Image-guided brachytherapy in cervical cancer including fractionation

Abstract

Image-guided brachytherapy in cervical cancer has been developed to be a feasible and very efficient component of the treatment of locally advanced cervical cancer in addition to concurrent chemoradiation treatment. This technique allows effective dose coverage of the target while sparing the organs at risk through adjustment of the implants (intracavitary and interstitial needles) and multi-pararametric three-dimensional treatment planning. Emerging evidence from prospective studies shows a high rate of local control throughout all stages, superior to two-dimensional brachytherapy, with limited toxicity for each organ site. This is associated with a high rate of pelvic control and overall survival. Based on clinical evidence, there is a dose–effect relationship for both disease and morbidity endpoints from which clear dose constraints for the target and organs at risk were derived. This review gives an overview of the major milestones that occurred in the development of image-guided adaptive brachytherapy in the last two decades, including outcome data and a summary of the hard and soft dose constraints recommended for targets and organs at risk.

Dosimetric parameters and safety analysis of 3D-printing non-coplanar template-assisted interstitial brachytherapy for non-centrally recurrent cervical cancer

“…Although ISBT has been used for years to treat cervical cancer, the treatment options for non-centrally recurrent cervical cancer remain limited and unsatisfactory due to the distinctive characteristics of non-central recurrent pelvic lesions (16,17). These recurrent lesions are 10-20 cm away from the body surface, with vessels, nerves, and important organs around them.…”

Safety and efficacy of single insertion accelerated MR-image guided brachytherapy following chemo-radiation in locally advanced cervix cancer: Modifying our EMBRACE during the COVID pandemic

“…Speci cally, bladder D2cc (< 80Gy), rectum D2cc (< 65Gy), and sigmoid/bowel D2cc (< 70Gy) were constraints in addition to maximal ICRU recto-vaginal (RV) dose point exposure of less than 65Gy. The latter correlates with vaginal shortening and stenosis (31,35). The principles and parameters of EMBRACE-I were validated by ICRU Report 89 (27).…”

“…OAR D0.1cc and D1.0cc exposures were also recorded. Emergent ICRU rectal, bladder, and vaginal late toxicity dose points, and vaginal reference length (VRL) were also identi ed (31,35). Vaginal toxicity points were located 0.5cm deep to the mucosa in the anterior and lateral fornices, and for T + R patients (12/14), relative (± 2cm) to the postero-inferior border of symphysis pubis (PIBS).…”

“…Modelled from a compendium of published COVID-19 fractionation options (29)(30)(31) and a small prospective series (32), a putative bio-equivalent accelerated single insertion 3-fraction modi ed IGABT (mIGABT) EMBRACE programme was trialled on 14 women with LACC. We report our 2-year progression-free survival (PFS), cost-saving, and toxicity outcomes.…”

Observation of hemostatic effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy in the treatment of larger cervical cancer with bleeding: A retrospective study

“…This method uses multiparametric 3D treatment planning to adapt the BT needles, effectively covering the target while preserving the OARs. [11,12] Both CT and ultrasound are imaging methods that can be utilized to see the tumor and its surrounding tissues. An improved understanding of the tumor and its location in relation to other body structures can be obtained by combining the 2 imaging methods.…”