Cervix cancer brachytherapyMRI-guided treatment-planning optimisation in intracavitary or combined intracavitary/interstitial PDR brachytherapy using tandem ovoid applicators in locally advanced cervical cancer
Section snippets
Diagnostic workup, treatment protocols and dose calculation for EBRT and BT
Diagnosis of cervical cancer was based on clinical investigation, gynaecological investigation under anaesthesia with cystoscopy and biopsy, MR imaging of the pelvic region and the retroperitoneal space, as well as whole body FDG-PET on indication. The analysis includes 24 patients with pathologically proven cervical cancer treated between February 2006 and December 2007. All patients had FIGO stage IB2 to IVA tumours. Treatment was performed according to our institutional protocol with a
Results
The dose–volume parameters derived for all patients and for three different treatment plans are listed in Table 1. The differences in treated volumes between the Standard and the Optimised plans were limited on average with not more than 5 cm3 for VPD and 2 cm3 for V2PD. However, in individual cases a difference of up to 30% was seen. Between the Scaled Standard and Optimised plans, differences were more pronounced but did not exceed 14 cm3 for VPD and 6 cm3 for V2PD. The average HR-CTV sizes
Discussion
In Utrecht BT for cervical cancer is delivered using tandem ovoid applicators with treatment planning having been traditionally performed according to the ICRU 38 guidelines [8]. Treatment plans were generated using standard loading patterns. Dose was prescribed to the Manchester point A and was reduced, if the dose to ICRU bladder and/or rectum point exceeded our institutional constraints. The dilemma of this strategy is that the OAR-related dose reduction decreases the tumour dose and
Conclusion
Performing MRI-guided adaptive BT for cervical cancer is feasible in our department with an advantage in dose–volume relationships over our traditional treatment-planning strategy. By comparing our data with the results from other groups, we could demonstrate that we reach similar dose levels in target volumes and OAR. These findings suggest that 3D MRI-guided adaptive BT treatment planning according to the GEC ESTRO recommendations brings different treatment strategies together. The guidelines
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