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Stereotactic Ablative Radiotherapy and Other Newer Treatment Delivery Techniques for Gynecologic Cancers

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Book cover Radiation Therapy Techniques for Gynecological Cancers

Part of the book series: Practical Guides in Radiation Oncology ((PGRO))

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Abstract

There are approximately 71,500 new gynecologic cancers diagnosed each year in the USA. Radiotherapy plays a significant role in the definitive or adjuvant management of gynecologic cancers. Techniques including permanent seed brachytherapy, particle therapy with carbon ion/proton beam radiotherapy, and stereotactic ablative radiotherapy (SAbR) are increasingly being investigated and used clinically for the management of newly diagnosed gynecologic cancers or in the recurrent or re-irradiation setting. The purpose of this chapter is to review the clinical literature, indications, simulation and treatment planning, and physics considerations with each of these techniques.

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References

  1. Prevention CfDCa. Get the facts about gynecologic cancer. Center for Disease Control and Prevention. 2017.

    Google Scholar 

  2. Bagshaw HP, Pappas LM, Kepka DL, Tward JD, Gaffney DK. Patterns of care with brachytherapy for cervical cancer. Int J Gynecol Cancer. 2014;24(9):1659–64. https://doi.org/10.1097/IGC.0000000000000276.

    Article  PubMed  Google Scholar 

  3. Gill BS, Lin JF, Krivak TC, Sukumvanich P, Laskey RA, Ross MS, et al. National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys. 2014;90(5):1083–90. https://doi.org/10.1016/j.ijrobp.2014.07.017.

    Article  PubMed  Google Scholar 

  4. Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. 2013;87(1):111–9. https://doi.org/10.1016/j.ijrobp.2013.05.033.

    Article  PubMed  Google Scholar 

  5. Orton A, Boothe D, Williams N, Buchmiller T, Huang YJ, Suneja G, et al. Brachytherapy improves survival in primary vaginal cancer. Gynecol Oncol. 2016;141(3):501–6. https://doi.org/10.1016/j.ygyno.2016.03.011.

    Article  PubMed  Google Scholar 

  6. Smith GL, Jiang J, Giordano SH, Meyer LA, Eifel PJ. Trends in the quality of treatment for patients with intact cervical cancer in the United States, 1999 through 2011. Int J Radiat Oncol Biol Phys. 2015;92(2):260–7. https://doi.org/10.1016/j.ijrobp.2015.01.037.

    Article  PubMed  Google Scholar 

  7. Tanderup K, Eifel PJ, Yashar CM, Potter R, Grigsby PW. Curative radiation therapy for locally advanced cervical cancer: brachytherapy is NOT optional. Int J Radiat Oncol Biol Phys. 2014;88(3):537–9. https://doi.org/10.1016/j.ijrobp.2013.11.011.

    Article  PubMed  Google Scholar 

  8. Viswanathan AN, Thomadsen B, American Brachytherapy Society Cervical Cancer Recommendations C, American Brachytherapy S. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: general principles. Brachytherapy. 2012;11(1):33–46. https://doi.org/10.1016/j.brachy.2011.07.003.

    Article  PubMed  Google Scholar 

  9. Fortin I, Tanderup K, Haie-Meder C, Lindegaard JC, Mahanshetty U, Segedin B, et al. Image guided brachytherapy in cervical cancer: a comparison between intracavitary and combined intracavitary/interstitial brachytherapy in regard to doses to HR CTV, OARs and late morbidity—early results from the Embrace study in 999 patients. Brachytherapy. 2016;15:S21.

    Article  Google Scholar 

  10. Bradford LS, Rauh-Hain JA, Schorge J, Birrer MJ, Dizon DS. Advances in the management of recurrent endometrial cancer. Am J Clin Oncol. 2015;38(2):206–12. https://doi.org/10.1097/COC.0b013e31829a2974.

    Article  CAS  PubMed  Google Scholar 

  11. Hunter DJ. Carcinoma of the vulva: a review of 361 patients. Gynecol Oncol. 1975;3(2):117–23.

    Article  CAS  PubMed  Google Scholar 

  12. Qiu JT, Abdullah NA, Chou HH, Lin CT, Jung SM, Wang CC, et al. Outcomes and prognosis of patients with recurrent cervical cancer after radical hysterectomy. Gynecol Oncol. 2012;127(3):472–7. https://doi.org/10.1016/j.ygyno.2012.08.008.

    Article  PubMed  Google Scholar 

  13. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. https://doi.org/10.3322/caac.21254.

    Article  PubMed  Google Scholar 

  14. Maggioni A, Roviglione G, Landoni F, Zanagnolo V, Peiretti M, Colombo N, et al. Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol. 2009;114(1):64–8. https://doi.org/10.1016/j.ygyno.2009.03.029.

