Prospective trial in 3D PDR brachytherapyImpact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study☆
Section snippets
Material and methods
From March 2005 to June 2007, twenty centers participated in the study. BT could be associated with EBRT/chemotherapy and/or surgery according to the stage of the disease. For IB1 tumors, patients were treated with BT followed by surgery 6 weeks later. For higher stages or in case of nodal involvement, treatment started with EBRT associated with chemotherapy in the absence of contra indication, followed by BT; surgery could be proposed according to each center protocol, for limited stages. The
Results
The study was completed in June 2007 after 801 patients were enrolled. By September 1st 2009, 705 patients were available for analysis and are reported here. The 96 remaining patients were excluded from the analysis as we were not able to retrieve any data about them.
The 2D and 3D arms were well balanced with regard to age, FIGO stage, histology, chemotherapy and EBRT (Table 1). The most frequent applicator used was the Fletcher’s, followed by the mold applicator (Table 2). In the 2D arm, PDR,
Discussion
During the last decades, the introduction of the afterloading miniaturized sources have led to improvements in BT by allowing for variation of the stepping time of the source (HDR or PDR BT) and additionally, the ability to visualize 3D dosimetry on cross-sectional images. The clinical impact of optimization of BT dose has been recently clearly demonstrated [21], [22]. 3D BT is now considered as a standard, although a number of questions remain to be clarified [23].
In 2004, our study was
Conclusion
This multicenter prospective study including 20 centers has shown that 3D BT is feasible and safe in routine practice. We also showed that even without complex procedures of optimization, 3D BT has improved the outcome of cervix carcinoma: it allowed for lower grade 3–4 toxicity by a factor 2 while improving local control, compared to 2D BT, although longer follow up is needed to confirm these results. Therefore, we propose conversion of 2D cervix BT to 3D dosimetry and optimization in all
Conflict of interest
None declared.
Acknowledgments
We wish to thank Astrid de Leeuw for the material support for the calculation of the radiobiologically equivalent dose of PDR BT.
The following radiation oncologists and physicists are being acknowledged for their contribution to the STIC PDR study:
P. Magnenet, N. Allières, T. Lacornerie, Y. Kirova, J. Bonnet, J. Coulot, P. Romestaing, M.-P. Sotton, P. Lang, G. Boisserie, S. Racadot, C. Malet, A. Chemin, D.Williaume, J. Bellec, C. Krzisch, K. Peignaux, J.-P. Brenier, A. Cussac, A. Lisbona, M.-H.
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The preliminary results of this study were presented in 2008 at World Congress of Brachytherapy Meeting. Boston, USA. Brunaud C, Haie-Meder C, Peiffert D Group SP: Preliminary results of a prospective multicentric French study of PDR 3D brachytherapy for cervix carcinoma. Brachytherapy 2008;7: 96.