3D MRI-based brachytherapy in patients with locally advanced cervical carcinoma – early clinical results


Authors: M. Doležel 1,2,5;  J. Vaňásek 1;  K. Odrážka 1,2;  T. Kroulík 1;  K. Kudelka 1;  M. Tichý 3;  M. Košťál 3;  Z. Vocásek 4
Authors‘ workplace: KOC, Pardubická krajská nemocnice, a. s., a Multiscan, s. r. o., Pardubice, primář doc. MUDr. J. Vaňásek, CSc. 1;  1. lékařská fakulta, Univerzita Karlova, Praha 2;  Porodnicko-gynekologické oddělení, Pardubická krajská nemocnice, a. s., Pardubice 3;  Porodnicko-gynekologické oddělení, Masarykova městská nemocnice v Jilemnici, Jilemnice 4;  Onkologická klinika, FN, Olomouc 5
Published in: Čes. Gynek.2012, 77, č. 6 s. 507-513

Overview

Objective:
To demonstrate the clinical benefit of MRI-based brachytherapy using CT and MRI data fusion.

Design:
Clinical trial.

Setting:
Oncology Centre, Multiscan and Pardubice Regional Hospital, Pardubice.

Methods:
Thirty six patients with locally advanced cervical cancer were treated with MRI-based brachytherapy (MRI-based preplanning 15 patients, MRI approximation 21 patients). All patients were continuously followed during and after treatment. Tumor control and toxicity were evaluated at each visit. Late gastrointestinal and genitourinary symptoms were recorded, using Fox Chase (FC) modification of the Radiation Therapy Oncology Group (RTOG) and Late Effects Normal Tissue Task Force (LENT) toxicity criteria.

Results:
We observed no complications during the entire MRI procedure at the radiology department. The cumulative incidence of grade ≥ 2 late genitourinary and gastrointestinal toxicity at median follow up of 30.3 months was 4.8% and 9.5% for MRI approximation, respectively 0% and 13.3% for MRI-based preplanning. Local control was 86.7% for MRI-based preplanning and 76.2% for MRI approximation.

Conclusion:
3D MRI-based brachytherapy with consecutive CT/MRI data fusion yields excellent local control with minor toxicity.

Key words:
MRI-based brachytherapy, cervical cancer, clinical results.


Sources

1. Dimopoulos, JCA., Lang, S., Kirisits, C., et al. Dose–volume histogram parameters and local tumor control in MR image guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys, 2009, 75, p. 56–63.

2. Dimopoulos, JCA., Schard, G., Berger, D., et al. Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: Potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys, 2006, 64, p. 1380–1388.

3. Doležel, M. 3D HDR brachyterapie v léčbě gynekologických malignit. Postgrad Med, 2009, 11, s. 315–317.

4. Dolezel, M., Odrazka, K., Vanasek, J., et al. MRI-based preplanning in patients with cervical cancer treated with 3D brachytherapy. Br J Radiol, 2011, 84, p. 850–856.

5. Dolezel, M., Odrazka, K., Zizka, J., et al. MRI-based preplanning using CT and MRI data fusion in patients with cervical cancer treated with 3D-based brachytherapy: feasibility and accuracy study. Int J Radiat Oncol Biol Phys, 2012, 84 (1), p. 146–152. DOI: 10.1016/j.ijrobp.2011.11.003

6. Doležel, M., Vaňásek, J., Odrážka, K., et al. Pokroky v léčbě karcinomu děložního hrdla – 3D plánování HDR brachyterapie pomocí CT/MR. Čes Gynek, 2008, 73, s. 144–149.

7. Doleželová, H., Slampa, P., Bolcak, K., et al. Význam PET v radioterapii karcinomu děložního hrdla – výsledky pilotní studie. Čes Gynek, 2008, 73, s. 135–140.

8. Eifel, PJ., Winter, K., Morria, M., et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and paraaortic irradiation for high risk cervical cancer: an update of radiation therapy on cology group trial (RTOG) 90-01. J Clin Oncol, 2004, 22, p. 872–880.

9. Fellner, C., Pötter, R., Knocke, T., et al. Comparison of radiography-and computed tomography-based treatment planning in cervix cancer in brachytherapy with specific attention to some quality assurance aspects. Radiother Oncol, 2001, 58, p. 53–62.

10. Fischerova, D., Cibula, D., Stenhova, H., et al. Use of transrectal ultrasound and magnetic resonance imaging in the staging of early-stage cervical cancer. Čes Gynek, 2009, 74, s. 323–329.

