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8 results

  • Impact of CT-based planning and bladder volume changes on the dosimetry of vaginal vault brachytherapy

  • Jeyaanth Venkatasai, Jebakarunya Ramireddy, Arvind Sathyamurthy, Henry Finlay Godson, Reka Karuppusami, Saikat Das, Thomas Samuel Ram
  • Journal:
    Journal of Radiotherapy in Practice / Volume 21 / Issue 3 / September 2022
    Published online by Cambridge University Press:
    09 February 2021, pp. 321-327
  • Aim:

    To compare dose to target and organs at risk (OARs) in conventional plan (2D) versus computed tomography (CT)-based three-dimensional (3D) plan in vaginal cuff brachytherapy (VBT) and to compare the effect of bladder distension on target and OARs dosimetry.

    Materials and methods:

    Post-hysterectomy patients with an indication for VBT were included in the study. All patients underwent planning CT scans with a full bladder and an empty bladder protocol. For each CT, two plans were generated—one library-based 2D plan and another CT-based 3D plan. Dosimetric parameters were recorded for clinical target volume (CTV) and OARs.

    Results:

    A total of 92 observations were made from data collected from 46 patients. Difference between CTV dose in terms of 2D and 3D plans were not statistically significant for CTV (p = 0·11). Significant reduction in D0·1cc, D1cc and D2cc dose parameters were observed in bladder, rectum, sigmoid and bowel doses with the 3D plan (p < 0·001). Bladder distension showed a 20% reduction in dose for bowel (p < 0·001). Bladder distension also showed a 6·12% (p = 0·047) increase in D2cc, but there was a significant reduction in the mean dose to the bladder.

    Conclusion:

    Our study demonstrates the dosimetric benefits with 3D CT-based planning for VBT over 2D-based conventional planning and benefit of bladder distension in the reduction of bowel dose without compromising dose to the target volume.

  • 15 - Current clinical trials in ovarian cancer

  • from SECTION 4 - WHAT QUESTIONS ARE BEING ASKED BY CURRENT CLINICAL TRIALS?
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 205-222

  • Summary

    Epithelial ovarian cancer (EOC) is the most common cause of death among women who develop gynaecological cancer and the fifth most common cause of cancer related death in females in Western countries. The value of the neoadjuvant approach in the primary treatment of advanced EOC is currently one of the most debated issues in gynaecological oncology worldwide. The disease-free interval, number of recurrence sites, patient's performance status, surgical outcome of the primary surgery and current amount of ascites have been discussed as possible predictive factors of clinical outcome in surgery at recurrence. Anti-angiogenic therapy represents huge effort in translational research, with high expectations from investigators and patients alike. The proliferation of clinical trials in ovarian cancer reflects the focus and determination of investigators internationally and many promising hypotheses are being explored within the international collaborative efforts.

  • 8 - The role of robotics and the future

  • from SECTION 3 - IMAGING AND THERAPY: STATE OF THE ART
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 99-108

  • Summary

    Laparoscopic surgery has become an essential part of the surgical treatment for gynaecological conditions including malignancy. This chapter describes the use of conventional laparoscopic surgery in gynaecological cancer, the advantages and disadvantages of robotic surgery, and the feasibility and outcomes of the use of robotics in gynaecological cancer surgery. The da Vinci Surgical System is equipped with a three-dimensional vision system. Robotic surgery is well suited to virtual reality training as the operation is computer guided. 3D virtual reality images can be projected into the console of the robot. A number of virtual reality training simulators have been created. Several authors have reported that robotically assisted staging surgery in endometrial cancer is comparable to conventional laparoscopic and open laparotomy approaches in terms of surgical outcomes. A phase III randomised clinical trial comparing laparoscopic with robotically assisted surgery in women with early-stage cervical cancer is under way.

  • 3 - Epigenetic biomarkers in ovarian cancer

  • from SECTION 1 - BIOLOGY OF GYNAECOLOGICAL CANCERS: OUR CURRENT UNDERSTANDING
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 31-40

  • Summary

    Tumour biomarkers and an understanding of the mechanisms of epigenetic regulation are a key to identify novel epigenetic therapies, and epigenetic biomarkers also have potential to impact on clinical management in gynaecological cancer. DNA methylation has many potential advantages as a cancer biomarker since it is stable, provides a binary read-out and is frequently aberrant in cancer. Methylation profiling of tumours has allowed the identification of genome-wide DNA methylation patterns as well as the identification of loci that are associated with response or survival of women with ovarian cancer following chemotherapy. EZH2 knockdown in ovarian cell lines has been shown to lead to reduced cell growth/proliferation, as well as cell migration and/or invasion in vitro. It has also led to the re-sensitisation of drug-resistant ovarian cancer cells to cisplatin. Histone deacetylase (HDAC) and DNA methyltransferases (DNMT) inhibitors are now used in the treatment of certain haematological malignancies.

