Reporting and Validation of Gynaecological Groupe Euopeen de Curietherapie European Society for Therapeutic Radiology and Oncology (ESTRO) Brachytherapy Recommendations for MR Image-Based Dose Volume Parameters and Clinical Outcome With High Dose-Rate Brachytherapy in Cervical Cancers

Abstract

The 3-D magnetic resonance image-based high dose-rate brachytherapy approach in cervical cancers is feasible. In our experience, the HR-CTV volumes are large, and D0.1cc and D2cc doses to bladder and sigmoid are higher than published literature so far.

MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

“…Integration of MRI with brachytherapy planning has shown enhanced target volume visualization, given that CT often underestimates residual disease and overestimates uterine width (12,13). Several single-institution series have demonstrated the efficacy of MRI-guided brachytherapy, although most studies have been limited by smaller sample sizes (14)(15)(16)(17)(18)(19).…”

Adaptive radiotherapy strategies for pelvic tumors – a systematic review of clinical implementations

“…Mature clinical outcome on recurrence and toxicity was reported by the gynecological cancers treated with a combination of EBRT and BT [23,[25][26][27][28][29][30][32][33][34][35][36][37][38][39] as well as from the large prostate trial conducted at Beaumont [12,[14][15][16]. For the gynecological cancers and most pronounced for the advanced stages, the improved target coverage obtained through ART has improved local control [37].…”

“…Most patients were treated with MR-guided BT, except for those included in the French multi-institutional study where the limited availability of MRI caused the regression analysis and adaptations to be based on CTs [37]. In two studies MR images were only used in the first BT fraction and CTs used for the remaining fractions [35,39]. In addition to the adaptations recommended by the Gynecological GEC-ESTRO, a group at Aarhus University Hospital, Aarhus, sculptured a supplementary stereotactic boost to the BT dose distribution.…”

“…For gynecological tumor sites ART implementations had been used since 1993 for treatment of in total of 1409 patients at 10 institutions and one multi-center study (Table 3) [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. All but four studies focused on cervical cancer, most commonly staged as FIGO IIB.…”

“…The BT was adapted through online re-planning prescribing different dose levels to each adapted risk volume and allowing an individual dose escalation bounded by the recommended OAR doses [42][43][44]. Twelve studies have so far reported their experience and outcomes after clinical implementation according to these recommendations (Table 3) [29][30][31][32][33][34][35][36][37][38][39][40], 10 of which focused solely on cervical cancer [29][30][31][34][35][36][37][38][39][40]. The majority (674/871) of the cervical cancer patients underwent EBRT combined with 1-3 fractions of pulsed-dose-rate (PDR) BT, 151 patients received EBRT and high-dose-rate (HDR) BT and 46 patients EBRT in addition to a combination of PDR and HDR (Table 3) [29][30][31][34][35][36][37][38][39][40].…”