Gynecological

An Emerging Option for the Treatment of Gynecological Cancers

A NEW TARGETED APPROACH WITH CESIUM-131

Permanent implants with Cesium-131 are an emerging treatment option for patients with recurrent gynecologic cancers. Treatment for these patients can be challenging, as the patients are often facing radical surgery with few other options. Historically, Au-198 (gold) implants were used in selected cases but widespread adoption was limited by dose to the clinician and ability to limit dose to surrounding tissue.

In recent years, the University of Kentucky has shifted their focus to the use of Cesium-131 for these patients. The energy profile and 9.7 day half-life of Cesium-131 allows for a high concentration of dose to the targeted tissue, while limiting dose to surrounding structure and the treatment team.

CESIUM-131 CAN BE USED FOR RECURRENT OR NEW CANCERS

Implantation with Cesium-131 is an efficient, out-patient alternative for patients to avoid exenteration procedures as well as a potentially curative therapy where exenteration is not a viable or acceptable option.

CESIUM-131 BRACHYTHERAPY CAN BE INCORPORATED INTO DEFINITIVE TREATMENT

The team at the University of Kentucky presented their initial data regarding using Cs-131 Brachytherapy in the treatment of gynecologic cancers at the 2016 World Congress of Brachytherapy2. All patients were locally controlled at the of the report. A total of 25 interstitial procedures were performed demonstrating the safety of brachytherapy. No unexpected toxicities were identified. They also showed that utilizing brachytherapy in place of intracavitary techniques could reduce the dose to organs at risk in many cases as much as 20% or more.

Local control rates following brachytherapy implants for recurrent implants.

Local control rates following brachytherapy implants for recurrent implants. Initial cohort included 17 treatments in 14 patients. After a median follow-up of 14 months, the local control rate with brachytherapy was 80.7%.

“PERMANENT INTERSTITIAL BRACHYTHERAPY WITH CESIUM-131 SHOULD AT LEAST BE CONSIDERED FOR ANY WOMAN PRESENTING WITH A LOCAL RECURRENCE OF A GYNECOLOGIC CANCER”

Jonathan Feddock

Assistant Professor, University of Kentucky

Resources

1. 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 May;133(2):268-73. doi: 10.1016/j.ygyno.2014.02.015. Epub 2014 Feb 17.

2. Feddock J, Aryal P, Wooten C, Randall M.Outpatient Interstitial Implants – Integrating Cesium-131 Permanent Interstitial Brachytherapy into Definitive Treatment for Gynecologic MalignanciesMay–June, 2016, Volume 15, Supplement 1, Pages S93–S94.

3. Okazawa K, Yuasa-Nakagawa K, Yoshimura R, Shibuya H. Permanent interstitial reirradiation with Au-198 seeds in patients with post-radiation locally recurrent uterine carcinoma. J Radiat Res. 2013 Mar; 54(2): 299–306.

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