Value of Magnetic Resonance Imaging Without or With Applicator in Place for Target Definition in Cervix Cancer Brachytherapy

Pötter, Richard; Federíco, M.; Sturdza, Alina; Fotina, I.; Hegazy, Neamat; Schmid, Maximilian; Kirisits, Christian; Nesvacil, N.

doi:10.1016/j.ijrobp.2015.09.023

Cited by 38 publications

(32 citation statements)

References 29 publications

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“…These included (i) CT-based CTV: CT with applicator insertion [13, 14], (ii) CT-based CTV HR : CT with applicator insertion and MRI just before first brachytherapy [15], and (iii) MRI-based CTV HR : MRI with applicator insertion [1, 2]. For all CTV contouring modalities, clinical examination findings at the time of brachytherapy were also used.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the tumor size and topography on MRI just before brachytherapy will be used as the reference in the present recommendations. When complex tumor volumes on MRI without applicator insertion before brachytherapy are visually translated into CT-based CTV HR contouring, there is a potential risk of geographical misses for extensively large tumors with parametrial or adjacent organ involvement [15]. Therefore, greater attentiveness is necessary to minimize such risks in extensively large tumors when determining their sizes and topographies using transverse, coronal and sagittal plane images on MRI.…”

Section: Resultsmentioning

confidence: 99%

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Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients

Ohno

Wakatsuki

Toita

et al. 2016

Journal of Radiation Research

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Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial–caudal, lateral, or anterior–posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients

Ohno

Wakatsuki

Toita

et al. 2016

Journal of Radiation Research

View full text Add to dashboard Cite

show abstract

“…However, the disadvantage is that patients require more insertional procedures and the reproducibility of inserted applicators needs to be validated. Alternatively, if resources are limited, a standard pre-brachytherapy MRI (without applicators in situ ) can be obtained to evaluate tumor shrinkage and to increase the accuracy of HR-CTV contouring on the CT with applicator in situ [43]. …”

Section: Imaging – Mri/us/ctmentioning

confidence: 99%

Improving the efficiency of image guided brachytherapy in cervical cancer

Otter¹,

Franklin²,

Ajaz³

et al. 2016

jcb

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Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. Traditionally, cervical brachytherapy was prescribed to point A but since the GEC-ESTRO guidelines were published in 2005, there has been a move towards prescribing the dose to a 3D volume. Image guided brachytherapy has been shown to reduce local recurrence, and improve survival and is optimally predicated on magnetic resonance imaging. Radiological studies, patient workflow, operative parameters, and intensive therapy planning can represent a challenge to clinical resources. This article explores the ways, in which 3D conformal brachytherapy can be implemented and draws findings from recent literature and a well-developed hospital practice in order to suggest ways to improve the efficiency and efficacy of a brachytherapy service. Finally, we discuss relatively underexploited translational research opportunities.

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“…Alternatively, Potter et al demonstrated a methodology, in which a pre-treatment MRI is performed prior to performing an implant. Their study found that the pre-BT MRI helped define HR-CTV, especially compared to CT images with the applicator in place [53]. Tait et al utilized a similar approach with a pre-implantation MRI, which was fused to the planning CT.…”

Section: Discussionmentioning

confidence: 99%

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Harkenrider¹,

Shea²,

Wood³

et al. 2017

jcb

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PurposeAdaptive magnetic resonance imaging (MRI)-based brachytherapy results in improved local control and decreased high-grade toxicities compared to historical controls. Incorporating MRI into the workflow of a department can be a major challenge when initiating an MRI-based brachytherapy program. This project aims to describe the goals, challenges, and solutions when initiating an MRI-based cervical cancer brachytherapy program at our institution.Material and methodsWe describe the 6-month multi-disciplinary planning phase to initiate an MRI-based brachytherapy program. We describe the specific challenges that were encountered prior to treating our first patient.ResultsWe describe the solutions that were realized and executed to solve the challenges that we faced to establish our MRI-based brachytherapy program. We emphasize detailed coordination of care, planning, and communication to make the workflow feasible. We detail the imaging and radiation physics solutions to safely deliver MRI-based brachytherapy. The focus of these efforts is always on the delivery of optimal, state of the art patient care and treatment delivery within the context of our available institutional resources.ConclusionsPrevious publications have supported a transition to MRI-based brachytherapy, and this can be safely and efficiently accomplished as described in this manuscript.

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Value of Magnetic Resonance Imaging Without or With Applicator in Place for Target Definition in Cervix Cancer Brachytherapy

Cited by 38 publications

References 29 publications

Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients

Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients

Improving the efficiency of image guided brachytherapy in cervical cancer

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

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