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Eckroate B, Ayala‐Peacock D, Venkataraman R, Campelo S, Chino J, Stephens SJ, Kim Y, Meltsner S, Raffi J, Craciunescu O. A novel multi-modality imaging phantom for validating interstitial needle guidance for high dose rate gynecological brachytherapy. J Appl Clin Med Phys 2023; 24:e14075. [PMID: 37335537 PMCID: PMC10562025 DOI: 10.1002/acm2.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To design, manufacture, and validate a female pelvic phantom for multi-modality imaging (CT, MRI, US) to benchmark a commercial needle tracking system with application in HDR gynecological (GYN) interstitial procedures. MATERIALS AND METHODS A GYN needle-tracking phantom was designed using CAD software to model an average uterus from a previous patient study, a vaginal canal from speculum dimensions, and a rectum to accommodate a transrectal ultrasound (TRUS) probe. A target volume (CTVHR ) was designed as an extension from the cervix-uterus complex. Negative space molds were created from modeled anatomy and 3D printed. Silicone was used to cast the anatomy molds. A 3D printed box was constructed to house the manufactured anatomy for structural integrity and to accommodate the insertion of a speculum, tandem, needles, and TRUS probe. The phantom was CT-imaged to identify potential imperfections that might impact US visualization. Free-hand TRUS was used to guide interstitial needles into the phantom. The commercial tracking system was used to generate a 3D US volume. After insertion, the phantom was imaged with CT and MR and the uterus and CTVHR dimensions were verified against the CAD model. RESULTS/CONCLUSIONS The manufactured phantom allows for accurate visualization with multiple imaging modalities and is conducive to applicator and needle insertion. The phantom dimensions from the CAD model were verified with those from each imaging modality. The phantom is low cost and can be reproducibly manufactured with the 3D printing and molding processes. Our initial experiments demonstrate the ability to integrate the phantom with a commercial tracking system for future needle tracking validation studies.
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Affiliation(s)
- Brett Eckroate
- Department of Radiation OncologyRutgers UniversityNew BrunswickNew JerseyUSA
| | - Diandra Ayala‐Peacock
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | | | - Sabrina Campelo
- Virginia Tech‐Wake Forest School of Biomedical Engineering and SciencesBlacksburgVirginiaUSA
| | - Junzo Chino
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Sarah Jo Stephens
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Yongbok Kim
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Sheridan Meltsner
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Julie Raffi
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Oana Craciunescu
- Department of Radiation OncologyDuke University Medical CenterDurhamNorth CarolinaUSA
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Zhang Z, Zhang N, Cheng G. Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer. LA RADIOLOGIA MEDICA 2023; 128:588-600. [PMID: 37138200 DOI: 10.1007/s11547-023-01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Three-dimensional (3D) imaging has an important role in brachytherapy and the treatment of cervical cancer. The main imaging methods used in the cervical cancer brachytherapy include magnetic resonance imaging (MRI), computer tomography (CT), ultrasound (US), and positron emission tomography (PET). However, single-imaging methods have certain limitations compared to multi-imaging. The application of multi-imaging can make up for the shortcomings and provide a more suitable imaging selection for brachytherapy. PURPOSE This review details the situation and scope of existing multi-imaging combination methods in cervical cancer brachytherapy and provides a reference for medical institutions. MATERIALS AND METHODS Searched the literature related to application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer in PubMed/Medline and Web of Science electronic databases. Summarized the existing combined imaging methods and the application of each method in cervical cancer brachytherapy. CONCLUSION The current imaging combination methods mainly include MRI/CT, US/CT, MRI/US, and MRI/PET. The combination of two imaging tools can be used for applicator implantation guidance, applicator reconstruction, target and organs at risk (OAR) contouring, dose optimization, prognosis evaluation, etc., which provides a more suitable imaging choice for brachytherapy.
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Affiliation(s)
- Zhaoming Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China.
