The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies

Pötter, Richard; Tanderup, Kari; Kirisits, Christian; Leeuw, Astrid de; Kirchheiner, Kathrin; Nout, Remi A.; Tan, Li Tee; Haie-Méder, Christine; Mahantshetty, Umesh; Šegedin, Barbara; Hoskin, Peter; Bruheim, Kjersti; Rai, Bhavana; Huang, Fleur; Limbergen, Erik; Schmid, Max; Nesvacil, N.; Sturdza, Alina; Fokdal, Lars; Jensen, Nina Boje Kibsgaard; Georg, Dietmar; Assenholt, M.S.; Seppenwoolde, Yvette; Nomden, C.N.; Fortin, I.; Chopra, Supriya; Heide, Uulke A. van der; Rumpold, Tamara; Lindegaard, Jacob Christian; Jürgenliemk-Schulz, Ina M.

doi:10.1016/j.ctro.2018.01.001

Cited by 496 publications

(521 citation statements)

References 86 publications

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“…Two patients had limited under-dosage after re-planning with 37.8 and 39.1 Gy to CTV-T LR, respectively, and marginally insufficient dose to CTV-T HR (42.5 Gy) in one patient. Furthermore it was found, that it [14][15][16][17][18][19][20] was the "large" rectal fillings assessed by the RTTs, that were most often associated with lack of target coverage during treatment (Fig. 3).…”

Section: Resultsmentioning

confidence: 99%

“…All measurements are visually assessed. [14][15][16][17][18][19][20] be that the macroscopic tumour occupies only a small fraction of the entire target volume irradiated to 45 Gy [30]. Therefore, the organ motion (and in particular systematic relocation of organs) is by far the most challenging aspect in EBRT for LACC.…”

Section: Discussionmentioning

confidence: 99%

“…A learning programme with online self-education (2½ h) as well as class teaching and "hands on training" (7 h) was conducted, N.B.K. Jensen et al Physics and Imaging in Radiation Oncology 9 (2019) [14][15][16][17][18][19][20] similar to previous experience with ART education [24]. Two general online modules introduced adaptive RT and CBCT image quality.…”

Section: Education Of Rtts Prior To Cbct-based Monitoringmentioning

confidence: 99%

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Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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A B S T R A C TBackground and purpose: Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach. Materials and methods: In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume + remaining cervix) and low risk (LR) CTV-T (CTV-T HR + uterus + parametriae + upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45 Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75 Gy) and CTV-T LR (aim 40 Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging. Results: Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5-2.2 and 1.0-2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7 Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2-1.8 Gy), and 3 patients did not benefit from re-planning. Conclusions: Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Education Of Rtts Prior To Cbct-based Monitoringmentioning

confidence: 99%

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Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Jensen

Assenholt

Fokdal

et al. 2019

Physics and Imaging in Radiation Oncology

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“…However, in the high-risk group (stage III or IVA, any stage and positive nodes) (p = 0.022), there were increased distant metastases (DMs) with a decreasing number of CTx cycles (fewer than five cycles). Early analysis from image-guided intensity-modulated external beam radio-CTx and MRI-based adaptive BT in a locally advanced cervical cancer (EMBRACE) I trial also showed higher DMs in node-positive and advancedstage patients who received fewer than five cycles of CTx [24].…”

Section: Delivery Of Chemotherapy To Enhance Treatment Results In Laccmentioning

confidence: 99%

“…The EMBRACE II study report was released in 2018 and reviewed the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and EMBRACE studies [24]. The EMBRACE II was initiated in April 2016 (https://www.embracestudy.dk) and defines interventions that address local, nodal, and systemic treatment as well as OAR exposure.…”

Section: Bt Is Mandatory Unless There Are Technical Problemsmentioning

confidence: 99%

Management for locally advanced cervical cancer: new trends and controversial issues

Cho

Chun

2018

Radiat Oncol J

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 254This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.

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Image guidance in radiation therapy for better cure of cancer

Grégoire

Gückenberger

Haustermans³

et al. 2020

Molecular Oncology

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The key goal and main challenge of radiation therapy is the elimination of tumors without any concurring damages of the surrounding healthy tissues and organs. Radiation doses required to achieve sufficient cancer‐cell kill exceed in most clinical situations the dose that can be tolerated by the healthy tissues, especially when large parts of the affected organ are irradiated. High‐precision radiation oncology aims at optimizing tumor coverage, while sparing normal tissues. Medical imaging during the preparation phase, as well as in the treatment room for localization of the tumor and directing the beam, referred to as image‐guided radiotherapy (IGRT), is the cornerstone of precision radiation oncology. Sophisticated high‐resolution real‐time IGRT using X‐rays, computer tomography, magnetic resonance imaging, or ultrasound, enables delivery of high radiation doses to tumors without significant damage of healthy organs. IGRT is the most convincing success story of radiation oncology over the last decades, and it remains a major driving force of innovation, contributing to the development of personalized oncology, for example, through the use of real‐time imaging biomarkers for individualized dose delivery.

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The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies

Abstract: Graphical abstract

Cited by 496 publications

References 86 publications

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

Management for locally advanced cervical cancer: new trends and controversial issues

Image guidance in radiation therapy for better cure of cancer

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