Dosimetric impact of target definition in brachytherapy for cervical cancer – Computed tomography and trans rectal ultrasound versus magnetic resonance imaging

Swamidas, Jamema; Jain, Jeevanshu; Nesvacil, N.; Tanderup, Kari; Kirisits, Christian; Schmid, Max; Agarwal, Priyanka; Joshi, Kishore; Naga, Pushpa; Khadanga, Chira Ranjan; Gudi, Shivakumar; Gurram, Lavanya; Chopra, Supriya; Mahantshetty, Umesh

doi:10.1016/j.phro.2022.02.002

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…Additionally, abdominal ultrasound-guided needle insertion is susceptible to hindrance caused by factors, such as intestinal gas and obesity. TRUS-guided implant insertion and incorporating TRUS-based measurements for CT-based target volume contouring can significantly improve outcomes in centers with limited access to MRI [ 3 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Trans-rectal ultrasound-guided hybrid intra-cavitary and interstitial brachytherapy in carcinoma cervix: A feasibility study from a tertiary cancer center in India

Bajwa,

Singareddy,

Talluri

et al. 2023

jcb

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Purpose To report the feasibility of performing hybrid intra-cavitary and interstitial (IC/IS) brachytherapy in patients with carcinoma cervix under trans-rectal ultrasound (TRUS) guidance. Material and methods All patients who received an external beam radiotherapy (EBRT) dose of 50 Gy in 25 fractions with weekly chemotherapy, followed by a brachytherapy boost (21 Gy in 3 fractions) were prospectively included for analysis. IC/IS brachytherapy was performed using Fletcher style tandem and ovoid applicator with interstitial component under TRUS guidance. Parameters of implant quality analyzed included ability to insert tandem, ratio of needles loaded to the number of needles inserted, and incidence of uterine or organ at risk (OARs) perforation. Dosimetric parameters evaluated were dose to point A*, TRAK, D 90 high-risk clinical target volume (HR-CTV), and D 2cc to OARs (bladder, rectum, and sigmoid). Width and thickness of the target was compared between TRUS (TRUS w and TRUS t ) and MRI (MRI w and MRI t ). Results Twenty carcinoma cervix patients treated with IC/IS brachytherapy were included for analysis. The mean HR-CTV volume was 36 cc. The median number of needles used were 6 (range, 2-10 needles). None of the patients had uterine perforation. Two patients had bowel and bladder perforation. The mean D 90 HR-CTV and D 98 HR-CTV were 87.3 Gy and 82 Gy EQD 2 , respectively. The mean D 2cc to the bladder, rectum, and sigmoid were 80 Gy, 70 Gy, and 64 Gy EQD 2 , respectively. The mean dose to point A* was 70.4 Gy EQD 2 . The mean TRAK was 0.40. The mean TRUS w (±SD) and MRI w (±SD) were 4.58 cm (±0.44) and 4.49 cm (±0.50), respectively. The mean TRUS t (±SD) and MRI t (±SD) were 2.7 cm (±0.59) and 2.62 cm (±0.59), respectively. On statistical analysis, there was a significant correlation between TRUS w and MRI w ( r = 0.93), and TRUS t and MRI t ( r = 0.98). Conclusions TRUS-guided IC/IS brachytherapy is feasible and provides adequate coverage of the target, with acceptable doses to OARs.

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Section: Discussionmentioning

confidence: 99%

Trans-rectal ultrasound-guided hybrid intra-cavitary and interstitial brachytherapy in carcinoma cervix: A feasibility study from a tertiary cancer center in India

Bajwa,

Singareddy,

Talluri

et al. 2023

jcb

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“…Based on the above findings, it is advisable to combine physical examination and pre-BT MRI to improve CT-guided delineations [20,34]. Furthermore, enhanced CT and/or ultrasound may also reduce the variations in and dose impacts of target delineation [41,42]. Several consensuses have been issued for CT-guided target delineation [43][44][45].…”

Section: Ct-guided Contouring and Planningmentioning

confidence: 99%

“…In follow-up studies, they developed an optical tracking device as a reference structure to overcome limitations in anterior and cranial borders of CTV HR due to the limited probe length and its acoustic shadowing [78]. Swamidas et al [41] also reported no statistically significant differences in CTV HR and OARs between TRUS/CT-and MRI-based planning in 21 patients who received IC/IS or IC. However, the dosimetric and clinical outcome impacts of TRUS-guided BT in a large sample remain to be reported.…”