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Lu Q, Guo D, Wei Y, Zheng J, Li J. Role of gastrointestinal ultrasound in image-guided radiation therapy: A review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Hanna S, Lapuz C, Lim A. Gynecological intrauterine brachytherapy training for radiation therapists: The development and implementation of a training program. Brachytherapy 2022; 21:678-685. [PMID: 35672241 DOI: 10.1016/j.brachy.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/26/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Gynecological brachytherapy (GynBT) is an important part of gynecological cancer management. At Olivia Newton-John Cancer Wellness & Research Centre (ONJCWRC), Melbourne, Australia, radiation therapists (RTs) are integral to the MRI adaptive GynBT program workflow. However, there is limited GynBT training available for RTs in Australia. A GynBT training program has been developed at ONJCWRC to meet this need and support RTs in becoming competent, proficient and confident in the various roles in GynBT. This is a preliminary report on the development and implementation of a credentialing program, providing a structured approach to GynBT training of RTs. METHODS AND MATERIALS A credentialing program was designed with modules and competency assessments to ensure efficiency and proficiency of RTs in the GynBT workflow. The program includes theoretical modules in anatomy, international GynBT guidelines, radiation safety and local protocols; and practical modules in equipment, ultrasound for GynBT, operating theatre procedures, MRI, contouring, applicator reconstruction, planning, quality assurance and treatment delivery. Learning strategies include self-directed learning, tutorials, practical sessions, and third-party courses. The program concludes with an exit examination assessing major competencies. RESULTS The program was implemented in April 2018 with three RTs completing the program and passing the exit examination on first attempt. On post-program survey, the RTs felt the program was comprehensive, helping to build their confidence, and proficiency in GynBT. CONCLUSIONS A GynBT RT credentialing program was successfully developed and implemented to improve the quality of training at ONJCWRC. This program is mandatory for RTs joining the GynBT team. This program can provide a framework for implementation of GynBT training in other centers.
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Affiliation(s)
- Sylvia Hanna
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Australia.
| | - Carminia Lapuz
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Australia
| | - Adeline Lim
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Australia
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Lin Y, Dong P, Shi D, Mao Z, Zhang N, Li W, Wang H, Cheng G, Wu X. Clinical values of transrectal ultrasound in judging GTV of cervical cancer. Brachytherapy 2021; 20:1172-1179. [PMID: 34588145 DOI: 10.1016/j.brachy.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/10/2021] [Accepted: 07/18/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the clinical value of transrectal ultrasound in judging the Gross Target Volume (GTV) of cervical cancer (CC). METHODS A total of 196 CC patients admitted to the Department of Radiotherapy, China-Japan Union Hospital, Jilin University, from January 2016 to June 2019 were selected as the study subjects. The GTVs before and after applicator insertion were determined by transrectal ultrasound and compared with those judged by MRI. RESULTS All 196 patients were successfully undergoing applicator insertion according to the pretreatment plan. The GTV doses reached the clinical requirements during treatment. There was no significant difference between the GTVs judged by MRI and ultrasound before insertion in terms of upper/lower diameter (MRI Before 1 vs. Ultrasound Before 1) (MB1 vs. UB1), left/right diameter (MB2 vs. UB2), or ventral/dorsal diameter (MB3 vs. UB3), and the intragroup correlation coefficients (ICC) were 0.59, 0.77, and 0.66, respectively; moreover, there was no significant difference between the GTVs judged by MRI and ultrasound after insertion in terms of MRI After one vs. Ultrasound After one (MA1 vs. UA1), MA2 vs. UA2, and MA3 vs. UA3, and the ICC values were 0.62, 0.79, and 0.76, respectively. CONCLUSIONS Transrectal ultrasound can satisfactorily determine the GTV of CC and has certain value in brachytherapy for CC.
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Affiliation(s)
- Yuanqiang Lin
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Peng Dong
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Dan Shi
- Department of Radiotherapy, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Zhuang Mao
- Department of Radiotherapy, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Ning Zhang
- Department of Radiotherapy, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Wenhui Li
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Guanghui Cheng
- Department of Radiotherapy, China-Japan Union Hospital, Jilin University, Changchun, China.
| | - Xiaoli Wu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China.
