Comparison of Computed Tomography and Magnetic Resonance Imaging in Cervical Cancer Brachytherapy Target and Normal Tissue Contouring

Eskander, Ramez N.; Scanderbeg, Daniel J.; Saenz, Cheryl C.; Brown, Michelle; Yashar, C.M.

doi:10.1111/igc.0b013e3181c4a627

Cited by 59 publications

(37 citation statements)

References 18 publications

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“…[5,14] Contouring the target volumes based on CT images is limited, however, because CT cannot distinguish residual tumor extension from normal tissue, and it may overestimate the tumor volume. [15,16] Although both MRI and CT provide anatomical information, FDG-PET provides metabolic information about the glucose uptake of a tumor, which is correlated with the viable tumor burden. Thus, the metabolic tumor volume can be delineated using FDG-PET.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes in cervical cancer patients treated by FDG-PET/CT-based 3-dimensional planning for the first brachytherapy session

Huh

Park

et al. 2016

Medicine

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The aim of the study was to evaluate the treatment outcomes in cervical cancer patients treated with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT)-guided 3-dimensional brachytherapy (3D-BT) planning for the first brachytherapy session.We retrospectively analyzed 87 patients with cervical cancer who received definitive radiotherapy (RT). Primary tumor size was ≤4 cm in 22 patients (25.3%), >4 cm and ≤6 cm in 45 patients (51.7%), and >6 cm in 20 patients (23.0%). The median total dose of external beam RT was 50.4 (50.4–60.4) Gy. FDG-PET/CT-guided 3D-BT with an iridium-192 source was performed. The clinical target volume (CTV) for 3D-BT included the entire cervix and the abnormal FDG-uptake with a 1-cm expansion. A planned total dose was 24 Gy at 4 Gy per insertion 3 times per week using a tandem and 2 ovoids.The mean D95 and D90 for the CTV were 73.4 (±5.9) Gy and 77.9 (±6.9) Gy, respectively (EQD2, α/β=10). The D2cc for the rectum and bladder was 374 (±97.4) cGy and 394 (±107.6) cGy per fraction, respectively. The EQD2 (α/β=3) for the D2cc was 74.5 (±12.4) Gy for the rectum and 77.3 (±14.6) Gy for the bladder. The median follow-up period was 40 (8–61) months. The 3-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 84.7%, 72.1%, and 89.2%, respectively. The 3-year LC rate was 100% for tumors ≤ 4 cm, 91.1% for tumors > 4 cm and ≤ 6 cm, and 70.5% for tumors > 6 cm (P = 0.014). Local failure developed in 9 patients. Three patients had local failures outside of the CTV. Grade 1, 2, and 3 rectal bleeding developed in 5, 4, and 2 patients, respectively. One patient experienced rectovaginal fistula.FDG-PET/CT-guided 3D-BT planning is a feasible approach, which showed favorable clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes in cervical cancer patients treated by FDG-PET/CT-based 3-dimensional planning for the first brachytherapy session

Huh

Park

et al. 2016

Medicine

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“…Combination of image based brachytherapy and intensity-modulated radiotherapy can also improve dose distribution in target volume and overdose to organs at risk (Tharavichitkul et al, 2013). Few studies have concluded that in centers where MRI based brachytherapy is not feasible due to logistics reasons, OAR and target may be contoured with CT which gives comparable results to MRI for dose volume estimation if clinical findings and baseline MRI findings are applied in contouring of CT images (Eskander et al, 2010;Krishnatry et al, 2012 observed MRI is being used by 20% for planning (Gueda et al, 2010). The limitation of our study included small sample size and lack of MRI based brachytherapy planning as CT may have overestimated the clinical target volume as compared to MRI.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Two-dimensional Radiography and Three Dimensional Computed Tomography Based Dose-volume Parameters for High-dose-rate Intracavitary Brachytherapy of Cervical Cancer: A Prospective Study

Madan

Pathy²,

Subramani³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Three-dimensional imaging modalities currently in use include computed tomography (CT) scan, and magnetic resonance imaging (MRI). MRI has been shown to be superior to CT in delineating gynecologic tumors and normal pelvic structures (19, 26, 30–31). However, no study has compared clinical outcomes and quality of life indices of MR-based to CT-based ISBT for vaginal recurrence of EC.…”

Section: Introductionmentioning

confidence: 99%

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

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Purpose To compare clinical outcomes of MR-based versus CT-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). Methods We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier (K-M) survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS) and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Results Median follow up was 33 months (CT 30 months, MR 35 months). Median cumulative EQD2 was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p=0.58). MR patients were older (p=0.03) and had larger tumor size (>4cm vs ≤4cm) compared to CT patients (p=0.04). For MR- vs. CT-based ISBT, 3-year KM rate for LC was 100% vs. 78% (p = 0.04), DFI was 69% vs. 55% (p= 0.1), and OS was 63% vs. 75% (p= 0.81), respectively. On multivariate analysis, tumor grade 3 was associated with worse OS (HR 3.57, 95%CI 1.25,11.36) in a model with MR-ISBT (HR=0.56, 95%CI 0.16,1.89). Toxicities were not significantly different between the two modalities. Conclusion Despite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.

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Comparison of Computed Tomography and Magnetic Resonance Imaging in Cervical Cancer Brachytherapy Target and Normal Tissue Contouring

Cited by 59 publications

References 18 publications

Clinical outcomes in cervical cancer patients treated by FDG-PET/CT-based 3-dimensional planning for the first brachytherapy session

Clinical outcomes in cervical cancer patients treated by FDG-PET/CT-based 3-dimensional planning for the first brachytherapy session

Comparative Evaluation of Two-dimensional Radiography and Three Dimensional Computed Tomography Based Dose-volume Parameters for High-dose-rate Intracavitary Brachytherapy of Cervical Cancer: A Prospective Study

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

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