Faculty Collaboration Database

3-T MRI-based adaptive brachytherapy for cervix cancer: treatment technique and initial clinical outcomes. Brachytherapy 2014;13(4):319-25

Date

05/20/2014

Pubmed ID

24837024

DOI

10.1016/j.brachy.2014.03.001

Scopus ID

2-s2.0-84902539256 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

PURPOSE: To report the techniques and initial clinical outcomes for MRI-based adaptive brachytherapy (MRIB-ABT) using 3-T MRI.

METHODS AND MATERIALS: All patients who underwent MRIB-ABT between January 2008 and June 2012 for cervical cancer using 3-T MRI for at least three fractions were retrospectively reviewed. The institutional standard for initiation of brachytherapy planning was 100% of dose at point A and 160% at the vaginal surface with five fractions of 500-550 cGy at Point A. The dose distribution was modified to enhance coverage of the high-risk clinical target volume (HR-CTV) and to spare the organs at risk (OAR) by altering dose specification distances around the tandem and the percentage of the Point A dose around the ring or ovoids.

RESULTS: Eighteen patients (FIGO stages IB = 4, II = 12, III = 1, and IVA = 1) underwent eighty-two 3-T MRI-based insertions. All patients received 3D conformal, external beam radiation (45-50.4 Gy). The median gross tumor volume pretreatment was 38 cm(3) (2-165 cm(3)) compared with 4.8 cm(3) (1-9 cm(3)) at the first high-dose rate fraction with a median volume reduction of 88%. Dose specification at the level of Point A was altered in 51% of 3-T MRI fractions from the standard 20 mm (range, 14-18 mm) and in 8% at the ring surface to optimally cover the HR-CTV and spare the OAR. The 2-year local control, disease-specific survival, and overall survival are 100%, 100%, and 93%, respectively.

CONCLUSIONS: MRIB-ABT using 3-T MRI for treatment of cervix cancer allows for customized alterations in dose specification that minimize dose to the OAR and maximize coverage of the HR-CTV.

Author List

Kharofa J, Morrow N, Kelly T, Rownd J, Paulson E, Rader J, Uyar D, Bradley W, Erickson B

Authors

Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Tracy R. Kelly MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Natalya V. Morrow PhD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin
Eric Paulson PhD Chief, Professor in the Radiation Oncology department at Medical College of Wisconsin
Janet Sue Rader MD Chair, Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Jason Rownd MS Instructor in the Radiation Oncology department at Medical College of Wisconsin
Denise S. Uyar MD Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Brachytherapy
Carcinoma, Squamous Cell
Female
Humans
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Middle Aged
Neoplasm Staging
Organs at Risk
Radiotherapy Dosage
Radiotherapy, Conformal
Retrospective Studies
Survival Analysis
Treatment Outcome
Tumor Burden
Uterine Cervical Neoplasms