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Rodgers JR, Mendez LC, Hoover DA, Bax J, D'Souza D, Fenster A. Feasibility of fusing three-dimensional transabdominal and transrectal ultrasound images for comprehensive intraoperative visualization of gynecologic brachytherapy applicators. Med Phys 2021; 48:5611-5623. [PMID: 34415069 DOI: 10.1002/mp.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, we propose combining three-dimensional (3D) transrectal ultrasound (TRUS) and 3D transabdominal ultrasound (TAUS) images of gynecologic brachytherapy applicators to leverage the advantages of each imaging perspective, providing a broader field-of-view and allowing previously obscured features to be recovered. The aim of this study was to evaluate the feasibility of fusing these 3D ultrasound (US) perspectives based on the applicator geometry in a phantom prior to clinical implementation. METHODS In proof-of-concept experiments, 3D US images of application-specific multimodality pelvic phantoms were acquired with tandem-and-ring and tandem-and-ovoids applicators using previously validated imaging systems. Two TRUS images were acquired at different insertion depths and manually fused based on the position of the ring/ovoids to broaden the TRUS field-of-view. The phantom design allowed "abdominal thickness" to be modified to represent different body habitus and TAUS images were acquired at three thicknesses for each applicator. The merged TRUS images were then combined with TAUS images by rigidly aligning applicator components and manually refining the registration using the positions of source channels and known tandem length, as well as the ring diameter for the tandem-and-ring applicator. Combined 3D US images were manually, rigidly registered to images from a second modality (magnetic resonance (MR) imaging for the tandem-and-ring applicator and X-ray computed tomography (CT) for the tandem-and-ovoids applicator (based on applicator compatibility)) to assess alignment. Four spherical fiducials were used to calculate target registration errors (TREs), providing a metric for validating registrations, where TREs were computed using root-mean-square distances to describe the alignment of manually identified corresponding fiducials. An analysis of variance (ANOVA) was used to identify statistically significant differences (p < 0.05) between the TREs for the three abdominal thicknesses for each applicator type. As an additional indicator of geometric accuracy, the bladder was segmented in the 3D US and corresponding MR/CT images, and volumetric differences and Dice similarity coefficients (DSCs) were calculated. RESULTS For both applicator types, the combination of 3D TRUS with 3D TAUS images allowed image information obscured by the shadowing artifacts under single imaging perspectives to be recovered. For the tandem-and-ring applicator, the mean ± one standard deviation (SD) TREs from the images with increasing thicknesses were 1.37 ± 1.35 mm, 1.84 ± 1.22 mm, and 1.60 ± 1.00 mm. Similarly, for the tandem-and-ovoids applicator, the mean ± SD TREs from the images with increasing thicknesses were 1.37 ± 0.35 mm, 1.95 ± 0.90 mm, and 1.61 ± 0.76 mm. No statistically significant difference was detected in the TREs for the three thicknesses for either applicator type. The mean volume differences for the bladder segmentations were 3.14% and 2.33% and mean DSCs were 87.8% and 87.7% for the tandem-and-ring and tandem-and-ovoids applicators, respectively. CONCLUSIONS In this proof-of-concept study, we demonstrated the feasibility of fusing 3D TRUS and 3D TAUS images based on the geometry of tandem-and-ring and tandem-and-ovoids applicators. This represents a step toward an accessible and low-cost 3D imaging method for gynecologic brachytherapy, with the potential to extend this approach to other intracavitary configurations and hybrid applicators.
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Affiliation(s)
- Jessica Robin Rodgers
- School of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Lucas C Mendez
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas A Hoover
- Department of Medical Physics, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Jeffrey Bax
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - David D'Souza
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
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Small W, Kim YS, Joyce C, Surucu M, Leshyk M, Harkenrider MM, Potkul RK, Liotta M, Winder A, Altoos B. Uterine perforation during brachytherapy for cervical cancer: Complications, outcomes, and best practices for forward treatment planning and management. Brachytherapy 2021; 20:557-564. [PMID: 33741275 DOI: 10.1016/j.brachy.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to determine the incidence of uterine perforations, review the associated complications, and propose guidelines for management of perforations after brachytherapy. METHODS AND MATERIALS A retrospective chart review was conducted for all patients with cervical cancer who received single or multiple high-dose-rate brachytherapy implants between April 2006 and May 2017 at a single academic institution. CT and MRI images were retrospectively evaluated to record incidences of uterine perforation of tandem during brachytherapy. Acute and long-term complications during and after treatment were scored using the Common Terminology Criteria for Adverse Events, Version 4.0, of the National Cancer Institute. RESULTS A total of 123 patients were included in the study. Perforations were observed in 22 patients (17.9%) with 31 (6.4%) of the 482 total implants. Of the different categories of adverse events, only the rate of acute infectious complications among those with perforations (n = 3, 13.6%) versus those without perforations (n = 3, 3.0%) was significant (p = 0.040). Two of the three perforated patients with acute infections had mild urinary tract infections, and all resolved without complications or treatment delays. The remaining one patient had a frank perforation of the anterior uterine wall with a subsequent Grade 3 pyometra infection despite administration of prophylactic antibiotics and 1-week treatment delay. This case was eventually resolved with cervical dilation and evacuation of fluid. Long-term complications were not different between the two arms. CONCLUSIONS Patients with cervical cancer with uterine perforations may be able to safely proceed with brachytherapy treatment without delay or need for prophylactic antibiotics in the acute setting. Further validating data would be able to assist in establishing a new standard of care and help prevent unnecessary and harmful breaks during treatment.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL.
| | - Yo Sup Kim
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Cara Joyce
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Mark Leshyk
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Margaret Liotta
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Abigail Winder
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Basel Altoos
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
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van Dyk S, Khaw P, Lin MY, Chang D, Bernshaw D. Ultrasound-guided Brachytherapy for Cervix Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e403-e411. [PMID: 33715936 DOI: 10.1016/j.clon.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.
