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Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality.A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken. All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity. Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.
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Abstract Close contact with the Tumor Board and gynecologic clinics of the White Memorial Hospital of the College of Medical Evangelists clearly impressed us with the large number of far-advanced genital cancers found in patients treated in this medical school clinic. Examination of the literature and our own records revealed a favorable five-year survival in completely treated Stage I cancers of the cervix in 80 per cent of cases. In Stage II, cervical cancer, five-year survival is approximately 30 per cent; while in Stage III, only 10 to 15 per cent were alive in five years. Taking the over-all results from the leading American clinics, we find only 25 to 30 per cent of the women with arrested cervical cancer alive after five years. These facts forcefully manifested the need for early diagnosis. Pack and Gallo 1 studied one thousand cases selected at random from the Memorial Hospital and the Patterson General Hospital from the standpoint of delay in treatment. The patient and/or physician was responsible for the delay in 35 per cent, and in only 20.7 per cent was there less than three months between onset of symptoms and the beginning of acceptable treatment. The patient was responsible for the delay in 44.3 per cent of the cases. The need for earlier diagnosis is imperative if present cure rates are to be improved upon by the use of our diagnostic and therapeutic facilities. Vaginal cytologic methods, as reported by Papanicolaou and Traut, 2 seem to offer an additional method for early diagnosis and screening of a large number of patients. A study was made of the method in 1944, and, early in 1945, the authors spent some weeks in the laboratory of Dr. Papanicolaou.
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Glaser S, Beriwal S. Brachytherapy for malignancies of the vagina in the 3D era. Journal of Contemporary Brachytherapy. 2015;7(4):312-318. doi:10.5114/jcb.2015.54053. APA Glaser, S., & Beriwal, S. (2015). Brachytherapy for malignancies of the vagina in the 3D era. Journal of Contemporary Brachytherapy, 7(4), 312-318. https://doi.org/10.5114/jcb.2015.54053 Chicago Glaser, Scott M., and Sushil Beriwal. 2015. "Brachytherapy for malignancies of the vagina in the 3D era". Journal of Contemporary Brachytherapy 7 (4): 312-318. doi:10.5114/jcb.2015.54053. Harvard Glaser, S., and Beriwal, S. (2015). Brachytherapy for malignancies of the vagina in the 3D era. Journal of Contemporary Brachytherapy, 7(4), pp.312-318. https://doi.org/10.5114/jcb.2015.54053 MLA Glaser, Scott M. et al. "Brachytherapy for malignancies of the vagina in the 3D era." Journal of Contemporary Brachytherapy, vol. 7, no. 4, 2015, pp. 312-318. doi:10.5114/jcb.2015.54053. Vancouver Glaser S, Beriwal S. Brachytherapy for malignancies of the vagina in the 3D era. Journal of Contemporary Brachytherapy. 2015;7(4):312-318. doi:10.5114/jcb.2015.54053.
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Abstract.
Tyree WC, Cardenes H, Randall M, Papiez L. High-dose-rate brachytherapy for vaginal cancer: learning from treatment complications. Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality. A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken. All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity. Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.Vaginal cancer
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