A Dose–Volume Analysis of Magnetic Resonance Imaging-Aided High-Dose-Rate Image-Based Interstitial Brachytherapy for Uterine Cervical Cancer

Daily computed tomography measurement of needle applicator displacement during high-dose-rate interstitial brachytherapy for previously untreated uterine cervical cancer

“…Our newly applied ambulatory technique (flexible needle applicator without rigid template guidance) enabled MRI to be used as a reference for treatment planning and resulted in more precise CTV contours with better dose conformity. We have previously reported the first results of this image-based ISBT (83% local control rate), although it was preliminary data (11).…”

“…Our unique implant technique has been described in detail previously (10,11). We performed a single applicator implantation procedure with multiple fractions for all the patients.…”

“…One is the use of a nonremovable rigid template that is fixed to the perineal skin with metallic needles, which disturbs the patient's QOL during treatment because the patients must stay in bed. To solve this problem, we used an ambulatory technique (10,11) using flexible needle applicators and a thin vinyl plate with a small cylinder fitted in the vagina, which allowed patients to stand up and walk freely 1 day after implantation of the applicator. This technique avoids metal equipment and enables the use of magnetic resonance image (MRI)-aided ISBT to delineate clinical target volume (CTV) more precisely (11).…”

Comparison of IPSA with dose-point optimization and manual optimization for interstitial template brachytherapy for gynecologic cancers

“…Martinez universal perineal interstitial template (MUPIT) for brachytherapy was first devised by Martinez for prostate, cervix, vagina, female urethra, perineum, and anorectal region. The review of literature shows the evolution of this technique over the years, overcoming a number of limitations with advanced imaging modalities (9,10) and dose optimization (11).…”

“…Three-dimensional treatment planning uses images of CT/ MR to visualize target volumes and critical structures with respect to the implanted needles to produce customized dose distributions that may improve local control and reduce complications relative to conventional brachytherapy treatment planning (9,10). Furthermore, CT/MR imaging provides excellent soft tissue definition such that delineation of target and organs at risk (OARs) in relation to the applicator is possible.…”