Section: Us-guided Bt: Promising and Low-costmentioning

confidence: 99%

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

Wang,

Jiang

2023

Current Oncology

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Background: Brachytherapy (BT) is a critical component of radiotherapy for locally advanced cervical cancer (LACC), and it has rapidly developed in recent decades. Since the advent of three-dimensional image-guided adaptive brachytherapy (3D-IGABT), magnetic resonance imaging (MRI) has emerged as the primary modality for image guidance. Meanwhile, other imaging modalities, such as computed tomography, 18F-fluorodeoxyglucose positron emission tomography, ultrasound, and their combinations have also been widely studied. Materials and methods: We reviewed studies on different imaging modalities utilized for target delineation and planning. Emerging techniques in IGABT like real-time image guidance and 3D printing were also included. We summarized research on their feasibility and concentrated on their clinical outcomes. Results: MRI-guided BT was the gold standard, and CT-guided BT was the most widely applied. Other modalities have shown feasibility and promising efficacy in dosimetry studies and preliminary outcomes. The longer-term clinical outcomes associated with these approaches require further elucidation. Conclusions: As 3D-IGABT was validated by promising clinical outcomes, the future of BT for LACC is expected to progress toward the refinement of more effective image-guided procedures. Moreover, achieving operational consensus and driving technological advancements to mitigate the inherent limitations associated with different imaging modes remain essential.

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“…There is only one study that compared clinical outcomes for MRI-only approach with hybrid CT/MRI-based approach, which found comparable cancer control and survival rates. Mahantshetty et al and a follow-up study by Swamidas et al have both demonstrated that the CT-based target incorporating real-time trans-rectal ultrasound information was comparable with MRI at the time of brachytherapy [35,36]. Given the wider availability of CT over MRI, a considerable amount of literature has been published recently by various groups on CT-based contouring consensus to enable more reliable and reproducible target volume delineation [37][38][39].…”

mentioning

confidence: 99%

Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

Sommat,

Yap,

Chert Yeo

et al. 2023

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Purpose To report outcomes of using image-guided hybrid intra-cavitary/interstitial applicators under moderate sedation for locally advanced cervical cancer patients in our institution. Material and methods A total of 69 fractions of brachytherapy with hybrid applicators were performed in 33 patients from January 2017 to April 2021. All patients underwent MRI pelvis 1 week pre-brachytherapy to determine suitability for interstitial brachytherapy and pre-plan needle placement. All insertion of applicators were performed under moderate sedation with midazolam and/or fentanyl. Fifty-eight (84.1%) fractions were planned with CT alone. Clinical outcomes, dose volume parameters, and toxicities were analyzed. Results The median follow-up was 28 months. A total of 320 needles (median, 5 needles per fraction) were implanted, with a median insertion depth of 3 cm (range, 1.5-4 cm). The median high-risk clinical target volume (HR-CTV) during initial brachytherapy was 34.5 cc (range, 17.8-74.7 cc). The median total EQD 2 D 2cc of the rectum, bladder, sigmoid, and small intestine colon was 71.8 Gy, 81.5 Gy, 69 Gy, and 58.3 Gy, respectively. The 2-year local control and overall survival were 80.7% and 77.7%, respectively. Larger volume HR-CTV was significantly associated with worse local control (HR = 1.08, p = 0.005) and overall survival (HR = 1.04, p = 0.015). None of the patients required in-patient admission or blood transfusion post-procedure. Late grade 3 gastrointestinal and genitourinary toxicities were observed in 4 patients (12.2%). Conclusions Hybrid applicators inserted under moderate sedation are feasible and safe. Image-guided interstitial brachytherapy with CT planning aided by MRI performed 1 week pre-brachytherapy is associated with favorable outcomes and modest toxicities.

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Dosimetric impact of target definition in brachytherapy for cervical cancer – Computed tomography and trans rectal ultrasound versus magnetic resonance imaging

Cited by 4 publications

References 34 publications

Trans-rectal ultrasound-guided hybrid intra-cavitary and interstitial brachytherapy in carcinoma cervix: A feasibility study from a tertiary cancer center in India

Trans-rectal ultrasound-guided hybrid intra-cavitary and interstitial brachytherapy in carcinoma cervix: A feasibility study from a tertiary cancer center in India

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

Oncologic outcomes after MRI-assisted image-guided brachytherapy with hybrid interstitial and intra-cavitary applicators under moderate sedation for locally advanced cervix cancer

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