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Affiliation(s)
- S van Dyk
- Radiation Therapy Services, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - P Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - M-Y Lin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Chang
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Shanmugam S, Saravanan S, Susikar S, Syed Afroze H, Mendu SK. Role of Ultrasound-Guided Brachytherapy Applicator Placement in Cancer Cervix. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Radical radiotherapy in patients with cervix uteri carcinoma: experience of Ondokuz Mayis University. BMC Cancer 2019; 19:1208. [PMID: 31830953 PMCID: PMC6909517 DOI: 10.1186/s12885-019-6402-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 11/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background Radical radiotherapy is the standard treatment for patients with locally advanced cervix uteri carcinoma (FIGO stage IB2–IVA). Worldwide, incidence and mortality rates vary among regions because of differences in lifestyles and treatment standards. Herein, we evaluated the outcomes of radical radiotherapy in patients with locally advanced cervix uteri carcinoma from the middle Black Sea region of Turkey. Methods We retrospectively reviewed the records of 64 consecutive patients with locally advanced cervix uteri carcinoma who were treated from January 2013 to 2016 in our radiation oncology department. All patients staging and radiotherapy planning were performed with modern imaging techniques including magnetic resonance imaging and positron-emission-tomography/computed tomography before radical radiotherapy. Thereafter, all of them were treated with external beam radiotherapy and concurrent cis-platinum-based chemotherapy followed by three-dimensional intra-cavitary high-dose-rate brachytherapy. Results The median age at diagnosis was 54.5 years. The median follow-up period was 21 months. Acute grade 3 toxicity was detected in 3.1% of patients. Late toxicity was not detected in any patient. The 1- and 3-year progression-free survival rates were 83.6 and 67.5%, respectively. The 1- and 3-year overall survival rates were 95.7 and 76.9%, respectively. The most important prognostic factor was the FIGO stage. Distant metastasis was the most common cause of death in patients with locally advanced cervix uteri carcinoma despite radical radiotherapy. Conclusions In patients with locally-advanced cervix uteri carcinoma from the middle Black Sea region of our developing country, acceptable toxicity and survival rates are achieved similar to the recent literature from developed countries with using of modern staging, planning and radical radiotherapy techniques. However, recurrence was mostly in the form of distant metastases and further investigations on systemic therapies are required.
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Prospective intra/inter-observer evaluation of pre-brachytherapy cervical cancer tumor width measured in TRUS and MR imaging. Radiat Oncol 2019; 14:173. [PMID: 31585543 PMCID: PMC6778388 DOI: 10.1186/s13014-019-1352-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasound (US) imaging has been proved as an excellent diagnostic tool in gynecology and, due to its wide availability and limited cost, is under intense investigation as base for dose adaptation in cervical cancer brachytherapy. Purpose of this work is to test inter/intra-observer uncertainties between magnetic resonance (MR) and trans-rectal ultrasound (TRUS) imaging in defining maximum tumor width before first brachytherapy (BT) application in a prospective cohort of cervical cancer patients undergoing image-guided adaptive brachytherapy (IGABT). METHODS One hundred ten consecutive cervical cancer patients treated between 2013 and 2016 were included. Before the first BT implant patients underwent MR and TRUS scan with no applicator in place. Images were independently analyzed by three examiners, blinded to the other's results. With clinical information at hand, maximum tumor width was measured on preBT TRUS and MR. Quantitative agreement analysis was undertaken. Intra-class correlation coefficient (ICC), Passing-Bablok and Bland Altman plots were used to evaluate the intra/inter-observers measurement agreement. RESULTS Average difference between tumor width measured on MR (HRCTVMR) and TRUS (HRCTVTRUS) was 1.3 ± 3.2 mm (p < 0.001); 1.1 ± 4.6 mm (p = 0.01) and 0.7 ± 3 mm (p = 0.01). The error was less than 3 mm in 79, 82 and 80% of the measurements for the three observers, respectively. Intra-observer ICC was 0.96 (CI95% 0.94-0.97), 0.93 (CI95% 0.9-0.95) and 0.96 (CI95% 0.95-0.98) respectively. Inter-observer ICC for HRCTVMR width measures was 0.92 (CI95% 0.89-0.94) with no difference among FIGO stages. Inter-observer ICC for HRCTVTRUS was 0.86 (CI95% 0.81-0.9). For FIGO stage I and II tumors, ICC HRCTVTRUS values were comparable to respective HRCTVMR ICC values. For larger tumors HRCTVTRUS inter-observer ICC values were lower than respective HRCTVMR although remaining acceptable. CONCLUSIONS Our results suggest that TRUS is equivalent to MR in assessing preBT tumor maximum width in cervical cancer FIGO stage I/II. In more advanced stages TRUS seems to be slightly inferior to MR although maintaining a good agreement to gold standard imaging.
