Cervical Gross Tumor Volume Dose Predicts Local Control Using Magnetic Resonance Imaging/Diffusion-Weighted Imaging—Guided High-Dose-Rate and Positron Emission Tomography/Computed Tomography—Guided Intensity Modulated Radiation Therapy

Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer

“…The mean D 2cm 3 dose for rectum (67 Gy) is comparable with those reported (65e66 Gy) (10,11,14). Although HR-CTV is used for dose reporting in many other groups (10,11,14), we used GTV instead of high-risk CTV (HR-CTV) to report target dose since this has been the practice in our clinic (27).…”

“…Twelve patients had International Federation of Gynecology and Obstetrics Stage IB cancer, 9 Stage IIA-IIB, 9 Stage IIIA-IIIB, and 3 Stage IVA-IVB. All patients underwent FDG-PET/CT simulation and were treated using IMRT as described previously (16,24,27). Elective nodal areas included the obturator, internal, and external iliac nodes to the level of the medial circumflex artery, common iliac nodal areas to the bifurcation of the aorta, and para-aortic lymph nodes to the level of the renal vessels, if involved.…”

Cervical cancer outcome prediction to high-dose rate brachytherapy using quantitative magnetic resonance imaging analysis of tumor response to external beam radiotherapy

“…For cervical cancer, a number of studies have evaluated MRImeasured volumetric response of gross disease to radiotherapy using dedicated diagnostic MRIs [5,[9][10][11][12][13]18]. Our results not only re-emphasize the ability to use MRI response to prognosticate patients, but uniquely highlight the feasibility of this practical approach through MRI-guided brachytherapy.…”

“…A recently published analysis by Dyk et al conducted a similar analysis to the one presented here, identifying absolute GTV and dose with brachytherapy to correlate with local control [18]. MRI GTV was evaluated at the time of first brachytherapy, which was conducted during the first week as opposed to the fourth week as done in the present study.…”

“…For both Mayr et al [5] and Nam et al [13], diagnostic MRIs were obtained prior to and throughout treatment. In comparison, the key difference in methodology here and in Dyk et al is the integration of brachytherapy planning-related, non-diagnostic MRI as opposed to a dedicated diagnostic MRI [18]. Although some quality degradation is anticipated using T2-weighted imaging and with the applicator in place, using this approach avoids an additional diagnostic test for the patient and integrates this prognostic tool into image-guided brachytherapy.…”