MRI-guided treatment-planning optimisation in intracavitary or combined intracavitary/interstitial PDR brachytherapy using tandem ovoid applicators in locally advanced cervical cancer

Jürgenliemk-Schulz, Ina M.; Tersteeg, Robbert J.H.A.; Roesink, Judith M.; Bijmolt, S.; Nomden, C.N.; Moerland, Marinus A.; Leeuw, Astrid A.C. de

doi:10.1016/j.radonc.2009.08.014

Cited by 106 publications

(66 citation statements)

References 34 publications

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“…Utrecht and Aarhus teams described their results. Jürgenliemk-Schulz et al reported the results of 24 patients with a mean D90 HR-CTV of 84 Gy [20]. Nomden et al analyzed the dosimetric results of 20 patients treated with two pulsed dose rate applications combining endocavitary and interstitial, and noticed a mean D90 HR-CTV of 83.9 Gy [7].…”

Section: Discussionmentioning

confidence: 99%

Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer

Bailleux¹,

Falk²,

Chand-Fouché³

et al. 2016

jcb

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Purpose: There is no consensus for parametrial boost technic while both transvaginal and transperineal approaches are discussed. A prototype was developed consisting of a perineal template, allowing transperineal needle insertion. This study analyzed acute toxicity of concomitant cervical and transperineal parametrial high-dose-rate brachytherapy (HDRB) boost for locally advanced cervical cancer.Material and methods: From 01.2011 to 12.2014, 33 patients (pts) presenting a locally advanced cervical cancer with parametrial invasion were treated. After the first course of external beam radiation therapy with cisplatinum, HDRB was performed combining endocavitary and interstitial technique for cervical and parametrial disease. Post-operative delineation (CTV, bladder, rectum, sigmoid) and planification were based on CT-scan/MRI. HDRB was delivered in 3-5 fractions over 2-3 consecutive days. Acute toxicities occurring within 6 months after HDRB were retrospectively reviewed.Results: Median age was 56.4 years (27-79). Clinical stages were: T2b = 23 pts (69.7%), T3a = 1 pt (3%), T3b = 6 pts (18.2%), and T4a = 3 pts (9.1%). Median HDRB prescribed dose was 21 Gy (21-27). Median CTV CT (16 pts) and HR-CTV MRI (17 pts) were 52.6 cc (28.5-74.3), 31.9 cc (17.1-58), respectively. Median EQD2 αβ10 for D90 CTV and D90 HR-CTV were 82.9 Gy (78.2-96.5), 84.8 Gy (80.6-91.4), respectively. Median EQD2 αβ3 (CT/MRI) for D 2cc bladder, rectum and sigmoid were 75.5 Gy (66.6-90.9), 64.4 Gy (51.9-77.4), and 60.4 Gy (50.9-81.1), respectively. Median follow-up was 14 months (ranged 6-51). Among the 24 pts with MFU = 24 months, 2-year LRFS rate, RRFS, and OS were 86.8%, 88.8%, and 94.1%, respectively. The rates of acute genitourinary and gastrointestinal toxicities were 36% (G1 dysuria = 8 pts, G2 infection = 2 pts, G3 infection = 2 pts), and 27% (G1 diarrhea = 9 pts), respectively. One patient presented vaginal bleeding at the time of applicator withdrawal (G3-blood transfusion); no bleeding was observed due to the parametrial implant.Conclusions: Concomitant cervical and transperineal parametrial HDRB boost for locally advanced cervical cancer appears feasible and safe with no specific acute toxicity compare to cervical HDRB alone. Longer follow-up and larger patient cohort will be needed.J Contemp Brachytherapy 2016; 8, 1: 23-31 DOI: 10.5114/jcb.2016.57535 Key words: boost, brachytherapy, cervical cancer, parametrial invasion, radiotherapy. PurposeCervical cancer is the fourth most common cancer in women in the world, with an estimated 528,000 new cases and 266,000 deaths in 2012 [1]. Surgery is the standard treatment for early stage cervical cancer (≤ T1b1). For locally advanced tumors, gold-standard treatment consists in a weekly platin-based chemotherapy combined with external beam radiation therapy (EBRT) followed by brachytherapy (BT) boost [2].Brachytherapy remains a key component for locally advanced stage cervical cancer. Indeed, Han et al. published the results of a US brachytherapy survey showing that the use of BT d...

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Section: Discussionmentioning

confidence: 99%

Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer

Bailleux¹,

Falk²,

Chand-Fouché³

et al. 2016

jcb

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“…As cautioned by ICRU report #89,11 the overall DVH pattern of OARs can change considerably with EBRT PA or PM boost, especially when IMRT or VMAT are used. Similar OAR DVHs pattern changes have occurred with BT treatments following the introduction of hybrid intracavitary and interstitial applicators such as the Vienna46, 47 or Urecht applicator 48. It is for these aforementioned reasons that similar overall D2cc EQD2 values, but significantly different volumetric doses (DVHs) are possible.…”

Section: Resultsmentioning

confidence: 93%

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD 2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.

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“…12,13 With the introduction of MRIguided brachytherapy, this can be even further improved. 76,77 In cervical cancer, this is further being investigated in the EMBRACE study. 78 Disadvantages of cLDR were exposure to staff and employees and the absence of 3D optimized image-based treatment plans.…”

Section: Discussionmentioning

confidence: 99%

A review of the clinical experience in pulsed dose rate brachytherapy

Balgobind

Koedooder

Zúñiga

et al. 2015

BJR

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Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.

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MRI-guided treatment-planning optimisation in intracavitary or combined intracavitary/interstitial PDR brachytherapy using tandem ovoid applicators in locally advanced cervical cancer

Cited by 106 publications

References 34 publications

Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer

Concomitant cervical and transperineal parametrial high-dose-rate brachytherapy boost for locally advanced cervical cancer

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

A review of the clinical experience in pulsed dose rate brachytherapy

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