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Tumor Boost Using External Beam Radiation in Cervical Cancer Patients Unable to Receive Intracavitary Brachytherapy: Outcome From a Multicenter Retrospective Study (Korean Radiation Oncology Group 1419). Int J Gynecol Cancer 2019; 28:371-378. [PMID: 29189448 DOI: 10.1097/igc.0000000000001155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We conducted this study to evaluate the outcomes of external-beam radiotherapy tumor boost (EBRT-B) in cervical cancer patients who could not receive intracavitary brachytherapy. METHODS A total of 11 hospitals provided the data of patients who received EBRT-B during the period from January 2005 through October 2012. RESULTS A total of 75 patients were included. The median radiotherapy dose was 46 Gy (range, 40-54 Gy) for whole pelvis and 24 Gy (range, 9-35 Gy) for EBRT-B. Initial tumor responses assessed at 2 to 6 months after radiotherapy were as follows: 46 with complete response, 22 with partial response, 2 with stable disease, and 3 with progressive disease. After a median follow-up time of 33 months, 30 patients (40.0%) showed disease progression including 21 (28.0%) with local progression. The 5-year local failure-free survival rate was 70.0%. Achieving complete response at the first follow-up visit and an overall treatment time of 53 days or less were significantly related to favorable local failure-free survival. The rate of grade 3 or higher toxicity was 2.6%. CONCLUSIONS Approximately 70% of patients had local tumor control after curative radiotherapy using EBRT-B. Early tumor response and overall treatment time of 53 days or less were closely associated with favorable local control.
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Richart J, Carmona-Meseguer V, García-Martínez T, Herreros A, Otal A, Pellejero S, Tornero-López A, Pérez-Calatayud J. Review of strategies for MRI based reconstruction of endocavitary and interstitial applicators in brachytherapy of cervical cancer. Rep Pract Oncol Radiother 2018; 23:547-561. [PMID: 30534019 PMCID: PMC6277512 DOI: 10.1016/j.rpor.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/04/2018] [Accepted: 06/23/2018] [Indexed: 12/14/2022] Open
Abstract
Brachytherapy plays an essential role in the curative intent management of locally advanced cervical cancer. The introduction of the magnetic resonance (MR) as a preferred image modality and the development of new type of applicators with interstitial components have further improved its benefits. The aim of this work is to review the current status of one important aspect in the cervix cancer brachytherapy procedure, namely catheter reconstruction. MR compatible intracavitary and interstitial applicators are described. Considerations about the use of MR imaging (MRI) regarding appropriate strategies for applicator reconstruction, technical requirements, MR sequences, patient preparation and applicator commissioning are included. It is recommendable to perform the reconstruction process in the same image study employed by the physician for contouring, that is, T2 weighted (T2W) sequences. Nevertheless, a clear identification of the source path inside the catheters and the applicators is a challenge when using exclusively T2W sequences. For the intracavitary component of the implant, sometimes the catheters may be filled with some substance that produces a high intensity signal on MRI. However, this strategy is not feasible for plastic tubes or titanium needles, which, moreover, induce magnetic susceptibility artifacts. In these situations, the use of applicator libraries available in the treatment planning system (TPS) is useful, since they not only include accurate geometrical models of the intracavitary applicators, but also recent developments have made possible the implementation of the interstitial component. Another strategy to improve the reconstruction process is based on the incorporation of MR markers, such as small pellets, to be used as anchor points. Many institutions employ computed tomography (CT) as a supporting image modality. The registration of CT and MR image sets should be carefully performed, and its uncertainty previously assessed. Besides, an important research work is being carried out regarding the use of ultrasound and electromagnetic tracking technologies.