    Article  PubMed  Google Scholar 

  15. Benn T, Brooks RA, Zhang Q, Powell MA, Thaker PH, Mutch DG, et al. Pelvic exenteration in gynecologic oncology: a single institution study over 20 years. Gynecol Oncol. 2011;122(1):14–8. https://doi.org/10.1016/j.ygyno.2011.03.003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hockel M, Dornhofer N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet Oncol. 2006;7(10):837–47. https://doi.org/10.1016/S1470-2045(06)70903-2.

    Article  PubMed  Google Scholar 

  17. Marnitz S, Kohler C, Muller M, Behrens K, Hasenbein K, Schneider A. Indications for primary and secondary exenterations in patients with cervical cancer. Gynecol Oncol. 2006;103(3):1023–30. https://doi.org/10.1016/j.ygyno.2006.06.027.

    Article  PubMed  Google Scholar 

  18. Peiretti M, Zapardiel I, Zanagnolo V, Landoni F, Morrow CP, Maggioni A. Management of recurrent cervical cancer: a review of the literature. Surg Oncol. 2012;21(2):e59–66. https://doi.org/10.1016/j.suronc.2011.12.008.

    Article  CAS  PubMed  Google Scholar 

  19. Sharma SK, Forgione H, Isaacs JH. Iodine-125 interstitial implants as salvage therapy for recurrent gynecologic malignancies. Cancer. 1991;67(10):2467–71.

    Article  CAS  PubMed  Google Scholar 

  20. Fotopoulou C, Neumann U, Kraetschell R, Schefold JC, Weidemann H, Lichtenegger W, et al. Long-term clinical outcome of pelvic exenteration in patients with advanced gynecological malignancies. J Surg Oncol. 2010;101(6):507–12. https://doi.org/10.1002/jso.21518.

    Article  PubMed  Google Scholar 

  21. Miller B, Morris M, Levenback C, Burke TW, Gershenson DM. Pelvic exenteration for primary and recurrent vulvar cancer. Gynecol Oncol. 1995;58(2):202–5. https://doi.org/10.1006/gyno.1995.1211.

    Article  CAS  PubMed  Google Scholar 

  22. Rutledge FN, Smith JP, Wharton JT, O'Quinn AG. Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol. 1977;129(8):881–92.

    Article  CAS  PubMed  Google Scholar 

  23. Martinez A, Herstein P, Portnuff J. Interstitial therapy of perineal and gynecological malignancies. Int J Radiat Oncol Biol Phys. 1983;9(3):409–16.

    Article  CAS  PubMed  Google Scholar 

  24. Dowdy SC, Mariani A, Cliby WA, Haddock MG, Petersen IA, Sim FH, et al. Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol. 2006;101(2):280–6. https://doi.org/10.1016/j.ygyno.2005.10.018.

    Article  PubMed  Google Scholar 

  25. Hockel M, Sclenger K, Hamm H, Knapstein PG, Hohenfellner R, Rosler HP. Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall. Cancer. 1996;77(9):1918–33. https://doi.org/10.1002/(SICI)1097-0142(19960501)77:9<1918::AID-CNCR24>3.0.CO;2-1.

    Article  CAS  PubMed  Google Scholar 

  26. Kitagawa R, Katsumata N, Shibata T, Kamura T, Kasamatsu T, Nakanishi T, et al. Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol. 2015;33(19):2129–35. https://doi.org/10.1200/JCO.2014.58.4391.

    Article  CAS  PubMed  Google Scholar 

  27. Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, et al. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2005;23(21):4626–33. https://doi.org/10.1200/JCO.2005.10.021.

    Article  CAS  PubMed  Google Scholar 

  28. Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Benda J, et al. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22(15):3113–9. https://doi.org/10.1200/JCO.2004.04.170.

    Article  CAS  PubMed  Google Scholar 

  29. Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM, et al. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014;370(8):734–43. https://doi.org/10.1056/NEJMoa1309748.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Brabham JG, Cardenes HR. Permanent interstitial reirradiation with 198Au as salvage therapy for low volume recurrent gynecologic malignancies: a single institution experience. Am J Clin Oncol. 2009;32(4):417–22. https://doi.org/10.1097/COC.0b013e318191bfc7.

    Article  PubMed  Google Scholar 

  31. Okazawa K, Yuasa-Nakagawa K, Yoshimura R, Shibuya H. Permanent interstitial re-irradiation with Au-198 seeds in patients with post-radiation locally recurrent uterine carcinoma. J Radiat Res. 2013;54(2):299–306. https://doi.org/10.1093/jrr/rrs092.

    Article  PubMed  Google Scholar 

  32. Puthawala AA, Syed AM, Fleming PA, DiSaia PJ. Re-irradiation with interstitial implant for recurrent pelvic malignancies. Cancer. 1982;50(12):2810–4.

    Article  CAS  PubMed  Google Scholar 

  33. Randall ME, Evans L, Greven KM, McCunniff AJ, Doline RM. Interstitial reirradiation for recurrent gynecologic malignancies: results and analysis of prognostic factors. Gynecol Oncol. 1993;48(1):23–31. https://doi.org/10.1006/gyno.1993.1005.

