Intercomparison of treatment concepts for MR image assisted brachytherapy of cervical carcinoma based on GYN GEC-ESTRO recommendations

Lang, Stefan; Nulens, A.; Briot, E.; Kirisits, Christian; Brabandere, Marisol De; Dumas, Isabelle; Dimopoulos, Johannes; Petrow, Peter; Georg, Dietmar; Limbergen, Erik; Haie-Méder, Christine; Pötter, Richard

doi:10.1016/j.radonc.2006.01.001

Cited by 80 publications

(32 citation statements)

References 37 publications

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“…From a radiobiological point of view the number of fractions and the size of the individual fractions are of importance, especially for late tissue reactions. To improve local tumor control and to minimize late tissue reactions in the risk organs image-guided treatment planning using both CT and MRI has been described and advocated (26)(27)(28). This new technique is very time-and resource-consuming compared with earlier used standard techniques.…”

Section: Discussionmentioning

confidence: 99%

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Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Sorbe¹

2009

Int J Oncol

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Abstract. In a series of 131 primary cervical carcinomas in FIGO stages I-IV suitable for combined external pelvic and intraluminal cervical-vaginal brachytherapy predictive and prognostic factors were analyzed with regard to locoregional tumor control, recurrences and survival data. Patients with prior surgery or patients treated with external beam therapy alone were excluded from this series. Concomitant chemotherapy was given to 47 patients (36%). The external beam therapy was given with a four-field technique (50-60 Gy) and brachytherapy with high dose-rate (Ir-192) using a ring applicator set. The dose (18-30 Gy) was specified according to the rules in ICRU 38 (a minimum dose to the surface of the target volume). Three or five fractions were given once a week in parallel with external beam irradiation. A CT-based 3-D dose-planning system (TMS) was used for the external beam therapy and for the brachytherapy planning (PLATO). The mean age of the patients was 65 years. One hundred and seven tumors were squamous cell carcinomas (82%) and 24 adenocarcinomas or adenosquamous carcinomas. One hundred and eight tumors were in FIGO stages I-II and 23 tumors in stages III-IV. The mean tumor diameter was 44 mm. Most tumors (92%) were moderately well or poorly differentiated. The primary cure rate of the complete series was 92% and 98% after chemoradiotherapy. Squamous cell carcinomas had complete remission in 96% and adenocarcinomas in 81% (Pearson Chi-square; P=0.00002). Tumor size was also highly significantly associated with local tumor control. The brachytherapy dose, the combined external and brachytherapy dose and the number of days of interruption (delay) of external irradiation were all significant predictive factors of local tumor control. In the complete series 39 recurrences (30%) were recorded. A lower FIGO stage, chemoradiotherapy, squamous cell histology, diploid DNA-profile, a higher brachytherapy dose, more brachytherapy fractions and a higher total combined irradiation dose were favorable factors with regard to the risk of tumor recurrences. The overall survival rate was 50% and the cancer-specific survival rate 65%. Tumor size was the strongest individual prognostic factor in multivariate analysis. Chemoradiotherapy therapy versus radiotherapy alone and squamous cell carcinomas versus adenocarcinomas were associated with improved survival rates. Early radiation reactions were recorded in 58% (mostly grade 1) and serious late radiation reactions (grade 3-4) in 11%.

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Section: Discussionmentioning

confidence: 99%

“…The results will form a base of clinical outcome which are important to know before forthcoming changes are implemented in both external therapy (e.g. IMRT) and brachytherapy (3-D image based 3-D treatment planning) (26)(27)(28)(29).…”

Section: Introductionmentioning

confidence: 99%

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Sorbe¹

2009

Int J Oncol

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“…The plans produced by three different types of applicator adapted for MRI (tandem and ovoids, individual moulds and Vienna ring) have been compared and have shown relative equivalence, with differences in dose distribution quality attributed to patient anatomy. 27 Additional modifications of traditional applicators have been developed, such as the insertion of interstitial needles through guide holes in the ring. 22 Even when dose distributions have been deliberately kept close to the classic 'pear shape', interstitial needles enabled larger GTVs to be treated to higher doses without increasing OAR doses.…”

Section: Patient Specific Planning For Cervical Brachytherapy: What Imentioning

confidence: 99%

The departmental impact of magnetic resonance imaging in the management of cervical cancer brachytherapy: a discussion paper

Warren

Eddy

2011

J Radiother Pract

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This discussion paper will explore the impact of using Magnetic Resonance Imaging (MRI) in the treatment of cervical cancer with brachytherapy. It is written from the perspective of current departmental practice in the UK and aims to highlight the issues associated with using MRI as a tool for image guided brachytherapy planning. To support the discussion, a literature review was undertaken focussing specifically on the use of MRI in brachytherapy treatment planning for cervical cancer. Results from planning case studies and clinical series were analysed, and the literature showed that image guided brachytherapy treatment planning is a promising development. MRI assisted planning could theoretically be implemented in centres that have access to a MRI scanner. Alternative brachytherapy technologies (e.g. Computed Tomography (CT) assisted planning), and alternative radiotherapy modalities (e.g. an external beam radiotherapy boost), were not found to be superior in effect or of implementation. Although MRI shows great promise, the evidence base for MRI in brachytherapy planning for cervical cancer is currently limited and therefore careful implementation and evaluation is required. It is suggested by the authors that new methods of working are devised to ensure consistency and quality in implementation and delivery, and that outcomes are measured and audited to evaluate efficacy.

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“…More comprehensive data is therefore needed to further (n 010) [15,18]), whereas more material is available according to data in publication process [16,17].…”

Section: Uncertainties In Target Contouringmentioning

confidence: 99%

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

et al. 2008

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Intercomparison of treatment concepts for MR image assisted brachytherapy of cervical carcinoma based on GYN GEC-ESTRO recommendations

Cited by 80 publications

References 37 publications

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

The departmental impact of magnetic resonance imaging in the management of cervical cancer brachytherapy: a discussion paper

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

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