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Affiliation(s)
- José Richart
- Hospital Clínica Benidorm, Medical Physics Department, Alicante, Spain
| | - Vicente Carmona-Meseguer
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
| | | | - Antonio Herreros
- Hospital Clínic, Department of Radiation Oncology, Medical Physics Section, Barcelona, Spain
| | - Antonio Otal
- Hospital Arnau de Vilanova, Medical Physics Department, Lleida, Spain
| | - Santiago Pellejero
- Complejo Hospitalario de Navarra, Medical Physics Department, Pamplona, Spain
| | - Ana Tornero-López
- Hospital Dr. Negrín, Medical Physics Department, Las Palmas de Gran Canaria, Spain
| | - José Pérez-Calatayud
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
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Sullivan T, Yacoub JH, Harkenrider MM, Small W, Surucu M, Shea SM. Providing MR Imaging for Cervical Cancer Brachytherapy: Lessons for Radiologists. Radiographics 2018; 38:932-944. [DOI: 10.1148/rg.2018170033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Sullivan
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
| | - Joseph H. Yacoub
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
| | - Matthew M. Harkenrider
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
| | - William Small
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
| | - Murat Surucu
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
| | - Steven M. Shea
- From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chicago, Stritch School of Medicine, Health Sciences Division, 2160 S 1st Ave, Maywood, IL 60153
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Lim K, van Dyk S, Khaw P, Veera J, Mileshkin L, Ohanessian L, Harrison M, Vinod SK. Patterns of practice survey for brachytherapy for cervix cancer in Australia and New Zealand. J Med Imaging Radiat Oncol 2017; 61:674-681. [DOI: 10.1111/1754-9485.12614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Karen Lim
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School, UNSW, Medical Education and Research Precinct Level 2, Clinical Building; Liverpool Hospital; Liverpool New South Wales Australia
| | - Sylvia van Dyk
- Peter MacCallum Cancer Centre; Parkville Victoria Australia
| | - Pearly Khaw
- Peter MacCallum Cancer Centre; Parkville Victoria Australia
| | - Jacqueline Veera
- South Western Sydney Clinical School, UNSW, Medical Education and Research Precinct Level 2, Clinical Building; Liverpool Hospital; Liverpool New South Wales Australia
- Peter MacCallum Cancer Centre; Parkville Victoria Australia
| | | | - Lucy Ohanessian
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
| | - Michelle Harrison
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- Chris O'Brien Lifehouse; Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Shalini K Vinod
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School, UNSW, Medical Education and Research Precinct Level 2, Clinical Building; Liverpool Hospital; Liverpool New South Wales Australia
- Western Sydney University, Medical Education and Research Precinct Level 2, Clinical Building; Liverpool Hospital; Liverpool New South Wales Australia
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St-Amant P, Foster W, Froment MA, Aubin S, Lavallée MC, Beaulieu L. Use of 3D transabdominal ultrasound imaging for treatment planning in cervical cancer brachytherapy: Comparison to magnetic resonance and computed tomography. Brachytherapy 2017; 16:847-854. [PMID: 28455092 DOI: 10.1016/j.brachy.2017.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate if the addition of 3D transabdominal ultrasound (3DTAUS) imaging to computed tomography (CT) can improve treatment planning in 3D adaptive brachytherapy when compared with CT-based planning alone, resulting in treatment plans closer to the ones obtained using magnetic resonance imaging (MRI)-based planning. METHODS AND MATERIALS Five patients with cervical cancer undergoing brachytherapy underwent three imaging modalities: MRI, CT, and CT-3DTAUS. Volumes were delineated by a radiation oncologist and treatment plans were optimized on each imaging modality. To compare treatment plans, the dwell times optimized on MRI were transferred on CT and CT-3DTAUS images and dose parameters were reported on volumes of the receiving imaging modality. The plans optimized on CT and CT-3DTAUS were also copied and evaluated on MRI images. RESULTS Treatment plans optimized and evaluated on the same imaging modalities were clinically acceptable but statistically different (p < 0.05) from one another. MR-based plans had the highest target coverage (98%) and CT-based plans the lowest (93%). For all treatment plans evaluated on MRI, the target coverage was equivalent. However, a decrease in target coverage (V100) was observed when MR-based plans were applied on CT-3DTAUS (6%) and CT (13%) with p < 0.05. An increase in the rectum/sigmoid dose (D2cc) was observed with both CT-3DTAUS-based (0.6 Gy) and CT-based planning (1 Gy) when compared with MR-based plans, whereas bladder dose stayed similar. CONCLUSIONS When compared with CT-based planning, the addition of 3DTAUS to CT results in treatment plans closer to MR-based planning. Its use reduces the high-risk clinical target volume overestimation typically observed on CT, improving coverage of the target volume while reducing dose to the organs at risk.
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Affiliation(s)
- Patricia St-Amant
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Physics, Physics Engineering and Optic, and Cancer Research Centre, Université Laval, Québec, Québec, Canada; Centre de recherche du CHU de Québec et Axe Oncologie, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - William Foster
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Marie-Anne Froment
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Sylviane Aubin
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Marie-Claude Lavallée
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Luc Beaulieu
- Radiation Oncology Department, CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Physics, Physics Engineering and Optic, and Cancer Research Centre, Université Laval, Québec, Québec, Canada; Centre de recherche du CHU de Québec et Axe Oncologie, CHU de Québec-Université Laval, Québec, Québec, Canada.
