MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study

Pötter, Richard; Tanderup, Kari; Schmid, Maximilian; Jürgenliemk-Schulz, Ina M.; Haie-Méder, Christine; Fokdal, Lars; Sturdza, Alina; Hoskin, Peter; Mahantshetty, Umesh; Šegedin, Barbara; Bruheim, Kjersti; Huang, Fleur; Rai, Bhavana; Cooper, R.; Steen-Banasik, Elzbieta van der; Limbergen, Erik; Pieters, Bradley R.; Tan, Lawrence; Nout, Remi A.; Leeuw, Astrid A.C. de; Ristl, Robin; Petrič, Primož; Nesvacil, N.; Kirchheiner, Kathrin; Kirisits, Christian; Lindegaard, Jacob Christian; Chargari, Cyrus; Dumas, Isabelle; Lowe, Gerry; Swamidas, J.; Hudej, R.; Hellebust, Taran Paulsen; Menon, Geetha; Oinam, Arun S; Bownes, Peter; Christiaens, Melissa; Brabandere, Marisol De; Janssen, Hilde; Oosterveld, B.J.; Koedooder, Kees; Marthinsen, Anne Beate Langeland; Sundset, Marit; Whitney, Diane; Ketelaars, M.; Lutgens, Ludy; Reinniers, Brigitte; Mora, Itxa; Villafranca, E.; Antal, Gergely; Hadjiev, Janaki; Bachand, François; Batchelar, Deidre; Erickson, Beth; Rownd, Jason; Jacobson, G.; Kim, Yusung; Anttila, Maarit; Palmgren, Jan-Erik; An, Jusheng; Assenholt, M.S.; Banerjee, Susovan; Bentzen, Søren M.; Berger, Thomas; Dankulchai, Pittaya; Diendorfer, Tamara; Dilworth, Ian; Dimopoulos, Johannes; Dörr, E.; Ecker, Stefan; Federíco, M.; Fidarova, Elena; Fortin, I.; Georg, Petra; Góra, J.; Hegazy, Neamat; Jastaniyah, Noha; Jensen, Nina Boje Kibsgaard; Liederer, Thomas; Majercakova, K.; Misimovic, Dragan; Motisi, Laura; Jamal, D. Najjari; Nkiwane, Karen S.; Schwartz-Vittrup, Anders; Şerban, M; Smet, Sofie de; Spampinato, S.; Trnková, Petra; Valgma, Margit; Westerveld, Henrike; Wong, Joyce Siu Yu; Yoshida, Kenji

doi:10.1016/s1470-2045(20)30753-1

Cited by 291 publications

(195 citation statements)

References 34 publications

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“…The advantages of 3D image-based brachytherapy are not only limited to dose distribution, including central hot spots and rapid dose fall-off, but also in the delivery of treatment with no setup margin. This has resulted in excellent outcomes, as seen in a recently published EMBRACE 1 study with 5-year local control of 92% (95% CI 90–93) and low grade 3 and above morbidities [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

A novel external beam radiotherapy method for cervical cancer patients using virtual straight or bending boost areas; an in-silico feasibility study

Cozzi

Beriwal

Kuusela³

et al. 2021

Radiat Oncol

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Aim To investigate the potential role of a novel spatially fractionated radiation therapy (SFRT) method where heterogeneous dose patterns are created in target areas with virtual rods, straight or curving, of variable position, diameter, separation and alignment personalised to a patient’s anatomy. The images chosen for this study were CT scans acquired for the external beam part of radiotherapy. Methods Ten patients with locally advanced cervical cancer were retrospectively investigated with SFRT. The dose prescription was 30 Gy in 5 fractions to 90% target volume coverage. Peak-and-valley (SFRT_1) and peak-only (SFRT_2) strategies were applied to generate the heterogeneous dose distributions. The planning objectives for the target (CTV) were D90% ≥ 30 Gy, V45Gy ≥ 50–55% and V60Gy ≥ 30%. The planning objectives for the organs at risk (OAR) were: D2cm3 ≤ 23.75 Gy, 17.0 Gy, 19.5 Gy, 17.0 Gy for the bladder, rectum, sigmoid and bowel, respectively. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The D2cm3 was 22.4 ± 2.0 (22.6 ± 2.1) and 13.9 ± 2.9 (13.2 ± 3.0) for the bladder and the rectum for SFRT_1 (SFRT_2). The results for the sigmoid and the bowel were 2.6 ± 3.1 (2.8 ± 3.0) and 9.1 ± 5.9 (9.7 ± 7.3), respectively. The hotspots in the target volume were V45Gy = 43.1 ± 7.5% (56.6 ± 5.6%) and V60Gy = 15.4 ± 5.6% (26.8 ± 6.6%) for SFRT_1 (SFRT_2). To account for potential uncertainties in the positioning, the dose prescription could be escalated to D90% = 33–35 Gy to the CTV without compromising any constraints to the OARs Conclusion In this dosimetric study, the proposed novel planning technique for boosting the cervix uteri was associated with high-quality plans, respecting constraints for the organs at risk and approaching the level of dose heterogeneity achieved with routine brachytherapy. Based on a sample of 10 patients, the results are promising and might lead to a phase I clinical trial.

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Section: Discussionmentioning

confidence: 99%

A novel external beam radiotherapy method for cervical cancer patients using virtual straight or bending boost areas; an in-silico feasibility study

Cozzi

Beriwal

Kuusela³

et al. 2021

Radiat Oncol

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“…Bladder cancer is well suitable for ART since the bladder has large interfractional changes and intra-fractional motion (144,145). MRIguided adaptive brachytherapy in cervical cancer (146,147) and primary vaginal cancer (148) results in effective and stable longterm local control at all stages of cervical cancer, while decreasing severe radiation-induced morbidity. Similarly, promising results are also observed in liver tumors (149), prostate cancer (150), and unresectable primary malignancies of the abdomen.…”

Section: Adaptive Radiation Therapymentioning

confidence: 99%

Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment

Zhang

Yang

2021

Front. Oncol.

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Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.

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“…For patients with locally advanced cervical cancer (LACC) treatment currently consists of concurrent (chemo) radiotherapy (CCRT) and image-guided adaptive 3D brachytherapy (IGABT) resulting in excellent local control and acceptable survival rates (1)(2)(3)(4). However, nodal failure (NF) remains challenging (5).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis

Peters

Leeuw

Nomden

et al. 2021

Radiotherapy and Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study

Cited by 291 publications

References 34 publications

A novel external beam radiotherapy method for cervical cancer patients using virtual straight or bending boost areas; an in-silico feasibility study

A novel external beam radiotherapy method for cervical cancer patients using virtual straight or bending boost areas; an in-silico feasibility study

Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment

Risk factors for nodal failure after radiochemotherapy and image guided brachytherapy in locally advanced cervical cancer: An EMBRACE analysis

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