How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Harkenrider, Matthew M.; Shea, Steven M.; Wood, Abbie M.; Chinsky, Bonnie; Bajaj, Amishi; Mysz, Michael; Yacoub, Joseph; Goldberg, Allen I.; Liotta, Margaret; Potkul, Ronald K.; Sürücü, Murat; Roeske, John C.; Small, William

doi:10.5114/jcb.2017.66892

Cited by 21 publications

(12 citation statements)

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“…Notably, shortening a patient's waiting time played an important role in reducing the total procedure time and improving their comfort. The waiting time (113.0 min) in the present study was significantly longer than that spent in some institutions (17,18). This could be attributed to the following reasons: Firstly, the radiation oncologists' and physicists' contouring, planning, checking speed were not fast during this period, which might result from caution.…”

Section: The Brachytherapy Procedures Timementioning

confidence: 57%

Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

et al. 2021

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PurposeTo report applicator insertion-related acute side effects during brachytherapy (BT) procedure for cervical cancer patients.Materials and MethodsBetween November 2017 and December 2019, 407 BT fractions were performed in 125 patients with locally advanced cervical cancer. Acute side effects recorded comprised anesthesia-related side effects, mechanical-related side effects and infection, whose frequency and degree were recorded. Pain was assessed using numeric rating scale; vaginal bleeding volume was counted by weighing gauze pieces used in packing. The BT procedure comprised eight stages: anesthesia, applicator insertion, image acquisition, transport, waiting for treatment, dose delivery, applicator removal, and removed which denoted 0.5–12.0 h period after removal, with time of each stage recorded. Factors influencing acute side effects were assessed by Spearman correlation and Mann–Whitney U test.ResultsThe most common acute side effect was pain, followed by vaginal bleeding. The mean scores for pain were highest during removal time, 4.9 ± 1.6 points. The mean vaginal bleeding volume was 44.4 ml during removal time. Mean total procedure time was 218.8 (175–336) min, having positive relationship with frequency of acute side effects. The total procedure time with acute side effects was longer than that without acute side effects. The longest procedure time was waiting time, 113.0 (91.0–132.0) min. More needles generated higher pain scores and larger volume of vaginal bleeding.ConclusionPain and vaginal bleeding were the most common acute side effects, especially during removal time, which physicians should focus on. Shortening patients’ waiting time helps to reduce the total procedure time, thus, reduce acute side effects. While meeting dose requirement, less needles are helpful to reduce acute side effects.

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Section: The Brachytherapy Procedures Timementioning

confidence: 57%

Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

et al. 2021

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“…Thus, delineation of the target volumes in consideration of at risk organs, and determining the accuracy of applicator placement, improves local control and survival without increasing acute and late morbidity. However, the most important disadvantage of CT is that it cannot adequately demonstrate the cervical tumor, including vaginal and parametrial extension [32]. Therefore, despite there being no difference between CT- and MRI-based delineation of at-risk organs, MRI is the gold standard 3D-imaging technique because it is optimal for soft tissue delineation for cervix uteri carcinoma, including primary tumor and soft tissue invasion.…”

Section: Discussionmentioning

confidence: 99%

Radical radiotherapy in patients with cervix uteri carcinoma: experience of Ondokuz Mayis University

et al. 2019

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BackgroundRadical radiotherapy is the standard treatment for patients with locally advanced cervix uteri carcinoma (FIGO stage IB2–IVA). Worldwide, incidence and mortality rates vary among regions because of differences in lifestyles and treatment standards. Herein, we evaluated the outcomes of radical radiotherapy in patients with locally advanced cervix uteri carcinoma from the middle Black Sea region of Turkey.MethodsWe retrospectively reviewed the records of 64 consecutive patients with locally advanced cervix uteri carcinoma who were treated from January 2013 to 2016 in our radiation oncology department. All patients staging and radiotherapy planning were performed with modern imaging techniques including magnetic resonance imaging and positron-emission-tomography/computed tomography before radical radiotherapy. Thereafter, all of them were treated with external beam radiotherapy and concurrent cis-platinum-based chemotherapy followed by three-dimensional intra-cavitary high-dose-rate brachytherapy.ResultsThe median age at diagnosis was 54.5 years. The median follow-up period was 21 months. Acute grade 3 toxicity was detected in 3.1% of patients. Late toxicity was not detected in any patient. The 1- and 3-year progression-free survival rates were 83.6 and 67.5%, respectively. The 1- and 3-year overall survival rates were 95.7 and 76.9%, respectively. The most important prognostic factor was the FIGO stage. Distant metastasis was the most common cause of death in patients with locally advanced cervix uteri carcinoma despite radical radiotherapy.ConclusionsIn patients with locally-advanced cervix uteri carcinoma from the middle Black Sea region of our developing country, acceptable toxicity and survival rates are achieved similar to the recent literature from developed countries with using of modern staging, planning and radical radiotherapy techniques. However, recurrence was mostly in the form of distant metastases and further investigations on systemic therapies are required.

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“…Transition to MRI-based BT as more accessible for institutions, with safe and efficient accomplishment was described by Harkenrider et al . [ 16 ].…”

Section: Purposementioning

confidence: 99%

Comparison of impact of target delineation of computed tomography- and magnetic resonance imaging-guided brachytherapy on dose distribution in cervical cancer

Tuntipumiamorn¹,

Lohasammakul²,

Dankulchai³

et al. 2018

jcb

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PurposeThe dose distributions obtained from three imaging approaches for target delineation in cervical cancer using high-dose-rate (HDR) brachytherapy were investigated.Material and methodsTen cervical cancer patients receiving four fractions of HDR brachytherapy were enrolled. Based on different imaging approaches, three brachytherapy plans were developed for each patient: with the high-risk clinical target volume (HRCTV) delineated on magnetic resonance (MRI) images for every fraction (approach A; MRI-only); on MRI for the first fraction and computed tomography (CT) images for the subsequent fractions (approach B; MRI1st/CT); and on CT images for all fractions (approach C; CT-only). The volume, height, width at point A, width at maximum level, and dosimetric parameters (D100, D98, D95, and D90 of the HRCTV; and D0.1cc, D1cc, and D2cc of all organs at risk, or organ at risk – OAR: bladder, rectum, sigmoid colon, and bowel) provided by each approach were compared.ResultsThe mean HRCTV volume, width, and height obtained from approach C (CT-only) were overestimated compared to those from approaches A (MRI-only) and B (MRI1st/CT). The doses to the HRCTV for approaches A and B were similar. However, the HRCTV doses for approach C were significantly lower than those for approaches A and B for all parameters (D95-D100). As to the OAR, the three approaches showed no differences.ConclusionsA combination of MRI and CT is a safe alternative approach for cervical cancer HDR brachytherapy. The technique provides comparable dosimetric outcomes to MRI-based planning, while being more cost-effective.

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How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Cited by 21 publications

References 50 publications

Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

Radical radiotherapy in patients with cervix uteri carcinoma: experience of Ondokuz Mayis University

Comparison of impact of target delineation of computed tomography- and magnetic resonance imaging-guided brachytherapy on dose distribution in cervical cancer

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