ABSTRACT
OBJECTIVES: To assess the outcome and the fertility aspects in the particular population of cervical and/or vaginal clear cell adenocarcinoma (CCA) associated or not to previous in utero diethylstilbestrol exposure. METHODS: From January 1970 to December 2003, data from 61 consecutive patients with cervical and/or vaginal histologically proven CCA treated with brachytherapy (BT) aimed at a conservative treatment at the Institut Gustave Roussy as a part of treatment were retrospectively analyzed. RESULTS: The median follow-up was 9.4 years, ranging from 0.3 to 27.4 years. The 5-year specific overall survival rate was 79%. The median time of disease-free survival was 5.8 years. In the subgroup of 42 patients with a cervical CCA, 12 patients tried to be pregnant, 2 patients became pregnant and had miscarriages (P2M2 and P1M1). No pregnancy has been observed in 10 patients exclusively owing to anomalies of the reproductive tract: 6 patients had partial or total diaphragm, 2 patients had an anatomical alteration of the uterus, 1 patient had atrophic endometrium, and 1 patient had primary infertility. In the subgroup of 19 patients with a vaginal CCA, 7 patients tried to be pregnant. All of them had no morphological and/or functional anomalies of the genital tract. Three of 7 patients had delivered healthy babies (P1D1, P2D2, and P3M2D1), and another one had a miscarriage (P1M1). Moreover, all babies were delivered by cesarean section. The pregnancy rate was 10% (6 of 61 patients) with 3 healthy babies. CONCLUSION: Conservative approach in patients with female genital tract CCA including BT gives good results with good survival rates and an interesting global pregnancy rate.
Subject(s)
Adenocarcinoma, Clear Cell/mortality , Brachytherapy , Fertility Preservation , Pregnancy Complications, Neoplastic/mortality , Uterine Cervical Neoplasms/mortality , Vaginal Neoplasms/mortality , Adenocarcinoma, Clear Cell/radiotherapy , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Neoplasm Staging , Pregnancy , Pregnancy Complications, Neoplastic/radiotherapy , Prognosis , Retrospective Studies , Survival Rate , Time Factors , Uterine Cervical Neoplasms/radiotherapy , Vaginal Neoplasms/radiotherapy , Young AdultABSTRACT
BACKGROUND AND PURPOSE: To investigate the inter-observer variation of target contouring when using the GYN GEC-ESTRO recommendations for MR image-guided brachytherapy (IGBT) for cervical cancer. MATERIALS AND METHODS: Nineteen cervical cancer patients, treated by radiotherapy at the Institut Gustave Roussy (IGR) in France (n=9) or at the Medical University of Vienna (AKH) in Austria (n=10) were included in this study. IGBT was used for all patients. Two radiation oncologists, one from IGR and the other from AKH, outlined the target volumes on MRI at the time of brachytherapy according to the GYN GEC-ESTRO recommendations. The absolute, common and encompassing volumes and their conformity indices (CIs) were assessed for the GTV, HR CTV and IR CTV. D90 and D100 for each volume were assessed. Visual evaluation was made to assess the reasons for the most frequent inter-observer differences. RESULTS: The mean volumes of GTV and HR CTV did not differ significantly between the observers, p>0.05. Significant differences were observed only for the mean volumes of the IR CTV of both centres, p<0.05. CIs ranged from 0.5 to 0.7. DVH-parameter analyses did not reveal any statistical differences, except for the D100 for the GTV at AKH, and the D90 for the IR CTV at IGR, p<0.05. Underlying reasons for inter-observer differences included image contrast adjustment and neglecting to consider anatomical borders. CONCLUSIONS: The results of this inter-observer study show that the application of the GYN GEC-ESTRO recommendations for IGBT contouring at two different institutions with two different traditions for applicators, CTV assessment, MR image acquisition and dose prescription is feasible, and it produces acceptable inter-observer variability.
