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Radiotherapy in Gynecological Cancer: State of the Art

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Special Issue Editors

Special Issue Information

Dear Colleagues,

This Special Issue of Cancers considers the quick evolution of radiation oncology in the gynaecological tumour sites of endometrial, cervical, vaginal and vulvar cancers. Considering the variety of advances achieved in the last decade, radiotherapy in gynaecological cancer has become increasingly well established and there has been an increase in cancer treatment results. At present, new indications and new techniques to be employed in this scenario include intensity-modulated radiotherapy, image-guided external beam irradiation, image-guided brachytherapy, stereotactic body radiation and intraoperative radiotherapy between others. Recently, tumour markers have been related to radiotherapy indications, leading omics-based and other adjuvant treatments to now be in the pipeline. Artificial intelligence is currently being developed for future use in this field.

This is a promising Special Issue that aims to establish the state of the art in the radiotherapy of gynaecological cancers via reviews or research articles developed by radiation oncologists, medical oncologists and medical physicists, with a view into the future.

The Guest Editors of this Special Issue look forward to receiving your contributions.

Dr. Àngeles Rovirosa
Dr. Gabriella Macchia
Dr. Luca Tagliaferri
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

interventional radiotherapy
brachytherapy techniques
gynecological oncology
educational gynecology
gynecological cancer

Published Papers (2 papers)

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Research

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14 pages, 2676 KiB

Open AccessArticle

Stages I–III Inoperable Endometrial Carcinoma: A Retrospective Analysis by the Gynaecological Cancer GEC-ESTRO Working Group of Patients Treated with External Beam Irradiation and 3D-Image Guided Brachytherapy

by Ángeles Rovirosa, Yaowen Zhang, Kari Tanderup, Carlos Ascaso, Cyrus Chargari, Elzbieta Van der Steen-Banasik, Piotr Wojcieszek, Magdalena Stankiewicz, Dina Najjari-Jamal, Peter Hoskin, Kathy Han, Barbara Segedin, Richard Potter and Erik Van Limbergen

Cancers 2023, 15(19), 4750; https://doi.org/10.3390/cancers15194750 - 27 Sep 2023

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Abstract

Background/Purpose: Analyse the outcomes of stages I–III inoperable endometrial cancer (IEC) patients treated with external-beam-irradiation (EBRT) and 3D-image-guided-brachytherapy (IGBT). Material and Methods: Medical records of IEC patients receiving EBRT + IGBT in eight European and one Canadian centres (2004–2019) were examined, including: pelvic ± para-aortic EBRT and lymph node boost; anaesthetic procedure, applicators, BT-planning imaging, clinical target volume (CTV), brachytherapy schedule, and EQD2 to the CTV_{(α/β=4.5Gy)} and D2 cm³_(α/β=3Gy) for organs at risk. Complications are evaluated using CTCAEv4 scores. The 2- and 5-year survival probability according to stages was estimated (cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS)). Statistics: descriptive analysis and the Kaplan–Meier method. Results: 103 patients (stages: I-44, II-14, III-44) were included. Median follow-up: 28 months (7–170). All patients received pelvic ± para-aortic EBRT. Median D90-EQD2_(α/β=4.5) to the CTV:73.3 Gy (44.6–132.7), 69.9 Gy (44.7–87.9 and 75.2 Gy (55.1–97) in stages I, II, and III, respectively. Thirty patients presented relapse (stages: 10-I, 3-II, 17-III): 24 uterine (stages: 7-I, 3-II, 14-III), 15 nodal (stages: 4-I, 1-II, 10-III), and 23 distant (stages: 6-I, 2-II, 15-III). Five year CSS was 71.2% (stages: 82%-I-II and 56%-III) and DFS, LRFS, LRRFS, and DMFS were 55.5%, 59%, 72%, and 67.2%, respectively. Late G3-G4 complications (crude): 1.3% small bowel, 2.5% rectum, and 5% bladder. Conclusion: In stages I–III of the IEC, EBRT + IGBT offer good 2- and 5-year CSS of 88.7% and 71.2%, respectively, with the best outcomes in stages I–II. Prospective studies are needed to determine how better outcomes can be achieved. Full article

(This article belongs to the Special Issue Radiotherapy in Gynecological Cancer: State of the Art)

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21 pages, 651 KiB

Open AccessSystematic Review

Hematologic Toxicity and Bone Marrow-Sparing Strategies in Chemoradiation for Locally Advanced Cervical Cancer: A Systematic Review

by Dinah Konnerth, Aurelie Gaasch, Annemarie Zinn, Paul Rogowski, Maya Rottler, Franziska Walter, Johannes Knoth, Alina Sturdza, Jan Oelmann, Freba Grawe, Raphael Bodensohn, Claus Belka and Stefanie Corradini

Cancers 2024, 16(10), 1842; https://doi.org/10.3390/cancers16101842 - 11 May 2024

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Abstract

The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT). Particularly, pelvic bone marrow dose exposure has been identified as a contributing factor to this hematologic toxicity. Chemotherapy further increases bone marrow suppression, often necessitating treatment interruptions or dose reductions. A systematic search for original articles published between 1 January 2006 and 7 January 2024 that reported on chemoradiotherapy for locally advanced cervical cancer and hematologic toxicities was conducted. Twenty-four articles comprising 1539 patients were included in the final analysis. HT of grade 2 and higher was observed across all studies and frequently exceeded 50%. When correlating active pelvic bone marrow and HT, significant correlations were found for volumes between 10 and 45 Gy and HT of grade 3 and higher. Several dose recommendations for pelvic bone and pelvic bone marrow sparing to reduce HT were established, including V10 < 90–95%, V20 < 65–86.6% and V40 < 22.8–40%. Applying dose constraints to the pelvic bone/bone marrow is a promising approach for reducing HT, and thus reliable implementation of therapy. However, prospective randomized controlled trials are needed to define precise dose constraints and optimize clinical strategies. Full article

(This article belongs to the Special Issue Radiotherapy in Gynecological Cancer: State of the Art)

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