Computer tomography-assisted three-dimensional technique to assess rectal and bladder wall dose in intracavitary brachytherapy for uterine cervical cancer

Sun, Li‐Min; Huang, Eng‐Yen; Ko, Sheung-Fat; Wang, Chong‐Jong; Leung, Stephen Wan; Lin, Hao; Wu, Jiaming; Wu, I-Hsien; Lee, Steve P.

doi:10.1016/j.radonc.2004.03.001

Cited by 26 publications

(17 citation statements)

References 15 publications

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“…With the introduction of a CT/MRI-based target concept, it is now possible to move from a 2D (using X-ray with prescription to the point A) to a 3D target definition and dose optimisation. Although CT imaging is sufficient for definition of OAR (rectum, bladder, sigmoid), it does not provide information about the tumour topography or the distinction between the uterine cervix and corpus [24,[26][27][28][29]. Recently, 3D MRI-guided brachytherapy has been introduced into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The rectum, sigmoid and bladder were considered to be OAR. Treatment pre-plan optimisation and evaluation was based on dose-volume histogram (DVH) parameters for the HR-CTV and OAR [17][18][19][20][21][22][23][24][25][26]. The following day, insertion of applicators was performed in congruent topography as on MRI: identical length of the tandem within the uterus; angle between the tandem and ovoids; distance between the tandem and ovoids; distance between the ovoids; angle between the longitudinal axis of the patient and longitudinal axis of the tandem and ovoids.…”

Section: Patients and Treatmentmentioning

confidence: 99%

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MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy

Doležel¹,

Odrážka²,

Vaňásek³

et al. 2011

BJR

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Objective: The aim of this study was to analyse the feasibility and determine the benefits of MRI-based pre-planning with CT/MRI data fusion in patients with cervical cancer treated with radical radiotherapy. Methods: Patients underwent MRI examination prior to external beam radiotherapy and prior to the first and fourth fraction of brachytherapy with applicators in place. Insertion of applicators at the radiology department was performed under paracervical anaesthesia. The benefit of MRI pre-planning was determined by comparing conventional treatment planning with dose specification to \point A" and dose specification to 90% of the high-risk clinical target volume (HR-CTV D90). Tolerance of MRI evaluation with applicators, coverage of HR-CTV and dose-volume parameters for organs at risk (OAR) has been assessed in 42 brachytherapy procedures. Results: Insertion of applicators at the radiology department was successful in all patients and there were no complications. The target dose was higher for MRI planning than for conventional planning (5.3 Gy vs 4.5 Gy). Maximum doses in the bladder and rectum were significantly lower (p,0.05) for MRI planning than for the conventional approach (6.49 Gy vs 7.45 Gy for bladder; 4.57 Gy vs 5.06 Gy for rectum). We found no correlation between the International Commission on Radiation Units (ICRU) point dose for OAR and the maximum dose in OAR. Nevertheless, a strong correlation between the maximum dose in OAR and the minimal dose in a volume of 2 cm 3 has been observed. Conclusion: MRI-based pre-planning with consecutive CT/MRI data fusion is feasible and safe, with the advantage of increasing the dose to the tumour and decreasing the dose to the organs at risk.

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Section: Discussionmentioning

confidence: 99%

Section: Patients and Treatmentmentioning

confidence: 99%

MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy

Doležel¹,

Odrážka²,

Vaňásek³

et al. 2011

BJR

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show abstract

“…This traditional method does not account for tumor and anatomic variations. As a result, point-based brachytherapy planning can underestimate tumor size and lead to underdosing and poor local control, especially in larger tumors (3,4). Point dosing can also lead to excessive normal tissue toxicity, as with smaller tumors and smaller uteri in which predefined points may deliver dose into the bladder or rectum.…”

Section: Introductionmentioning

confidence: 99%

“…Point dosing can also lead to excessive normal tissue toxicity, as with smaller tumors and smaller uteri in which predefined points may deliver dose into the bladder or rectum. Conventional International Commission on Radiation Units and Measurements (ICRU) points have been shown in several studies to underestimate maximum doses to the bladder and rectum (3,(5)(6)(7)(8)(9)(10)(11), and doses to these points have often failed to correlate with late toxicity (12). This may in part explain the relatively high rates of severe late gastrointestinal (GI) and genitourinary (GU) toxicity in the range of 5% to 10% reported in previous studies of conventional treatment techniques (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Computed Tomography–Based Volumetric Brachytherapy Planning for Cervical Cancer

Simpson¹,

Scanderbeg²,

Carmona³

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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SummaryImage guided brachytherapy (IGBT) has been adopted by multiple centers in recent years for the treatment of cervical cancer. The clinical outcomes are promising, with favorable results compared with those of conventional techniques. Previously reported studies have used primarily magnetic resonance imagingdbased treatment planning. We report the clinical outcomes of a novel hybrid computed tomographyebased IGBT technique. At 2 years, local control was excellent, with low rates of treatment toxicity. Further Purpose/Objectives: A report of clinical outcomes of a computed tomography (CT)-based image guided brachytherapy (IGBT) technique for treatment of cervical cancer. Methods and Materials: Seventy-six women with International Federation of Gynecology and Obstetrics stage IB to IVA cervical carcinoma diagnosed between 2007 and 2014 were treated with definitive external beam radiation therapy (EBRT) with or without concurrent chemotherapy followed by high-dose-rate (HDR) IGBT. All patients underwent planning CT simulation at each implantation. A high-risk clinical target volume (HRCTV) encompassing any visible tumor and the entire cervix was contoured on the simulation CT. When available, magnetic resonance imaging (MRI) was performed at implantation to assist with tumor delineation. The prescription dose was prescribed to the HRCTV. Results: The median follow-up time was 17 months. Thirteen patients (17%) had an MRI done before brachytherapy, and 16 patients (21%) were treated without MRI guidance. The mean EBRT/IGBT sum 2-Gy equivalent dose (EQD2) delivered to the 90% volume of the HRCTV was 86.3 Gy. The mean maximum EQD2s delivered to 2 cm 3 of the rectum, sigmoid, and bladder were 67.5 Gy, 66.2 Gy, and 75.3 Gy, respectively. The 2-year cumulative incidences of local, locoregional, and distant failure were 5.8% (95% confidence interval [CI]: 1.4%-14.8%), 15.1% (95% CI: 5.4%-29.4%), and 24.3% (95% CI: 12.1%-38.9%), respectively. The 2-year overall and disease-free survival rates were 75% (95% CI, 61%-91%) and 73% (95% CI, 60%-90%), respectively. Twenty-nine patients (38%) experienced grade !2 acute toxicity, with 5 cases of acute grade 3 toxicity and no grade !4 toxicities. One

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“…Another study suggested the use of ultrasound to define bladder dose (30). More recently, three-dimensional imaging has been offered as a way to minimize bladder dose in the treatment of cervical cancer (31). Bladder distention by use of a balloon inflated inside the bladder has also been used to standardize bladder volume in the treatment of cervical cancer (32).…”

Section: Discussionmentioning

confidence: 99%

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Barney¹,

Macdonald²,

Lee³

et al. 2007

Brachytherapy

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Computer tomography-assisted three-dimensional technique to assess rectal and bladder wall dose in intracavitary brachytherapy for uterine cervical cancer

Cited by 26 publications

References 15 publications

MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy

MRI-based pre-planning in patients with cervical cancer treated with three-dimensional brachytherapy

Clinical Outcomes of Computed Tomography–Based Volumetric Brachytherapy Planning for Cervical Cancer

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

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