    Article  CAS  PubMed  Google Scholar 

  34. Russell AH, Koh WJ, Markette K, Russell KJ, Cain JM, Tamimi HK, et al. Radical reirradiation for recurrent or second primary carcinoma of the female reproductive tract. Gynecol Oncol. 1987;27(2):226–32.

    Article  CAS  PubMed  Google Scholar 

  35. Wooten CE, Randall M, Edwards J, Aryal P, Luo W, Feddock J. Implementation and early clinical results utilizing Cs-131 permanent interstitial implants for gynecologic malignancies. Gynecol Oncol. 2014;133(2):268–73. https://doi.org/10.1016/j.ygyno.2014.02.015.

    Article  PubMed  Google Scholar 

  36. Feddock J, Aryal P, Steber C, Edwards J, Cheek D, Randall M. Outpatient template-guided permanent interstitial brachytherapy using 131Cs in gynecologic malignancies: initial report. Brachytherapy. 2017;16(2):393–401. https://doi.org/10.1016/j.brachy.2016.12.008.

    Article  PubMed  Google Scholar 

  37. Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys. 2003;56(5):1366–72.

    Article  PubMed  Google Scholar 

  38. Beriwal S, Bhatnagar A, Heron DE, Selvaraj R, Mogus R, Kim H, et al. High-dose-rate interstitial brachytherapy for gynecologic malignancies. Brachytherapy. 2006;5(4):218–22. https://doi.org/10.1016/j.brachy.2006.09.002.

    Article  PubMed  Google Scholar 

  39. Chung JY, Roberts K, Peschel RE, Nath R, Pourang R, Kacinski B, et al. Treatment of recurrent pelvic and selected primary gynecologic malignancies with 241Am. Radiat Oncol Investig. 1997;5(5):227–34. https://doi.org/10.1002/(SICI)1520-6823(1997)5:5<227::AID-ROI3>3.0.CO;2-#.

    Article  CAS  PubMed  Google Scholar 

  40. Monk BJ, Walker JL, Tewari K, Ramsinghani NS, Nisar Syed AM, DiSaia PJ. Open interstitial brachytherapy for the treatment of local-regional recurrences of uterine corpus and cervix cancer after primary surgery. Gynecol Oncol. 1994;52(2):222–8.

    Article  CAS  PubMed  Google Scholar 

  41. Nag S, Yacoub S, Copeland LJ, Fowler JM. Interstitial brachytherapy for salvage treatment of vaginal recurrences in previously unirradiated endometrial cancer patients. Int J Radiat Oncol Biol Phys. 2002;54(4):1153–9.

    Article  PubMed  Google Scholar 

  42. Tewari K, Cappuccini F, Brewster WR, DiSaia PJ, Berman ML, Manetta A, et al. Interstitial brachytherapy for vaginal recurrences of endometrial carcinoma. Gynecol Oncol. 1999;74(3):416–22. https://doi.org/10.1006/gyno.1999.5487.

    Article  CAS  PubMed  Google Scholar 

  43. Beriwal S, Demanes DJ, Erickson B, Jones E, De Los Santos JF, Cormack RA, et al. American Brachytherapy Society consensus guidelines for interstitial brachytherapy for vaginal cancer. Brachytherapy. 2012;11(1):68–75. https://doi.org/10.1016/j.brachy.2011.06.008.

    Article  PubMed  Google Scholar 

  44. Lee LJ, Das IJ, Higgins SA, Jhingran A, Small W Jr, Thomadsen B, et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part III: low-dose-rate and pulsed-dose-rate brachytherapy. Brachytherapy. 2012;11(1):53–7. https://doi.org/10.1016/j.brachy.2011.07.001.

    Article  PubMed  Google Scholar 

  45. ICRUNo38. Dose and volume specification for reporting intracavitary therapy in gynecology. 1985. http://www.icru.org/home/reports/dose-and-volume-specification-for-reporting-intracavitary-therapy-in-gynecology-report-38/.

  46. Kunos CA, Sherertz TM, Mislmani M, Ellis RJ, Lo SS, Waggoner SE, et al. Phase I trial of carboplatin and gemcitabine chemotherapy and stereotactic ablative radiosurgery for the palliative treatment of persistent or recurrent gynecologic cancer. Front Oncol. 2015;5(126):1–6. https://doi.org/10.3389/fonc.2015.00126.

    Article  Google Scholar 

  47. Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group Study. Gynecol Oncol. 2009;112(3):543–52. https://doi.org/10.1016/j.ygyno.2008.11.014.

    Article  CAS  PubMed  Google Scholar 

  48. Kunos C, von Gruenigen V, Waggoner S, Brindle J, Zhang Y, Myers B, et al. Cyberknife radiosurgery for squamous cell carcinoma of vulva after prior pelvic radiation therapy. Technol Cancer Res Treat. 2008;7(5):375–80.

    Article  PubMed  Google Scholar 

  49. Feddock J, Aryal P, Wooten C, Randall M. Outpatient interstitial implants—integrating cesium-131 permanent interstitial brachytherapy into definitive treatment for gynecologic malignancies. Brachytherapy. 2016;15:S93–S4.

