Presentation on theme: "Incorporating Cesium-131 Interstitial Implants into Daily Clinical Practice: How to Make Radiation appear exactly where you want. Jonathan Feddock, MD."— Presentation transcript:
1Incorporating Cesium-131 Interstitial Implants into Daily Clinical Practice: How to Make Radiation appear exactly where you want.Jonathan Feddock, MDDepartment of Radiation MedicineUniversity of Kentucky
2Vaginal cuff recurrence of cervix cancer s/p rad hysterectomy and adjuvant RT
3Okazawa et al. J Rad Res, Open Access, October 15, 2012.
4Basic FactsRadiation Therapy has a well-established role in the curative management of many gynecologic cancers.Local recurrences following initial treatment including RT are problematic. Options are felt to include radical surgery in very selected patients or palliative care.Exenterative surgery will be aborted in 25-35% of patients in whom it is attempted. When performed serious acute morbidity, some mortality, and uniform loss of structure and function result.
5Basic FactsRe-irradiation is often not considered, in spite of data suggesting its curative potential in well-selected patients. Reasons for not considering re-irradiation include:Concerns about radiation injury.Patient eligibility for phase I-II trials.Familiarity of the treating physicianIf pelvic exenteration is an option (small, central pelvic recurrence), wouldn’t it still be an option if small-volume re-irradiation was either unsuccessful or caused a local complication?
6Vaginal cuff recurrence of cervix cancer s/p rad hysterectomy and adjuvant RT
7Orthogonal Radiographs of an Interstitial Au-198 Implant of a Vaginal Cuff Recurrence
108 weeks after Au-198 permanent seed implant (still NED after 10 years)
11Interstitial Re-irradiation (IRI) 13 pts with recurrent or new primary gyn cancers underwent IRI betweenMean and median age: 63, 70 yrs, respectivelyDiagnosis at time of IRIRecurrent endometrial ca, n = 6Recurrent cervical ca, n = 4New primary vaginal ca, n = 3All biopsy-confirmed recurrenceMetastatic work-up negativeRandall ME, Evans L, Greven KM, et al. Interstitial Reirradiation for Recurrent Gynecologic Malignancies: Results and Analysis of Prognostic Factors. Gyn Oncol (1993) 48:
12Interstitial Re-irradiation (IRI) 7 permanent seed implants (5 Au-198, 2 Pd-103)6 temporary implants (LDR Ir-192, SNIT)Mean and median implanted volumes: 14.3, 12 cc9/13 (69%) had CR6/14 (46%) NED months laterMedian f/u = 58 monthsOnly 1 possible complication: R-V fistula 22 months following SNIT, in presence of recurrent dzRandall ME, Evans L, Greven KM, et al. Interstitial Reirradiation for Recurrent Gynecologic Malignancies: Results and Analysis of Prognostic Factors. . Gyn Oncol (1993) 48:
13IRI Prognostic Factors Cervical and vaginal > endometrialSquamous > adenocarcinomaSmaller tumor volumesHigher RT doses (> 50 Gy)Permanent implants > temporary (SNIT)Vaginal wall/suburethra > vaginal cuffLonger disease-free intervalsRandall ME, Evans L, Greven KM, et al. Interstitial Reirradiation for Recurrent Gynecologic Malignancies: Results and Analysis of Prognostic Factors. Gyn Oncol (1993) 48:
14RECURRENT DISEASE Advantages for using Surgery Ability to assess extent of disease and act accordinglyApplicable to larger volume recurrencesAvoids risk of late radiation injury
15RECURRENT DISEASE Advantages for Re-Irradiation Little peri-operative morbidity or mortalityLittle or no hospitalization required, especially for permanent implantsPreserves structure and function in most patientsMore applicable to patients with medical co- morbiditiesMore acceptable to patientsRelatively inexpensive compared to surgery