MRI-guided adaptive brachytherapy for locally advanced cervix cancer: Treatment outcomes from a single institution in Hong Kong

Wu, Philip Yuguang; Wong, Tai Wai; Yip, Yan Yee Chloe; Chang, Tien Yee Amy; Chan, L.K.; Lee, Michael Chi Hang; Law, Lai Yau; Yeung, M. Au; Soong, Sung Inda

doi:10.1016/j.brachy.2018.11.007

Cited by 7 publications

(7 citation statements)

References 47 publications

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“…Such a high effort in particular also precludes the acquisition of magnetic resonance imaging (MRI) scans at off-site locations. On-site MRI for interventional purposes, which would be most desirable due to the superior soft tissue delineability [27][28][29], is logistically still not implementable at many brachytherapy sites at all.…”

Section: Discussionmentioning

confidence: 99%

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy

et al. 2022

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Background and purpose On-site cone-beam computed tomography (CBCT) has gained in importance in adaptive brachytherapy during recent years. Besides treatment planning, there is increased need particularly for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide. We present the first clinical images and experiences. Materials and methods The novel CBCT system is constructed of a 121 cm diameter ring gantry, and features a 43.2 × 43.2 cm2 flat-panel detector, wireless remote-control via tablet-PC, and battery-powered maneuverability. Within the first months of clinical operation, we performed CBCT-based treatment QA for a total of 26 patients (8 with breast, 16 with cervix, and 2 with vaginal cancer). CBCT scans were analyzed regarding potential movements of implanted applicators in-situ during the brachytherapy course. Results With the presented device, treatment QA was feasible for the majority of patients. The CBCT scans of breast patients showed sufficient contrast between implanted catheters and tissue. For gynecologic patients, a distinct visualization of applicators was achieved in general. However, reasonable differentiations of organic soft tissues were not feasible. Conclusion The CBCT system allowed basic treatment QA measures for breast and gynecologic patients. For image-guidance during interventional brachytherapy procedures, the current image quality is not adequate. Substantial performance enhancements are required for intraoperative image-guidance.

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Section: Discussionmentioning

confidence: 99%

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy

et al. 2022

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“…For Chinese patients with LACC, Wu et al. ( 18 ) recently evaluated the clinical outcomes of MR-IGABT where MRI was repeated at each implant (with implant in situ ), in limited patient numbers (49 Chinese patients), with the first and the third brachytherapy fractions using MR-IGABT and other brachytherapy fractions were planned on CT imaging. Two-year OS and LC were both achieved in 90% of the patients with no severe late toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Table 7 ( 5 – 8 , 17 , 18 , 25 – 30 ) summarizes the clinical outcomes of IGABT mentioned in this study and/or other studies recently published. The clinical outcomes of MR-IGABT, including the present study, show favorable OS, LC, and limited severe morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Even so, it is difficult for every institution to gain MRI access for each individual brachytherapy fraction ( 7 , 12 – 17 ). Due to the limited MRI availability, some institutions use MRI only in some of the brachytherapy fractions ( 12 , 16 – 18 ). The use of MRI-guided adaptive brachytherapy (MR-IGABT) in each fraction is still limited ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

“…Due to the limited MRI availability, some institutions use MRI only in some of the brachytherapy fractions ( 12 , 16 – 18 ). The use of MRI-guided adaptive brachytherapy (MR-IGABT) in each fraction is still limited ( 18 ). The aim of this study was to evaluate the clinical outcomes of MR-IGABT in each fraction for Chinese patients with LACC.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

et al. 2022

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PurposeThis study aims to evaluate clinical outcomes of MRI-guided adaptive brachytherapy (MR-IGABT) for each brachytherapy fraction in patients with locally advanced cervical cancer (LACC).Methods and MaterialsA retrospective analysis was performed on 97 consecutive patients with LACC treated with 44.0–50.4 Gy external beam radiotherapy (EBRT) ± concurrent platinum-containing chemotherapy followed by 4 × 7 Gy MR-IGABT between September 2014 and April 2019. Intracavitary (IC)/interstitial (IS)/hybrid intracavitary and interstitial (IC/IS) brachytherapy was used in MR-IGABT. Brachytherapy planning and dose reporting followed the GEC-ESTRO recommendations. Clinical outcomes including overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), local control (LC), and treatment-related toxicity evaluated by the RTOG criteria were analyzed. Kaplan–Meier and univariable and multivariable Cox regression analyses were used to analyze the prognostic factor.ResultsMedian follow-up was 21.1 months. Median dose to 90% (D90) of the high-risk clinical target volume (HR-CTV) was 91.7 Gy (range 76.7~107.2 Gy). Two-year OS, CSS, PFS, and LC were 83.5%, 84.1%, 71.1%, and 94.8%, respectively. Four patients (4.1%) suffered from grade 3 late gastrointestinal radiation toxicity, and no other grade 3 or greater radiation toxicity occurred. Initial HR-CTV was an independent factor of OS (p = 0.001, HR = 1.018/cm3), PFS (p = 0.012, HR = 1.012/cm3), and LC (p = 0.011, HR = 1.028/cm3). The HR-CTV D90 (p = 0.044, HR = 0.923/Gy) was an independent factor of PFS. Age was an independent factor of LC (p = 0.010, HR = 1.111/year).ConclusionFor patients with LACC, MR-IGABT was effective and safe. It showed favorable LC, OS, and minimal toxicity. Moreover, initial HR-CTV, HR-CTV D90, and age were significant prognostic factors.

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Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer

Zhang

Cheng

2023

Radiol med

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MRI-guided adaptive brachytherapy for locally advanced cervix cancer: Treatment outcomes from a single institution in Hong Kong

Cited by 7 publications

References 47 publications

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy

Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer

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