  • 10 - Antivascular therapy in gynaecological cancers

  • from SECTION 3 - IMAGING AND THERAPY: STATE OF THE ART
  • Edited by Sean Kehoe, Richard J. Edmondson, Martin Gore, Iain A. McNeish
  • Book:
    Gynaecological Cancers
    Published online:
    05 February 2014
    Print publication:
    01 June 2011, pp 121-138

  • Summary

    The great majority of women with advanced ovarian cancer will relapse and die from the disease. Angiogenesis is particularly relevant to ovarian cancer. Tumour vascular endothelial growth factor (VEGF) overexpression is associated with tumour angiogenesis, malignant progression and metastasis, ascites formation and early recurrence and death from the disease. Chemotherapy and vascular disrupting agents (VDAs) can cause mobilisation of bone marrow progenitor cells, including circulating endothelial progenitor cells (CEPs), which could theoretically increase angiogenesis. Two trials of combination therapy that included bevacizumab have suggested discrepancies between CA125 and RECIST response evaluation. VDAs selectively target pre-existing tumour vasculature, leading to rapid tumour cell ischaemia and death. The decrease in vascular tumour perfusion seen using dynamic contrast imaging suggests dynamic methods such as DCE-MRI, positron emission tomography-computed tomography (PET/CT) and MR spectroscopy in phase I and II trials may give an early indication of antivascular effect.

  • Patient compliance with the use of vaginal dilators following pelvic radiotherapy for a gynaecological cancer

  • Lisa Punt
  • Journal:
    Journal of Radiotherapy in Practice / Volume 10 / Issue 1 / March 2011
    Published online by Cambridge University Press:
    15 March 2011, pp. 13-25

  • Background: In July 2005 the national forum of gynaecological oncology nurses published the first UK best practice guidelines for the use of vaginal dilators after pelvic radiotherapy. It was written following a Cochrane review by Denton and Maher suggesting that vaginal dilators minimised vaginal stenosis and improved sexual function. Women within the author’s large cancer centre are advised to use vaginal dilators in accordance with the national recommendations.

    Primary outcome measure: To evaluate compliance with the use of vaginal dilators in women who have received radiotherapy for either cervix or endometrial cancer. Compliance was defined as the use of vaginal dilators two or more times a week, at 6 months.

    Design: One hundred and sixty-four women were posted questionnaires. Potential participants had received pelvic radiotherapy for cancer of the cervix or endometrium, were 6 months to 5 years post-treatment and disease free. The 18-point questionnaire consisted of 11 points assessing demographics and dilator use, while points 12–18 related to vaginal symptoms. Simple descriptive statistics were used to describe demographics. Mann–Whitney U and Fisher’s exact tests were used for one-at-a-time analysis of compliance against age, vaginal symptoms, treatment modality and cancer type.

    Results: Seventy-five completed questionnaires were returned (response rate 45.7%). Seventy-four out of the 75 respondents had been offered vaginal dilators during treatment. 89.2% (66/74) were compliant with vaginal dilation (95% confidence interval 80.1% to 94.4%).

    Conclusion: The compliance rate in this study was greater than seen in previously published studies. This could be due to the intervention by practitioners within the author’s cancer centre. Further prospective evaluation studies are required to explore the potential benefits of intervention at 6 months post-treatment to improve long-term compliance.

  • 2 - Basic pathology of gynaecological cancer

  • Edited by Nigel Acheson, David Luesley
  • Book:
    Gynaecological Oncology for the MRCOG and Beyond
    Published online:
    05 August 2014
    Print publication:
    01 January 2011, pp 15-34

  • Summary

    This chapter describes the salient features that would enable the gynaecologist to aid and understand the pathologist in examination of specimens removed for diagnosis and definitive surgery for gynaecological cancers. Cervical intraepithelial neoplasia (CIN) is the term used to describe proliferative intraepithelial squamous lesions that display abnormal maturation and cytonuclear atypia. The diagnosis of endometrial hyperplasia has been shown to be an area of gynaecological pathology with low diagnostic reproducibility. Mixed tumours of the uterus contain a mixture of glands and mesenchymal tissue: müllerian adenomyomas, including adenomyoma of endocervical type, typical adenomyomas of endometrioid type, atypical polypoid adenomyoma. There are three main groups of primary ovarian tumours: epithelial tumours that are derived from müllerian epithelium; sex-cord or stromal tumours, derived from the ovarian stroma, sex-cord derivatives or both; and germ cell tumours, which originate from the ovarian germ cells.