Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Mazeron, R.; Fokdal, Lars; Kirchheiner, Kathrin; Georg, Petra; Jastaniyah, Noha; Šegedin, Barbara; Mahantshetty, Umesh; Hoskin, Peter; Jürgenliemk-Schulz, Ina M.; Kirisits, Christian; Lindegaard, J.C.; Dörr, Wolfgang; Haie-Méder, Christine; Tanderup, Kari; Pötter, Richard

doi:10.1016/j.radonc.2016.06.006

Cited by 217 publications

(139 citation statements)

References 31 publications

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“…In a prospective trial of MR-guided brachytherapy (EMBRACE, international study on MRI-guided Brachytherapy in Locally Advanced Cervical Cancer) 23% of patients received a combined intracavitary/interstitial approach for at least one BT fraction. A follow-up analysis of rectal toxicities showed that the 3-year fistula risk was 12.5% with D2cc ≥ 75 Gy, and patients had a two-fold lower risk of proctitis with D2cc <65 Gy [5]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix

Kamran¹,

Manuel

Cho

et al. 2017

Gynecologic Oncology

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Objective The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT). Methods 56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005–2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®. Results Median follow-up time was 19.7 months (MR group) and 18.4 months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size >4 cm, grade, FIGO stage or lymph node involvement between the groups. Patients in the MR group had more lymphovascular involvement compared to patients in the CT group (p<0.01). When evaluating plans generated, there were no statistically significant differences in median cumulative dose to the high-risk clinical target volume or the OAR. 2-year K-M LC rates for MR-based and CT-based treatments were 96% and 87%, respectively (log-rank p=0.65). At 2 years, OS was significantly better in the MR-guided cohort (84% vs. 56%, p=0.036). On multivariate analysis, squamous histology was associated with longer OS (HR 0.23, 95% CI 0.07–0.72) in a model with MR BT (HR 0.35, 95% CI 0.08–1.18). Conclusion In this population of locally advanced cervical-cancer patients, MR-guided HDR BT resulted in estimated 96% 2-year local control and excellent early survival rates. Squamous cell histology was the most significant predictor for survival.

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Section: Introductionmentioning

confidence: 99%

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix

Kamran¹,

Manuel

Cho

et al. 2017

Gynecologic Oncology

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“…39 The IGABT could optimize bowel dosimetry, especially for underweight patients with no or less intraabdominal fat, as the bowel loops are usually in very close proximity to the cervix and uterus. 18 Despite these limitations, the strength of this study was the inclusion of 245 patients treated with IMRT in a consistent fashion and a follow-up period of more than 5 years. Moreover, both clinical and dosimetric predictors of GI toxicity were evaluated.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Body Mass Index and Weight Change on Late Gastrointestinal Toxicity in Locally Advanced Cervical Cancer Treated With Intensity-modulated Radiotherapy

Lee

Chang

Lin

et al. 2018

Int J Gynecol Cancer

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“…[63] have published the dose-volume effect relationship for late rectal morbidity of 960 patients treated in EMBRACE protocol. This data has to be compared cautiously with patients treated exclusively with a perineal IC/interstitial implant, mainly because of the bigger volumes of treatment in the last ones.…”

Section: Discussionmentioning

confidence: 99%

Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience

Villalba

Sancho

Palacin

et al. 2016

jcb

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PurposeTo study outcome and toxicity in 59 patients with locally advanced cervix carcinoma treated with computed tomography (CT)-based Martinez universal perineal interstitial template (MUPIT) and the new magnetic resonance imaging (MRI)-compatible template Benidorm (TB).Material and methodsFrom December 2005 to October 2015, we retrospectively analyzed 34 patients treated with MUPIT and 25 treated with the TB. Six 4 Gy fractions were prescribed to the clinical target volume (CTV) combined with external beam radiotherapy (EBRT). The organs at risk (OARs) and the CTV were delineated by CT scan in the MUPIT implants and by MRI in the TB implants. Dosimetry was CT-based for MUPIT and exclusively MRI-based for TB. Dose values were biologically normalized to equivalent doses in 2 Gy fractions (EQD2).ResultsMedian CTV volumes were 163.5 cm3 for CT-based MUPIT (range 81.8-329.4 cm3) and 91.9 cm3 for MRI-based TB (range 26.2-161 cm3). Median D90 CTV (EBRT + BT) was 75.8 Gy for CT-based MUPIT (range 69-82 Gy) and 78.6 Gy for MRI-based TB (range 62.5-84.2 Gy). Median D2cm3 for the rectum was 75.3 Gy for CT-based MUPIT (range 69.8-132.1 Gy) and 69.9 Gy for MRI-based TB (range 58.3-83.7 Gy). Median D2cm3 for the bladder was 79.8 Gy for CT-based MUPIT (range 71.2-121.1 Gy) and 77.1 Gy for MRI-based TB (range 60.5-90.8 Gy). Local control (LC) was 88%. Overall survival (OS), disease free survival (DFS), and LC were not statistically significant in either group. Patients treated with CT-based MUPIT had a significantly higher percentage of rectal bleeding G3 (p = 0.040) than those treated with MRI-based TB, 13% vs. 2%.ConclusionsTemplate Benidorm treatment using MRI-based dosimetry provides advantages of MRI volume definition, and allows definition of smaller volumes that result in statistically significant decreased rectal toxicity compared to that seen with CT-based MUPIT treatment.

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Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

Cited by 217 publications

References 31 publications

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix

The Effect of Body Mass Index and Weight Change on Late Gastrointestinal Toxicity in Locally Advanced Cervical Cancer Treated With Intensity-modulated Radiotherapy

Development and clinical implementation of a new template for MRI-based intracavitary/interstitial gynecologic brachytherapy for locally advanced cervical cancer: from CT-based MUPIT to the MRI compatible Template Benidorm. Ten years of experience

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