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Nesvacil N, Schmid MP, Pötter R, Kronreif G, Kirisits C. Combining transrectal ultrasound and CT for image-guided adaptive brachytherapy of cervical cancer: Proof of concept. Brachytherapy 2016; 15:839-844. [PMID: 27693172 DOI: 10.1016/j.brachy.2016.08.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/16/2016] [Accepted: 08/25/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the feasibility of a treatment planning workflow for three-dimensional image-guided cervix cancer brachytherapy, combining volumetric transrectal ultrasound (TRUS) for target definition with CT for dose optimization to organs at risk (OARs), for settings with no access to MRI. METHODS AND MATERIALS A workflow for TRUS/CT-based volumetric treatment planning was developed, based on a customized system including ultrasound probe, stepper unit, and software for image volume acquisition. A full TRUS/CT-based workflow was simulated in a clinical case and compared with MR- or CT-only delineation. High-risk clinical target volume was delineated on TRUS, and OARs were delineated on CT. Manually defined tandem/ring applicator positions on TRUS and CT were used as a reference for rigid registration of the image volumes. Treatment plan optimization for TRUS target and CT organ volumes was performed and compared to MRI and CT target contours. RESULTS TRUS/CT-based contouring, applicator reconstruction, image fusion, and treatment planning were feasible, and the full workflow could be successfully demonstrated. The TRUS/CT plan fulfilled all clinical planning aims. Dose-volume histogram evaluation of the TRUS/CT-optimized plan (high-risk clinical target volume D90, OARs D2cm³ for) on different image modalities showed good agreement between dose values reported for TRUS/CT and MRI-only reference contours and large deviations for CT-only target parameters. CONCLUSIONS A TRUS/CT-based workflow for full three-dimensional image-guided cervix brachytherapy treatment planning seems feasible and may be clinically comparable to MRI-based treatment planning. Further development to solve challenges with applicator definition in the TRUS volume is required before systematic applicability of this workflow.
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Affiliation(s)
- Nicole Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
| | - Maximilian P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology, Wr. Neustadt, Austria
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
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18
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Patel S, Ragab O, Kamrava M. Real-time image guidance for gynecologic brachytherapy? Radiother Oncol 2016; 120:542-543. [DOI: 10.1016/j.radonc.2016.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/08/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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19
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Image-guided adaptive brachytherapy in locally advanced cervical cancer: recent advances and perspectives. Curr Opin Oncol 2016; 28:419-28. [DOI: 10.1097/cco.0000000000000309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Han DY, Safigholi H, Soliman A, Ravi A, Leung E, Scanderbeg DJ, Liu Z, Owrangi A, Song WY. Direction Modulated Brachytherapy for Treatment of Cervical Cancer. II: Comparative Planning Study With Intracavitary and Intracavitary-Interstitial Techniques. Int J Radiat Oncol Biol Phys 2016; 96:440-448. [PMID: 27598809 DOI: 10.1016/j.ijrobp.2016.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/12/2016] [Accepted: 06/10/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer. METHODS AND MATERIALS A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm(3), capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house-developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans. RESULTS In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm(3) reductions achieved were -2.48% ± 11.03%, -4.45% ± 5.24%, and -5.66% ± 6.43% for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used. CONCLUSIONS Integrating the novel DMBT tandem onto both intracavitary and intracavitary-interstitial applicator assembly enabled consistent improvement in the sparing of the OARs, over a standard "single-channel" tandem, though individual variations in benefit were considerable. Although at an early stage of development, the DMBT concept design is demonstrated to be useful and pragmatic for potential clinical translation.
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Affiliation(s)
- Dae Yup Han
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of California, San Francisco, San Francisco, California; Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California
| | - Habib Safigholi
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Abraam Soliman
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel J Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Zhaowei Liu
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California
| | - Amir Owrangi
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - William Y Song
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Kirisits C, Schmid MP, Beriwal S, Pötter R. In response to the letter to the editor from Sylvia van Dyk et al. regarding our editorial “High-tech image-guided therapy vs. low-tech, simple, cheap gynecologic brachytherapy”. Brachytherapy 2016; 15:207. [DOI: 10.1016/j.brachy.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
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van Dyk S, Garth M, Oates A, Kondalsamy-Chennakesavan S, Schneider M, Bernshaw D, Narayan K. Reproducibility and interoperator reliability of obtaining images and measurements of the cervix and uterus with brachytherapy treatment applicators in situ using transabdominal ultrasound. Brachytherapy 2015; 15:71-8. [PMID: 26614235 DOI: 10.1016/j.brachy.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/06/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To validate interoperator reliability of brachytherapy radiation therapists (RTs) in obtaining an ultrasound image and measuring the cervix and uterine dimensions using transabdominal ultrasound. METHODS AND MATERIALS Patients who underwent MRI with applicators in situ after the first insertion were included in the study. Imaging was performed by three RTs (RT1, RT2, and RT3) with varying degrees of ultrasound experience. All RTs were required to obtain a longitudinal planning image depicting the applicator in the uterine canal and measure the cervix and uterus. The MRI scan, taken 1 hour after the ultrasound, was used as the reference standard against which all measurements were compared. Measurements were analyzed with intraclass correlation coefficient and Bland-Altman plots. RESULTS All RTs were able to obtain a suitable longitudinal image for each patient in the study. Mean differences (SD) between MRI and ultrasound measurements obtained by RTs ranged from 3.5 (3.6) to 4.4 (4.23) mm and 0 (3.0) to 0.9 (2.5) mm on the anterior and posterior surface of the cervix, respectively. Intraclass correlation coefficient for absolute agreement between MRI and RTs was >0.9 for all posterior measurement points in the cervix and ranged from 0.41 to 0.92 on the anterior surface. Measurements were not statistically different between RTs at any measurement point. CONCLUSIONS RTs with variable training attained high levels of interoperator reliability when using transabdominal ultrasound to obtain images and measurements of the uterus and cervix with brachytherapy applicators in situ. Access to training and use of a well-defined protocol assist in achieving these high levels of reliability.
