clinical Results of a Prospective Registry Study
by Morgan Michalet, Olivier Riou, Jeremy Cottet-Moine, Florence Castan, Sophie Gourgou, Simon Valdenaire, Pierre Debuire, Norbert Ailleres, Roxana Draghici, Marie Charissoux, Carmen Llacer Moscardo, Marie-Pierre Farcy-Jacquet, Pascal Fenoglietto and David Azria
Cancers 2022, 14(8), 1943; https://doi.org/10.3390/cancers14081943 - 12 Apr 2022
Cited by 12 | Viewed by 2214
Abstract
Around 33% of patients treated by EBRT or brachytherapy will present a biochemical recurrence. SBRT is a new option for the treatment of patients with local-only recurrence. MRgRT seems to be interesting for the treatment of these recurrences. This article presents the one-year [...] Read more.
Around 33% of patients treated by EBRT or brachytherapy will present a biochemical recurrence. SBRT is a new option for the treatment of patients with local-only recurrence. MRgRT seems to be interesting for the treatment of these recurrences. This article presents the one-year late tolerance and biochemical recurrence-free survival results of a prospective registry study. Patients with intraprostatic (or in the prostate bed) recurrence were treated with 5 to 9 fractions (median dose of 30 Gy in 5 fractions) with the MRIdian® system. PSA level and toxicities were evaluated before treatment and at three, six and 12 months after treatment. Thirty-seven patients with a median age of 74.5 years old were treated between 21 October 2019 and 7 December 2020. Acute tolerance was excellent with no grade >2 toxicities. Twelve months after treatment, we observed an increase of grade 1–2 dysuria (46% vs. 13% before treatment) and grade 1 polyuria (73% vs. 7%). The six, nine and 12-months biochemical-recurrence free survival were 97.3%, 86.5% and 65.0%. Fifteen patients (40%) presented a biochemical recurrence. Nine of these 15 patients (60%) had a persistent disease within the treated volume. In conclusion, MRgRT is safe and has promising survival results. Full article
(This article belongs to the Special Issue Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in Genitourinary Cancer, Gynecologic Cancer, and Pelvic Sarcoma)
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12 pages, 1033 KiB  
Article
Brachytherapy for the Conservative Treatment of Female Peri-Urethral Carcinoma
by Mickaël Andraud, Manon Kissel, Roger Sun, Elie Rassy, Sophie Espenel, Samir Achkar, Philippe Morice, Christine Haie-Meder, Sébastien Gouy and Cyrus Chargari
Cancers 2022, 14(3), 845; https://doi.org/10.3390/cancers14030845 - 8 Feb 2022
Viewed by 2797
Abstract
Introduction: Peri-urethral cancers (PUC) are rare tumors. Brachytherapy (BT), either monotherapy or combined with radiation therapy, is a preferred treatment option to spare the morbidity of surgery and achieve organ preservation. We report, to the best of our knowledge, the largest experience of [...] Read more.
Introduction: Peri-urethral cancers (PUC) are rare tumors. Brachytherapy (BT), either monotherapy or combined with radiation therapy, is a preferred treatment option to spare the morbidity of surgery and achieve organ preservation. We report, to the best of our knowledge, the largest experience of brachytherapy among women with PUC. Patients and Methods: This is a retrospective review of the medical records of female patients with PUC who underwent low- or pulse-dose-rate BT with or without external beam radiotherapy at Gustave Roussy between 1990 and 2018. Patients were categorized according to the treatment intention into a primary and recurrent group. The Kaplan–Meier method was used for survival analysis, and the Cox proportional-hazard model was used for univariate analysis. Brachythewharapy-related adverse events were reported according to Common Terminology Criteria for Adverse Events version 4. Results: We identified 44 patients with PUC who underwent BT. Of the 44 patients, 22 had primary tumors and 22 had recurrent tumors. Histologies were mainly adenocarcinoma (n = 20) and squamous cell carcinoma (n = 14). The median prescribed dose was 60 Gy for the 24 patients treated with BT alone and 20 Gy (IQ range: 15–56.25 Gy) for the 20 patients treated with BT in combination with EBRT. With a median follow-up of 21.5 months (range 7.5–60.8), a total of six patients experienced local relapse (17.5%). The 2-year overall survival probability was 63% (95%CI: 49.2–81.4%). The most common toxicities were acute genito-urinary grade 1–2 toxicities. At the last follow-up, four patients experienced focal necrosis. Conclusions: In this cohort of women with PUC undergoing BT, we observed an 80% probability of local control with acceptable morbidity. Though survival was poor, with high metastatic relapse probability, BT was useful to focally escalate the dose and optimize local control in the context of an organ sparing strategy. Full article
(This article belongs to the Special Issue Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in Genitourinary Cancer, Gynecologic Cancer, and Pelvic Sarcoma)
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Review

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15 pages, 558 KiB  
Review
Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies
by Yuedan Zhou, Elie Rassy, Alexandre Coutte, Samir Achkar, Sophie Espenel, Catherine Genestie, Patricia Pautier, Philippe Morice, Sébastien Gouy and Cyrus Chargari
Cancers 2022, 14(10), 2449; https://doi.org/10.3390/cancers14102449 - 16 May 2022
Cited by 17 | Viewed by 4376
Abstract
Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative [...] Read more.
Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients’ outcome and minimize treatment-related morbidity. Full article
(This article belongs to the Special Issue Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in Genitourinary Cancer, Gynecologic Cancer, and Pelvic Sarcoma)
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10 pages, 265 KiB  
Review
Adjuvant or Salvage Radiation Therapy for Prostate Cancer after Prostatectomy: Current Status, Controversies and Perspectives
by Mario Terlizzi, Elaine Johanna Limkin, Yasmina Moukasse and Pierre Blanchard
Cancers 2022, 14(7), 1688; https://doi.org/10.3390/cancers14071688 - 26 Mar 2022
Cited by 7 | Viewed by 4378
Abstract
Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk [...] Read more.
Nearly one-third of the patients who undergo prostatectomy for prostate cancer have a biochemical recurrence (BCR) during follow-up. While several randomized trials have shown that adjuvant radiation therapy (aRT) improves biochemical control, this strategy has not been widely used because of the risk of toxicity and the fear of overtreating patients who would not have relapsed. In addition, the possibility of close PSA monitoring in the era of ultrasensitive assays enables to anticipate early salvage strategies (sRT). Three recent randomized trials and their meta-analysis have confirmed that aRT does not improve event-free survival compared to sRT, imposing the latter as the new standard of treatment. The addition of androgen deprivation therapy (ADT) to RT has been shown to improve biochemical control and metastasis-free survival, but the precise definition of to whom it should be proposed is still a matter of debate. The development of genomic tests or the use of artificial intelligence will allow more individualized treatment in the future. Therapeutic intensification with the combination of new-generation hormone therapy and RT is under study. Finally, the growing importance of metabolic imaging (PET/CT) due to its performance especially for low PSA levels will help in further personalizing management strategies. Full article
(This article belongs to the Special Issue Place of Radiotherapy/Brachytherapy as an Adjuvant or Salvage Treatment in Genitourinary Cancer, Gynecologic Cancer, and Pelvic Sarcoma)
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