    Article  Google Scholar 

  50. Erickson B, Gillin MT. Interstitial implantation of gynecologic malignancies. J Surg Oncol. 1997;66(4):285–95.

    Article  CAS  PubMed  Google Scholar 

  51. Syed AM, Puthawala AA, Abdelaziz NN, el-Naggar M, Disaia P, Berman M, et al. Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2002;54(1):67–78.

    Article  PubMed  Google Scholar 

  52. Cunningham J. In: Thomas C, editor. The physics of radiobiology. 4th ed. Springfield, IL: Thomas C; 1983.

    Google Scholar 

  53. Tod M, Meredith WJ. Treatment of cancer of the cervix uteri, a revised Manchester method. Br J Radiol. 1953;26(305):252–7. https://doi.org/10.1259/0007-1285-26-305-252.

    Article  CAS  PubMed  Google Scholar 

  54. Abbe R. The use of radium in malignant disease. Lancet. 1913;2:524–7.

    Article  Google Scholar 

  55. Lenz M. Radiotherapy of cancer of the cervix at the Radium Institute, Paris, France. Am J Roentgenol. 1927;17:335–42.

    Google Scholar 

  56. Tod MC, Meredith WJ. The optimum dosage system for use in the treatment of cancer of the uterine cervix. Br J Radiol. 1938;11:809–24.

    Article  Google Scholar 

  57. Demanes DJ, Rodriguez RR, Bendre DD, Ewing TL. High dose rate transperineal interstitial brachytherapy for cervical cancer: high pelvic control and low complication rates. Int J Radiat Oncol Biol Phys. 1999;45(1):105–12.

    Article  CAS  PubMed  Google Scholar 

  58. Monk BJ, Tewari KS, Puthawala AA, Syed AM, Haugen JA, Burger RA. Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation. Int J Radiat Oncol Biol Phys. 2002;52(3):806–15.

    Article  PubMed  Google Scholar 

  59. Reed DR, Wallner KE, Merrick GS, Arthurs S, Mueller A, Cavanagh W, et al. A prospective randomized comparison of stranded vs. loose 125I seeds for prostate brachytherapy. Brachytherapy. 2007;6(2):129–34. https://doi.org/10.1016/j.brachy.2007.01.003.

    Article  PubMed  Google Scholar 

  60. Luo W, Molloy J, Aryal P, Feddock J, Randall M. Determination of prescription dose for Cs-131 permanent implants using the BED formalism including resensitization correction. Med Phys. 2014;41(2):024101. https://doi.org/10.1118/1.4860255.

    Article  CAS  PubMed  Google Scholar 

  61. Kunos CA, Brindle J, Waggoner S, Zanotti K, Resnick K, Fusco N, et al. Phase II clinical trial of robotic stereotactic body radiosurgery for metastatic gynecologic malignancies. Front Oncol. 2012;2:181. https://doi.org/10.3389/fonc.2012.00181.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Kunos C, Chen W, DeBernardo R, Waggoner S, Brindle J, Zhang Y, et al. Stereotactic body radiosurgery for pelvic relapse of gynecologic malignancies. Technol Cancer Res Treat. 2009;8(5):393–400.

    Article  PubMed  Google Scholar 

  63. Kunos C, Brindle JM, Debernardo R. Stereotactic radiosurgery for gynecologic cancer. J Vis Exp. 2012;(62). https://doi.org/10.3791/3793.

  64. Kunos CA, Debernardo R, Radivoyevitch T, Fabien J, Dobbins DC, Zhang Y, et al. Hematological toxicity after robotic stereotactic body radiosurgery for treatment of metastatic gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2012;84(1):e35–41. https://doi.org/10.1016/j.ijrobp.2012.02.027.

    Article  PubMed  Google Scholar 

  65. Mislmani M, Frasure H, Suppiah S, Fabien J, Lo SS, Debernardo R, et al. Acute gastrointestinal toxicity after robotic stereotactic ablative radiotherapy for treatment of metastatic gynecological malignancies. Future Oncol. 2014;10(2):241–8. https://doi.org/10.2217/fon.13.215.

    Article  CAS  PubMed  Google Scholar 

  66. Kunos C, Shaffer H, Fabien J. Hybrid arc stereotactic ablative body radiation therapy for pelvic relapse of gynecologic malignancies. Obstet Gynecol Cases Rev. 2015;2:030.

    Article  Google Scholar 

  67. Kunos CA, Fabien JM, Shanahan JP, Collen C, Gevaert T, Poels K et al. Dynamic lung tumor tracking for stereotactic ablative body radiation therapy. J Vis Exp. 2015;100:e52875. https://doi.org/10.3791/52875.

  68. Choi CW, Cho CK, Yoo SY, Kim MS, Yang KM, Yoo HJ, et al. Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer. Int J Radiat Oncol Biol Phys. 2009;74(1):147–53. https://doi.org/10.1016/j.ijrobp.2008.07.020.