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Affiliation(s)
- Sylvia van Dyk
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
| | - Margaret Garth
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Amanda Oates
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | - Michal Schneider
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Kailash Narayan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
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Kirisits C, Schmid MP, Beriwal S, Pötter R. High-tech image-guided therapy versus low-tech, simple, cheap gynecologic brachytherapy. Brachytherapy 2015; 14:910-2. [PMID: 26427957 DOI: 10.1016/j.brachy.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
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University Cooperation Platform (UCP) between Christian-Albrechts-University Kiel (Germany) and Chiang Mai University (Thailand): implementation of image-guided gynecological brachytherapy. J Contemp Brachytherapy 2015; 7:86-92. [PMID: 25829941 PMCID: PMC4371068 DOI: 10.5114/jcb.2015.49444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/11/2015] [Accepted: 02/19/2015] [Indexed: 11/17/2022] Open
Abstract
Starting in 1999, the University Cooperation Platform (UCP) implemented an exchange program of researchers and clinicians/physicists between the Christian-Albrechts-University Kiel in Germany and Chiang Mai University in Thailand, to initiate a sustainable base for long-term development of image-guided brachytherapy and in general for high-technology radiotherapy in Chiang Mai. A series of UCP protocols, based constructively on each other, were performed and evaluated at intermediate term follow-up. The first protocol, addressing computed tomography (CT)-optimized brachytherapy for advanced cervical cancer (n = 17), showed a significant reduction of D2cc for the bladder and sigmoid (p < 0.001) while maintaining a very high dose in D90 high-risk clinical target volume (HR-CTV) in comparison with standard point-based planning. In addition, after a follow-up of 19 months no tumor relapse was observed. The second UCP protocol, testing the impact of magnetic resonance imaging (MRI) guidance (n = 15) in patients with cervical cancer, proved significantly smaller D2cc doses for the bladder, rectum, and sigmoid (p = 0.003, p = 0.015, and p = 0.012), and secured highly curative mean doses in D90 HR-CTV of 99.2 Gy. The acute and late toxicity was excellent without any observed grade 3 or higher morbidity. In the third protocol, the combination of image-guided brachytherapy (IGBT) and whole pelvis intensity-modulated external beam radiotherapy (WP-IMRT) (n = 15) reaffirmed the significant reduction of D2cc doses for the bladder, rectum, and sigmoid (p = 0.001 or p < 0.001) along with high equivalent dose at 2 Gy (EQD2) in the HR-CTV, and demonstrated very low acute therapy-related toxicity in absence of grade 3 morbidity. The implementation of transabdominal ultrasound (TAUS) was the focus of the fourth UCP project aiming a more generous potential use of image-guidance on long-term, and enhancing the quality of soft tissue assessment complementary to conventionally planned gynecological brachytherapy. Analyses in 29 patients revealed significantly reduced OARs doses in bladder with a total EQD2 > 80 Gy for bladder in only 17.2% versus 62.1% in conventional planning, and in rectum EQD2 > 75 Gy in 44.8% versus 79.3%, respectively. In conclusion, analyses revealed excellent results for the high-dose-rate IGBT in patients with advanced gynecological cancer both by using CT and MRI, and/or the combination with WP-IMRT. They also define MRI as gold standard for soft tissue assessment and to determine more accurately HR-CTV. The use of TAUS-guidance adds quality aspects to the “classical” conventional X-ray based planning, especially in terms of real-time measures and adequate soft tissue information, and may lower significantly the dose in OARs. The review of all UCP-results reconfirms the importance of the established program that will continue to operate with subsequent projects.
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