Inversely and adaptively planned interstitial brachytherapy: A single implant approach
| Autor: | Ahmet Bulut, Mark D. Bonnen, Michelle Ludwig, Alison Yoder, John Bowers, Pamela Myers, S. Eraj, Z. Henry Yu, Alfredo Echeverria, Matthew L. Anderson, Tracilyn R. Hall, Alexander N. Hanania |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Adult medicine.medical_specialty Genital Neoplasms Female Brachytherapy 03 medical and health sciences 0302 clinical medicine Adaptive planning medicine Recurrent disease Humans In patient Cervix Aged Retrospective Studies business.industry Single implant Radiotherapy Planning Computer-Assisted Interstitial brachytherapy Obstetrics and Gynecology Middle Aged Regimen 030104 developmental biology medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Female Radiology Outcome data Neoplasm Recurrence Local business Radiotherapy Image-Guided |
| Zdroj: | Gynecologic oncology. 152(2) |
| ISSN: | 1095-6859 |
| Popis: | Objective To evaluate the efficacy, feasibility and safety of image-based, inversely and adaptively planned high-dose rate interstitial brachytherapy (HDR-ISBT) to treat advanced primary or recurrent gynecologic malignancy in a single implant, three-consecutive-day regimen. Methods Clinical demographics and outcome data were abstracted from all patients with primary and recurrent gynecologic malignancies who received HDR-ISBT boost from 2014 to 2017. Treatment consisted of a single implant (~7 Gy × 4 fractions) of interstitial needles using the Syed-Neblett template over a three-day hospital admission. CT-based (3D) simulation with inverse and adaptive planning was utilized for each fraction. MR prior to and MR immediately after external beam therapy were fused for HDR-ISBT target delineation. Results Forty women with an overall median follow-up of 18 months (range: 6–54 months) received an HDR-ISBT boost. Of the 30 primary cases (83% cervix, 10% vaginal, 7% uterine), 44% had organ invasion (bladder, rectal or both) on MRI. Median coverage and dose are reported (V100: 98%, HR-CTV EQD2: 85.1 Gy, D90: 92 Gy). A significant association existed between rectal doses exceeding GEC-ESTRO recommendations (D2cc Conclusions A four fraction, inversely and adaptively planned, single-implant approach of image-based HDR-ISBT provides excellent coverage, minimal toxicity and effective local control in patients with advanced and recurrent disease. |
| Databáze: | OpenAIRE |
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