    Article  PubMed  Google Scholar 

  69. Higginson DS, Morris DE, Jones EL, Clarke-Pearson D, Varia MA. Stereotactic body radiotherapy (SBRT): technological innovation and application in gynecologic oncology. Gynecol Oncol. 2011;120(3):404–12. https://doi.org/10.1016/j.ygyno.2010.11.042.

    Article  PubMed  Google Scholar 

  70. Park HJ, Chang AR, Seo Y, Cho CK, Jang WI, Kim MS, et al. Stereotactic body radiotherapy for recurrent or oligometastatic uterine cervix cancer: a cooperative study of the Korean radiation oncology group (KROG 14-11). Anticancer Res. 2015;35(9):5103–10.

    PubMed  Google Scholar 

  71. Seo YS, Kim MS, Cho CK, Yoo HJ, Jang WI, Kim KB, et al. Stereotactic body radiotherapy for oligometastases confined to the para-aortic region: clinical outcomes and the significance of radiotherapy field and dose. Cancer Investig. 2015;33(5):180–7. https://doi.org/10.3109/07357907.2015.1019678.

    Article  CAS  Google Scholar 

  72. Seo Y, Kim MS, Yoo HJ, Jang WI, Rhu SY, Choi SC, et al. Salvage stereotactic body radiotherapy for locally recurrent uterine cervix cancer at the pelvic sidewall: feasibility and complication. Asia Pac J Clin Oncol. 2016;12(2):e280–8. https://doi.org/10.1111/ajco.12185.

    Article  PubMed  Google Scholar 

  73. Barraclough LH, Swindell R, Livsey JE, Hunter RD, Davidson SE. External beam boost for cancer of the cervix uteri when intracavitary therapy cannot be performed. Int J Radiat Oncol Biol Phys. 2008;71(3):772–8. https://doi.org/10.1016/j.ijrobp.2007.10.066.

    Article  PubMed  Google Scholar 

  74. Swamidas VJ, Mahantshetty U, Vineeta G, Engineer R, Deshpande DD, Sarin R, et al. Treatment planning of epithelial ovarian cancers using helical tomotherapy. J Appl Clin Med Phys. 2009;10(4):3003.

    Google Scholar 

  75. Hsieh CH, Tien HJ, Hsiao SM, Wei MC, Wu WY, Sun HD, et al. Stereotactic body radiation therapy via helical tomotherapy to replace brachytherapy for brachytherapy-unsuitable cervical cancer patients—a preliminary result. Onco Targets Ther. 2013;6:59–66. https://doi.org/10.2147/ott.s40370.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Jones R, Chen Q, Best R, Libby B, Crandley EF, Showalter TN. Dosimetric feasibility of stereotactic body radiation therapy as an alternative to brachytherapy for definitive treatment of medically inoperable early stage endometrial cancer. Radiat Oncol. 2014;9:164. https://doi.org/10.1186/1748-717x-9-164.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Molla M, Escude L, Nouet P, Popowski Y, Hidalgo A, Rouzaud M, et al. Fractionated stereotactic radiotherapy boost for gynecologic tumors: an alternative to brachytherapy? Int J Radiat Oncol Biol Phys. 2005;62(1):118–24. https://doi.org/10.1016/j.ijrobp.2004.09.028.

    Article  PubMed  Google Scholar 

  78. Jorcano S, Molla M, Escude L, Sanz S, Hidalgo A, Toscas JI, et al. Hypofractionated extracranial stereotactic radiotherapy boost for gynecologic tumors: a promising alternative to high-dose rate brachytherapy. Technol Cancer Res Treat. 2010;9(5):509–14.

    Article  PubMed  Google Scholar 

  79. Deodato F, Macchia G, Grimaldi L, Ferrandina G, Lorusso D, Salutari V, et al. Stereotactic radiotherapy in recurrent gynecological cancer: a case series. Oncol Rep. 2009;22(2):415–9.

    PubMed  Google Scholar 

  80. Guckenberger M, Bachmann J, Wulf J, Mueller G, Krieger T, Baier K, et al. Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer. Radiother Oncol. 2010;94(1):53–9. https://doi.org/10.1016/j.radonc.2009.12.004.

    Article  PubMed  Google Scholar 

  81. Kemmerer E, Hernandez E, Ferriss JS, Valakh V, Miyamoto C, Li S, et al. Use of image-guided stereotactic body radiation therapy in lieu of intracavitary brachytherapy for the treatment of inoperable endometrial neoplasia. Int J Radiat Oncol Biol Phys. 2013;85(1):129–35. https://doi.org/10.1016/j.ijrobp.2012.02.058.

    Article  PubMed  Google Scholar 

  82. Demiral S, Beyzadeoglu M, Uysal B, Oysul K, Kahya YE, Sager O, et al. Evaluation of stereotactic body radiotherapy (SBRT) boost in the management of endometrial cancer. Neoplasma. 2013;60(3):322–7. https://doi.org/10.4149/neo_2013_043.

