Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

Pötter, Richard; Kirisits, Christian; Fidarova, Elena; Dimopoulos, Johannes; Berger, Daniel; Tanderup, Kari; Lindegaard, J.C.

doi:10.1080/02841860802282794

Cited by 104 publications

(70 citation statements)

References 43 publications

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“…Local tumor control can be improved and the risk of early recurrences reduced compared with external beam therapy alone. The improved accuracy of the brachytherapy technique achieved by using a 3-D image-guided dose-planning seems to reduce radiation side effects but with unchanged or in certain cases improved tumor control rate (40). Since smaller tissue volumes are irradiated with this technique it is obviously a clinically significant improvement in brachytherapy with regard to the risk of unwanted tissue reactions (41), but at the cost of substantially increased resources of time and personnel.…”

Section: Discussionmentioning

confidence: 99%

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Sorbe¹

2009

Int J Oncol

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Abstract. In a series of 131 primary cervical carcinomas in FIGO stages I-IV suitable for combined external pelvic and intraluminal cervical-vaginal brachytherapy predictive and prognostic factors were analyzed with regard to locoregional tumor control, recurrences and survival data. Patients with prior surgery or patients treated with external beam therapy alone were excluded from this series. Concomitant chemotherapy was given to 47 patients (36%). The external beam therapy was given with a four-field technique (50-60 Gy) and brachytherapy with high dose-rate (Ir-192) using a ring applicator set. The dose (18-30 Gy) was specified according to the rules in ICRU 38 (a minimum dose to the surface of the target volume). Three or five fractions were given once a week in parallel with external beam irradiation. A CT-based 3-D dose-planning system (TMS) was used for the external beam therapy and for the brachytherapy planning (PLATO). The mean age of the patients was 65 years. One hundred and seven tumors were squamous cell carcinomas (82%) and 24 adenocarcinomas or adenosquamous carcinomas. One hundred and eight tumors were in FIGO stages I-II and 23 tumors in stages III-IV. The mean tumor diameter was 44 mm. Most tumors (92%) were moderately well or poorly differentiated. The primary cure rate of the complete series was 92% and 98% after chemoradiotherapy. Squamous cell carcinomas had complete remission in 96% and adenocarcinomas in 81% (Pearson Chi-square; P=0.00002). Tumor size was also highly significantly associated with local tumor control. The brachytherapy dose, the combined external and brachytherapy dose and the number of days of interruption (delay) of external irradiation were all significant predictive factors of local tumor control. In the complete series 39 recurrences (30%) were recorded. A lower FIGO stage, chemoradiotherapy, squamous cell histology, diploid DNA-profile, a higher brachytherapy dose, more brachytherapy fractions and a higher total combined irradiation dose were favorable factors with regard to the risk of tumor recurrences. The overall survival rate was 50% and the cancer-specific survival rate 65%. Tumor size was the strongest individual prognostic factor in multivariate analysis. Chemoradiotherapy therapy versus radiotherapy alone and squamous cell carcinomas versus adenocarcinomas were associated with improved survival rates. Early radiation reactions were recorded in 58% (mostly grade 1) and serious late radiation reactions (grade 3-4) in 11%.

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Section: Discussionmentioning

confidence: 99%

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Sorbe¹

2009

Int J Oncol

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“…With the advent of image-based BT, new volumetric (3D) and temporal (4D) information has deepened our understanding of BT thus far [9][10][11][12][13][14][15][16][17][18] but also presents us with new medical challenges and concepts that must be understood and interpreted correctly to reap the potential benefit of image-based BT treatment planning [19].…”

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confidence: 99%

Clinical Aspects of Treatment Planning

Lindegaard

Pötter

Limbergen³

et al. 2010

Gynecologic Radiation Therapy

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The goal of treatment planning in image-guided brachytherapy (BT) is to widen the therapeutic window, i.e., to obtain the best possible chance for an uncomplicated cure of the patient [1] by optimizing the organization and delivery of the treatment. If a medical compromise has to be accepted it is vital to have maximal information about the consequences of any decisions taken during the treatment planning process. From quantitative radiobiology [2] and clinical experience [3,4] we know that the dose-response curves for many organs at risk (OAR) in the pelvis are almost as steep as the dose fall-off curve of BT, implying that we may often balance on the knife's edge between success and failure in our attempt to selectively deliver a high curative dose to the tumor.Over decades of traditional X-ray-based two-dimensional BT for gynecological cancer, invaluable experience has been gained in treatment planning [4][5][6][7][8]. With the advent of image-based BT, new volumetric (3D) and temporal (4D) information has deepened our understanding of BT thus far [9][10][11][12][13][14][15][16][17][18] but also presents us with new medical challenges and concepts that must be understood and interpreted correctly to reap the potential benefit of image-based BT treatment planning [19].

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“…The evolution from conventional brachytherapy with twodimensional treatment planning to 3D imageguided brachytherapy has enabled higher and more conformal dose delivery. Early data suggest that tumor control may be further improved with image-guided brachytherapy (11,30). This change marks a paradigm shift in brachytherapy similar to the earlier advances in external beam radiation therapy from conventional two-dimensional radiation to 3D conformal radiation therapy and IMRT delivery.…”

Section: Cervical Cancermentioning

confidence: 97%

Imaging across the Life Span: Innovations in Imaging and Therapy for Gynecologic Cancer

Xu‐Welliver¹,

Yuh²,

Macura

et al. 2014

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The focus of this article is radiation therapy for gynecologic cancers, with emphasis on imaging-based treatment planning and delivery. For the various gynecologic cancers, radiation oncologists rely on essential clinical information to triage treatment options, and various imaging studies are performed for treatment planning and radiation therapy delivery. A practical approach is provided to help radiologists tailor their reports for the needs of their radiation oncology and gynecologic oncology colleagues, to optimize multidisciplinary care for patients with gynecologic cancer. Template radiology reports are proposed to address the specific information needs of oncologists at each phase-before, during, and after treatment. Fueled by the rapid progress in engineering and computer sciences during the past 2 decades, remarkable advances have been made in anatomic, functional, and molecular imaging and in radiation treatment planning and delivery in patients with gynecologic cancer. Radiation therapy has evolved from a nontargeted approach to a precisely targeted, highly conformal treatment modality, to further improve treatment outcomes and reduce morbidity. Highquality imaging has become essential for staging of the disease, delineation of tumor extent for treatment planning and delivery, and monitoring therapy response. Anatomic and functional imaging has also been shown to provide prognostic information that allows clinicians to tailor therapy on the basis of personalized patient information. This field is an area of active research, and future clinical trials are warranted to validate preliminary results in the field.

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Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

Abstract: (2008) Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma,

Cited by 104 publications

References 43 publications

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: Predictive factors for local tumor control and early recurrences

Clinical Aspects of Treatment Planning

Imaging across the Life Span: Innovations in Imaging and Therapy for Gynecologic Cancer

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