Image-Guided Radiotherapy for Cervix Cancer: High-Tech External Beam Therapy Versus High-Tech Brachytherapy

Georg, Dietmar; Kirisits, Christian; Hillbrand, Martin; Dimopoulos, Johannes; Pötter, Richard

doi:10.1016/j.ijrobp.2008.03.032

Cited by 144 publications

(84 citation statements)

References 26 publications

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“…And, the BT associated major complication rates can reach up to 10% (80)(81)(82) that may include fatality (1.4%) as reported by Ferrigno et al (78). These comparable results of EBRT and BT boost can be explained by the fact that, although the superiority of the BT physical dose distribution is undeniable (45), the implementation of a perfect brachytherapy implant is not devoid of limitations with high interfraction and interpractitioner variability. Such variability should be reduced in properly executed EBRT techniques.…”

Section: Clinical Evidence Supporting Brachytherapy Alternativesmentioning

confidence: 91%

“…These results are discordant with Georg et al dosimetric study in which image guided BT was superior to EBRT plans using either photon or proton radiotherapy. For the modulated photon plans, the target coverage was compromised if optimization did not exceed the d 1cc , d 2cc achieved by BT; however, the modulated proton plansoptimized to target volume with 3 mm PTV expansion-were comparable to BT in term of PTV dose coverage (45).…”

Section: Newer Techniques May Offer Dose Distribution Not Exceedinglymentioning

confidence: 99%

See 1 more Smart Citation

External beam techniques to boost cervical cancer when brachytherapy is not an option—theories and applications

Mahmoud¹,

Kilic²,

Khan³

et al. 2017

Ann. Transl. Med.

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The management of locally advanced cervical cancer relies on brachytherapy (BT) as an integral part of the radiotherapy delivery armamentarium. Occasionally, intracavitary BT is neither possible nor available. In these circumstances, post-external beam radiotherapy (EBRT) interstitial brachytherapy and/or hysterectomy may represent viable options that must be adequately executed in a timely manner. However, if these options are not applicable due to patient related or facility related reasons, a formal contingency plan should be in place. Innovative EBRT techniques such as intensity modulated and stereotactic radiotherapy may be considered for patients unable to undergo brachytherapy. Relying on provocative arguments and recent data, this review explores the rationale for and limitations of non-brachytherapy substitutes in that setting aiming to establish a formal process for the optimal execution of this alternative plan.

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Section: Clinical Evidence Supporting Brachytherapy Alternativesmentioning

confidence: 91%

Section: Newer Techniques May Offer Dose Distribution Not Exceedinglymentioning

confidence: 99%

External beam techniques to boost cervical cancer when brachytherapy is not an option—theories and applications

Mahmoud¹,

Kilic²,

Khan³

et al. 2017

Ann. Transl. Med.

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“…Previously, only a limited number of studies investigated the potential benefit of proton-based RT compared to photonbased RT in cervical cancer [8,[11][12][13]. Even though the planning target volume (PTV) concept is less suitable for IMPT [10], those studies used the PTV concept to anticipate on uncertainties.…”

mentioning

confidence: 99%

Dosimetric advantages of proton therapy compared with photon therapy using an adaptive strategy in cervical cancer

et al. 2016

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Background Image-guided adaptive proton therapy (IGAPT) can potentially be applied to take into account interfraction motion while limiting organ at risk (OAR) dose in cervical cancer radiation therapy (RT). In this study, the potential dosimetric advantages of IGAPT compared with photonbased image-guided adaptive RT (IGART) were investigated. Material and methods For 13 cervical cancer patients, full and empty bladder planning computed tomography (CT) images and weekly CTs were acquired. Based on both primary clinical target volumes (pCTVs) [i.e. gross tumor volume (GTV), cervix, corpus-uterus and upper part of the vagina] on planning CTs, the pretreatment observed full range primary internal target volume (pITV) was interpolated to derive pITV subranges. Given corresponding ITVs (i.e. pITVs including lymph nodes), patient-specific photon and proton plan libraries were generated. Using all weekly CTs, IGART and IGAPT treatments were simulated by selecting library plans and recalculating the dose. For each recalculated IGART and IGAPT fraction, CTV (i.e. pCTV including lymph nodes) coverage was assessed and differences in fractionated substitutes of dose-volume histogram (DVH) parameters (V 15Gy , V 30Gy , V 45Gy , D mean , D 2cc ) for bladder, bowel and rectum were tested for significance (Wilcoxon signed-rank test). Also, differences in toxicity-related DVH parameters (rectum V 30Gy , bowel V 45Gy ) were approximated based on accumulated dose distributions. Results In 92% (96%) of all recalculated IGAPT (IGART) fractions adequate CTV coverage (V 95% 498%) was obtained. All dose parameters for bladder, bowel and rectum, except the fractionated substitute for rectum V 45Gy , were improved using IGAPT. Also, IGAPT reduced the mean dose to bowel, bladder and rectum significantly (p50.01). In addition, an average decrease of rectum V 30Gy and bowel V 45Gy indicated reductions in toxicity probabilities when using IGAPT. Conclusion This study demonstrates the feasibility of IGAPT in cervical cancer using a plan-library based plan-of-the-day approach. Compared to photon-based IGART, IGAPT maintains target coverage while significant dose reductions for the bladder, bowel and rectum can be achieved.

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“…Pioneering studies have investigated the feasibility of using IMRT or intensity‐modulated proton therapy (IMPT) boosts 36. Georg et al.…”

Section: Resultsmentioning

confidence: 99%

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD 2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.

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Image-Guided Radiotherapy for Cervix Cancer: High-Tech External Beam Therapy Versus High-Tech Brachytherapy

Cited by 144 publications

References 26 publications

External beam techniques to boost cervical cancer when brachytherapy is not an option—theories and applications

External beam techniques to boost cervical cancer when brachytherapy is not an option—theories and applications

Dosimetric advantages of proton therapy compared with photon therapy using an adaptive strategy in cervical cancer

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

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