    Article  CAS  PubMed  Google Scholar 

  83. Mesko S, Sandler K, Cohen J, Konecny G, Steinberg M, Kamrava M. Clinical outcomes for stereotactic ablative radiotherapy in oligometastatic and oligoprogressive gynecological malignancies. Int J Gynecol Cancer. 2016. https://doi.org/10.1097/igc.0000000000000869.

    Article  PubMed  Google Scholar 

  84. Depuydt T, Penne R, Verellen D, Hrbacek J, Lang S, Leysen K, et al. Computer-aided analysis of star shot films for high-accuracy radiation therapy treatment units. Phys Med Biol. 2012;57(10):2997–3011. https://doi.org/10.1088/0031-9155/57/10/2997.

    Article  PubMed  Google Scholar 

  85. Wilcox EE, Daskalov GM. Evaluation of GAFCHROMIC EBT film for Cyberknife dosimetry. Med Phys. 2007;34(6):1967–74. https://doi.org/10.1118/1.2734384.

    Article  CAS  PubMed  Google Scholar 

  86. Antypas C, Pantelis E. Performance evaluation of a CyberKnife G4 image-guided robotic stereotactic radiosurgery system. Phys Med Biol. 2008;53(17):4697–718. https://doi.org/10.1088/0031-9155/53/17/016.

    Article  PubMed  Google Scholar 

  87. Mackie TR, Holmes T, Swerdloff S, Reckwerdt P, Deasy JO, Yang J, et al. Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy. Med Phys. 1993;20(6):1709–19. https://doi.org/10.1118/1.596958.

    Article  CAS  PubMed  Google Scholar 

  88. Warren W, Grant WH, Teh B. Helical tomotherapy system. In: Lo S, Teh B, Lu J, Schefter T, editors. Stereotactic body radiation therapy. New York, NY: Springer; 2012. p. 67–77.

    Chapter  Google Scholar 

  89. Kim J, Jin JY, Walls N, Nurushev T, Movsas B, Chetty IJ, et al. Image-guided localization accuracy of stereoscopic planar and volumetric imaging methods for stereotactic radiation surgery and stereotactic body radiation therapy: a phantom study. Int J Radiat Oncol Biol Phys. 2011;79(5):1588–96. https://doi.org/10.1016/j.ijrobp.2010.05.052.

    Article  PubMed  Google Scholar 

  90. Kunos CA, Sherertz TM, Mislmani M, Ellis RJ, Lo SS, Waggoner SE, et al. Phase I trial of carboplatin and gemcitabine chemotherapy and stereotactic ablative radiosurgery for the palliative treatment of persistent or recurrent gynecologic cancer. Front Oncol. 2015;5:126. https://doi.org/10.3389/fonc.2015.00126.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Kunos C, Brindle JM, Debernardo R. Stereotactic radiosurgery for gynecologic cancer. J Vis Exp. 2012;62:e3793. https://doi.org/10.3791/3793.

  92. Mendez LC, Leung E, Cheung P, Barbera L. The role of stereotactic ablative body radiotherapy in gynaecological cancers: a systematic review. Clin Oncol (R Coll Radiol). 2017;29(6):378–84. https://doi.org/10.1016/j.clon.2017.01.009.

    Article  CAS  Google Scholar 

  93. Leung EW, Gladwish A, Sahgal A, Lo SS, Kunos CA, Lanciano RM, et al. An international radiosurgery consortium survey for gynecological stereotactic ablative radiation therapy. Int J Radiat Oncol Biol Phys. 2017;99(2):E300. https://doi.org/10.1016/j.ijrobp.2017.06.1320.

    Article  Google Scholar 

  94. Milby AB, Both S, Ingram M, Lin LL. Dosimetric comparison of combined intensity-modulated radiotherapy (IMRT) and proton therapy versus IMRT alone for pelvic and para-aortic radiotherapy in gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2012;82(3):e477–84. https://doi.org/10.1016/j.ijrobp.2011.07.012.

    Article  PubMed  Google Scholar 

  95. Chera BS, Vargas C, Morris CG, Louis D, Flampouri S, Yeung D, et al. Dosimetric study of pelvic proton radiotherapy for high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2009;75(4):994–1002. https://doi.org/10.1016/j.ijrobp.2009.01.044.

    Article  PubMed  Google Scholar 

  96. Lin LL, Kirk M, Scholey J, Taku N, Kiely JB, White B, et al. Initial report of pencil beam scanning proton therapy for posthysterectomy patients with gynecologic cancer. Int J Radiat Oncol Biol Phys. 2016;95(1):181–9. https://doi.org/10.1016/j.ijrobp.2015.07.2205.

    Article  PubMed  Google Scholar 

  97. Clivio A, Kluge A, Cozzi L, Kohler C, Neumann O, Vanetti E, et al. Intensity modulated proton beam radiation for brachytherapy in patients with cervical carcinoma. Int J Radiat Oncol Biol Phys. 2013;87(5):897–903. https://doi.org/10.1016/j.ijrobp.2013.08.027.

