Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer employing MRI with a tandem/ring applicator in situ and virtual preplanning of the interstitial component
| Autor: | Erik Morre Pedersen, Jacob Christian Lindegaard, Merete Paludan, S.B. Hokland, Kari Tanderup, Lars Fokdal, Søren Kynde Nielsen, Lisbeth Røhl |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Brachytherapy Uterine Cervical Neoplasms Magnetic Resonance Imaging Interventional Imaging Three-Dimensional Medicine Humans Radiology Nuclear Medicine and imaging Pulsed-Dose Rate Brachytherapy External beam radiotherapy Neoplasm Staging Cervical cancer Reproducibility medicine.diagnostic_test business.industry Radiotherapy Planning Computer-Assisted Magnetic resonance imaging Radiotherapy Dosage Hematology medicine.disease Surgery Radiation therapy Oncology Feasibility Studies Female Implant Morbidity business Nuclear medicine Radiotherapy Image-Guided |
| Zdroj: | Fokdal, L, Tanderup, K, Hokland, S B, Røhl, L, Pedersen, E M, Nielsen, S K, Paludan, M & Lindegaard, J C 2013, ' Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer employing MRI with a tandem/ring applicator in situ and virtual preplanning of the interstitial component ', Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology . https://doi.org/10.1016/j.radonc.2013.01.010 |
| ISSN: | 1879-0887 |
| DOI: | 10.1016/j.radonc.2013.01.010 |
| Popis: | To investigate the reproducibility of virtually planned needles, changes in DVH parameters and clinical feasibility of combined intracavitary/interstitial (IC/IS) pulsed dose rate brachytherapy (PDR-BT) for locally advanced cervical cancer based on 3D MRI preplanning.Fifty-eight consecutively patients accrued in the EMBRACE study were included. Treatment was initiated with external beam radiotherapy and cisplatin. Three BT implants and MRI with the applicator in situ were performed in all patients, i.e. week 5 (BT0), week 6 (BT1) and week 7 (BT2) of the treatment. BT0 was only used for preplanning of subsequent implantations, whereas BT1 and BT2 comprised 2 equal sized fractions of PDR BT.Based on BT0, 24 patients (41%) were selected for a combined IC/IS implant at BT1 and BT2. Patients treated with IC/IS BT had significantly larger tumours compared with patients treated with IC BT only (p0.03). Additional time in general anaesthesia for the IC/IS component was on average 16 min. The number of preplanned virtual needles was 5.3±2.7 compared to 5.3±2.9 and 5.4±3.0 needles implanted at BT1 and BT2, respectively (p=0.72). Planned needle implantation depth was 33±15 mm compared to 30±10 mm at BT1 and 29±11 mm at BT2 (p=0.04). In the 24 patients selected for IC/IS BT both the virtual IC/IS plan (BT0) and the actually delivered plan (BT1+BT2) significantly increased D90 and D100 for HR CTV (p0.01) and reduced D2cc for sigmoid (p0.01) and bowel (p=0.04) compared to the optimised IC preplan (BT0). IC/IS BT was only associated with minor morbidity, which was resolved at a 3-month follow up.Combined IC/IS BT based on full 3D MRI preplanning is clinically feasible. The virtual preplanned needle positions are reproducible at subsequent BT applications leading to significantly improved DVH parameters and a clinically feasible and fast implant procedure. |
| Databáze: | OpenAIRE |
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