11. Georg, P., Lang, S., Dimopoulos, JC., et al. Dose-volume histogram parameters and late side effects in magnetic resonance image-guided adaptive cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys, 2011, 79, p. 356–362.

12. Haie-Meder, C., Chargari, C., Rey, A., et al. DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI-based low dose rate brachytherapy followed by surgery. Radiother Oncol, 2009, 93, p. 316–321.

13. Haie-Meder, C., Pötter, R., van Limbergen, E., et al. Recommendations from the Gynaecological (GYN) GEC ESTRO Working Group: Concepts and terms in 3D-image based 3D-treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol, 2004, 74, p. 235–245.

14. Hanlon AL, Schultheiss TE, Hunt MA, et al. Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants modification of existing morbidity scales. Int J Radiat Oncol Biol Phys, 1997, 38, p. 59–63.

15. Chiara, S., Bruzzone, M., Merlini, L., et al. for the GONO (North-West Oncologic Cooperative Group). Randomized study comparing chemotherapy plus radiotherapy versus radiotherapy alone in FIGO stage IIB-III cervical carcinoma. Am J Clin Oncol, 1994, 17, p. 294–297.

16. Christie, DRH., Bull, CA., Gebski, V., et al. Concurrent 5-fuorouracil, mitomycin C and irradiation in locally advanced cervix cancer. Radiother Oncol, 1995, 37, p. 181–189.

17. Keys, H., Bundy, B., Stehman, F., et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med, 1999, 340, p. 1154–1161.

18. Kim, RY., Pareek, P. Radiography-based treatment planning compared with computed tomography (CT)-based treatment planning for intracavitary brachytherapy in cancer of thecervix: analysis of dose-volume histograms. Brachytherapy, 2003, 2, p. 200–206.

19. Kirisits, C., Pötter, R., Lang, S., et al. Dose and volume parameters for MRI based treatment planning in intracavitary brachytherapy of cervix cancer. Int J Radiat Oncol Biol Phys, 2005, 62, p. 901–911.

20. Petera, J., Odrážka, K., Doležel, M., et al. Radioterapie velkými poli a brachyterapie s vysokým dávkovým příkonem s konkomitantní chemoterapií u pacientek s lokálně pokročilým cervikálním karcinomem. Čes Gynek, 2007, 72, s. 126–130.

21. Peters, WA. III,, Liu, PY., Barrett, RJ., et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol, 2000, 18, p. 1606–1613.

22. Pötter, R., Dimopoulos, J., Bachtiary, B., et al. 3D-conformal HDR brachytherapy and external beam therapy plus simultaneous cisplatin for high-risk cervical cancer: Clinical experience with 3 year follow up. Radiother Oncol, 2006, 79, p. 80–86.

23. Pötter, R., Dimopoulos, J., Georg, P., et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol, 2007, 83, p. 148–155.

24. Pötter, R., Georg, P., Dimopoulos, JC., et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol, 2011, 100, p. 116–123.

25. Pötter, R., Haie-Meder, C., vanLimbergen, E., et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose-volume parameters and aspects of 3D-image-based anatomy, radiation physics, radiobiology. Radiother Oncol, 2006, 78, p. 67–77.

26. Rose, PG., Bundy, BN., Watkins, EB., et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 1999, 340, p. 1144–1153.

27. Shin, K., Kim, T., Cho, J., et al. CT-guded intracavitary radiotherapy for cervical cancer: Comparison of conventional Point A plan with clinical target volume-based 3D plan using dose-volume parameters. Int J Radiat Oncol Biol Phys, 2006, 64, p. 197–204.

28. Sirák, I., Petera, J., Odrážka, K., et al. Význam intenzity chemoterapie v konkomitantní chemoradioterapii lokálně pokročilého karcinomu hrdla děložního. Čes Gynek, 2006, 71, s. 308–311.

29. Tanderup, K., Hellebust, TP., Lang, S., et al. Consequences of random and systematic reconstruction uncertainties in 3D image based brachytherapy in cervical cancer. Radiother Oncol, 2008, 89, p. 156–163.

30. Tanderup, K., Nielsen, SK., Nyvang, GB., et al. From point A to the sculpted pear: MR image guidance significantly improves tumour dose and sparing of organs at risk in brachytherapy of cervical cancer. Radiother Oncol, 2010, 94, p. 173–180.

31. Whitney, CW., Sause, W., Bundy, BN., et al. Randomized comparison of uorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative paraaortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol, 1999, 17, p. 1339–1348.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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