    Article  PubMed  Google Scholar 

  98. Arnesen MR, Rekstad BL, Stokke C, Bruheim K, Londalen AM, Hellebust TP, et al. Short-course PET based simultaneous integrated boost for locally advanced cervical cancer. Radiat Oncol. 2016;11:39. https://doi.org/10.1186/s13014-016-0612-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Hashimoto S, Shibamoto Y, Iwata H, Ogino H, Shibata H, Toshito T, et al. Whole-pelvic radiotherapy with spot-scanning proton beams for uterine cervical cancer: a planning study. J Radiat Res. 2016;57(5):524–32. https://doi.org/10.1093/jrr/rrw052.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Nakano T, Kato S, Ohno T, Tsujii H, Sato S, Fukuhisa K, et al. Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix. Cancer. 2005;103(1):92–101. https://doi.org/10.1002/cncr.20734.

    Article  PubMed  Google Scholar 

  101. Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004;22(5):872–80. https://doi.org/10.1200/Jco.2004.07.197.

    Article  PubMed  Google Scholar 

  102. Rose PG, Ali S, Watkins E, Thigpen JT, Deppe G, Clarke-Pearson DL, et al. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25(19):2804–10. https://doi.org/10.1200/Jco.2006.09.4532.

    Article  CAS  PubMed  Google Scholar 

  103. Vale C, Tierney JF, Stewart LA, Brady M, Dinshaw K, Jakobsen A, et al. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26(35):5802–12. https://doi.org/10.1200/Jco.2008.16.4368.

    Article  CAS  Google Scholar 

  104. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116(1):140–6. https://doi.org/10.1016/j.ygyno.2009.09.040.

    Article  CAS  PubMed  Google Scholar 

  105. Grigsby PW, Perez CA, Kuske RR, Camel HM, Kao MS, Galakatos AE, et al. Adenocarcinoma of the uterine cervix - lack of evidence for a poor prognosis. Radiother Oncol. 1988;12(4):289–96. https://doi.org/10.1016/0167-8140(88)90018-7.

    Article  CAS  PubMed  Google Scholar 

  106. Kanai T, Endo M, Minohara S, Miyahara N, Koyama-Ito H, Tomura H, et al. Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy. Int J Radiat Oncol Biol Phys. 1999;44(1):201–10. https://doi.org/10.1016/S0360-3016(98)00544-6.

    Article  CAS  PubMed  Google Scholar 

  107. Kanai T, Furusawa Y, Fukutsu K, Itsukaichi H, EguchiKasai K, Ohara H. Irradiation of mixed beam and design of spread-out Bragg peak for heavy-ion radiotherapy. Radiat Res. 1997;147(1):78–85. https://doi.org/10.2307/3579446.

    Article  CAS  PubMed  Google Scholar 

  108. Kato S, Ohno T, Tsujii H, Nakano T, Mizoe JE, Kamada T, et al. Dose escalation study of carbon ion radiotherapy for locally advanced carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 2006;65(2):388–97. https://doi.org/10.1016/j.jrobp.2005.12.050.

    Article  PubMed  Google Scholar 

  109. Ando K, Koike S, Nojima K, Chen YJ, Ohira C, Ando S, et al. Mouse skin reactions following fractionated irradiation with carbon ions. Int J Radiat Biol. 1998;74(1):129–38. https://doi.org/10.1080/095530098141799.

    Article  CAS  PubMed  Google Scholar 

  110. Endo M, Koyama-Ito H, Minohara S. HIPLAN. A heavy ion treatment planning system at HIMAC. J Jpn Soc Ther Radiol Oncol. 1996;8:231–8.

    Google Scholar 

  111. Lim K, Small W, Portelance L, Creutzberg C, Jurgenliemk-Schulz IM, Mundt A, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys. 2011;79(2):348–55. https://doi.org/10.1016/j.ijrobp.2009.10.075.

    Article  PubMed  Google Scholar 

  112. Small W, Winter K, Levenback C, Iyer R, Gaffney D, Asbell S, et al. Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of ARM 1 of RTOG 0116. Int J Radiat Oncol Biol Phys. 2007;68(4):1081–7. https://doi.org/10.1016/j.ijrobp.2007.01.026.

    Article  CAS  PubMed  Google Scholar 

  113. Taylor A, Rockall AG, Reznek RH, Powell MEB. Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63(5):1604–12. https://doi.org/10.1016/j.ijrobp.2005.05.062.

    Article  PubMed  Google Scholar 

  114. Toita T, Ohno T, Kaneyasu Y, Uno T, Yoshimura R, Kodaira T, et al. A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer. Jpn J Clin Oncol. 2010;40(5):456–63. https://doi.org/10.1093/jjco/hyp191.

    Article  PubMed  Google Scholar 

  115. Wakatsuki M, Kato S, Ohno T, Karasawa K, Ando K, Kiyohara H, et al. Dose-escalation study of carbon ion radiotherapy for locally advanced squamous cell carcinoma of the uterine cervix (9902). Gynecol Oncol. 2014;132(1):87–92. https://doi.org/10.1016/j.ygyno.2013.10.021.

    Article  PubMed  Google Scholar 

  116. Girinsky T, Rey A, Roche B, Haie C, Gerbaulet A, Randrianarivello H, et al. Overall treatment time in advanced cervical carcinomas - a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys. 1993;27(5):1051–6.

    Article  CAS  PubMed  Google Scholar 

  117. Perez CA, Grigsby PW, CastroVita H, Lockett MA. Carcinoma of the uterine cervix. II. Lack of impact of prolongation of overall treatment time on morbidity of radiation therapy. Int J Radiat Oncol Biol Phys. 1996;34(1):3–11. https://doi.org/10.1016/0360-3016(95)00169-7.

    Article  CAS  PubMed  Google Scholar 

  118. Toita T, Kitagawa R, Hamano T, Umayahara K, Hirashima Y, Aoki Y, et al. Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: efficacy and toxicity of a low cumulative radiation dose schedule. Gynecol Oncol. 2012;126(2):211–6. https://doi.org/10.1016/j.ygyno.2012.04.036.

    Article  CAS  PubMed  Google Scholar 

  119. Kodaira T, Fuwa N, Toita T, Nomoto Y, Kuzuya K, Tachibana K, et al. Clinical evaluation using magnetic resonance imaging for patients with stage III cervical carcinoma treated by radiation alone in multicenter analysis—its usefulness and limitations in clinical practice. Am J Clin Oncol. 2003;26(6):574–83. https://doi.org/10.1097/01.coc.0000045811.97903.2A.

    Article  PubMed  Google Scholar 

  120. Wakatsuki M, Kato S, Kiyohara H, Ohno T, Karasawa K, Tamaki T, et al. Clinical trial of prophylactic extended-field carbon-ion radiotherapy for locally advanced uterine cervical cancer (protocol 0508). PLos One. 2015;10(11):e0143301. https://doi.org/10.1371/journal.pone.0143301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  121. Berman ML, Keys H, Creasman W, Disaia P, Bundy B, Blessing J. Survival and patterns of recurrence in cervical-cancer metastatic to periaortic lymph-nodes—(a Gynecologic Oncology Group-Study). Gynecol Oncol. 1984;19(1):8–16. https://doi.org/10.1016/0090-8258(84)90151-3.

    Article  CAS  PubMed  Google Scholar 

  122. Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, et al. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol. 2012;13(5):E212–E20.

    Article  PubMed  Google Scholar 

  123. Nelson JH, Boyce J, Macasaet M, Lu T, Bohorquez JF, Nicastri AD, et al. Incidence, significance, and follow-up of para-aortic lymph-node metastases in late invasive carcinoma of cervix. Am J Obstet Gynecol. 1977;128(3):336–40.

    Article  PubMed  Google Scholar 

  124. Haie C, Pejovic MH, Gerbaulet A, Horiot JC, Pourquier H, Delouche J, et al. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical-carcinoma - results of a controlled clinical-trial of the EORTC radiotherapy group. Radiother Oncol. 1988;11(2):101–12. https://doi.org/10.1016/0167-8140(88)90245-9.

    Article  CAS  PubMed  Google Scholar 

  125. Rotman M, Pajak TF, Choi K, Clery M, Marcial V, Grigsby PW, et al. Prophylactic extended-field irradiation of paraaortic lymph-nodes in stage-IIB and bulky stage-IB and stage-IIA cervical carcinomas - 10-year treatment results of RTOG-79-20. J Am Med Assoc. 1995;274(5):387–93. https://doi.org/10.1001/jama.274.5.387.

    Article  CAS  Google Scholar 

  126. Grigsby PW, Heydon K, Mutch DG, Kim RY, Eifel P. Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys. 2001;51(4):982–7. https://doi.org/10.1016/S0360-3016(01)01723-0.

    Article  CAS  PubMed  Google Scholar 

  127. Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, et al. Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a Gynecologic Oncology Group Study. Int J Radiat Oncol Biol Phys. 1998;42(5):1015–23. https://doi.org/10.1016/S0360-3016(98)00267-3.

    Article  CAS  PubMed  Google Scholar 

  128. Wakatsuki M, Kato S, Ohno T, Karasawa K, Kiyohara H, Tamaki T, et al. Clinical outcomes of carbon ion radiotherapy for locally advanced adenocarcinoma of the uterine cervix in phase 1/2 clinical trial (protocol 9704). Cancer. 2014;120(11):1663–9. https://doi.org/10.1002/cncr.28621.

    Article  PubMed  Google Scholar 

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Feddock, J., Kunos, C., Pompos, A., Albuquerque, K., Lin, L.L. (2019). Stereotactic Ablative Radiotherapy and Other Newer Treatment Delivery Techniques for Gynecologic Cancers. In: Albuquerque, K., Beriwal, S., Viswanathan, A., Erickson, B. (eds) Radiation Therapy Techniques for Gynecological Cancers. Practical Guides in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-01443-8_10

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