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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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Wu Y, Yu H, Tang T, Li L, Tian Y. Difference after radiotherapy observed in patients with nasopharyngeal carcinoma. Bull Cancer 2023; 110:487-495. [PMID: 36966055 DOI: 10.1016/j.bulcan.2023.02.012] [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: 10/20/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 03/27/2023]
Abstract
To evaluate the shrinkage rate of small cervical lymph nodes (SCLNs) at different levels in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy retrospectively. 96 adult patients with NPC who underwent intensity-modulated radiotherapy (IMRT) at our institution were analyzed and followed-up. Evaluation of the response (shrinking rate) of SCLNs was determined by the bidimensional tumor area. Binary logistic regression was conducted to explore the risk factors associated with the shrinking rate of SCLNs. Of the 96 patients included in this study, 1,194 SCLNs were identified. Among the SCLNs, 28.6% were level IIb and 21.3% were level IIa. SCLNs at level IIa (96.1%), tended to have a response effect of no change (NC) with shrinking rate <50% (odds ratio [OR]=0.007; 95% CI: 0.003-0.021, P=5.287×10-25). Conversely, the most proportionate share of SCLNs for shrinking rate ≥50% (complete response (CR) or partial response (PR)) was observed at level IIb (67.2%) (OR=6.104; 95% CI: 3.267-11.407, P=1.420×10-8). There was no significant difference of shrinking rate between irradiation doses of 60Gy and 63Gy. Most SCLNs at level IIa were not shrunk after radiotherapy. The irradiation dose of SCLNs at level IIa should be not more than 60Gy to reduce side effects.
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Affiliation(s)
- Yang Wu
- The Second Affiliated Hospital of Soochow University, Department of Radiotherapy & Oncology, 215004 Suzhou, Jiangsu, PR China
| | - Hongmin Yu
- School of Public Health, Xuzhou Medical University, 221004 Xuzhou, Jiangsu, PR China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, 221004 Jiangsu, PR China
| | - Tianyou Tang
- Xuzhou Medical University Affiliated Hospital, Department of Radiation Oncology, Xuzhou, 221004 Jiangsu, PR China
| | - Liantao Li
- Xuzhou Medical University Affiliated Hospital, Department of Radiation Oncology, Xuzhou, 221004 Jiangsu, PR China
| | - Ye Tian
- The Second Affiliated Hospital of Soochow University, Department of Radiotherapy & Oncology, 215004 Suzhou, Jiangsu, PR China; Institution of Radiotherapy & Oncology, Soochow University, 215004 Jiangsu, PR China.
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Dose-effect relationship between dose-volume parameters of residual gross tumor volume and clinical prognosis in MRI-guided adaptive brachytherapy for locally advanced cervical cancer: a single-center retrospective study. Strahlenther Onkol 2023; 199:131-140. [PMID: 36109399 DOI: 10.1007/s00066-022-02000-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/14/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate the dose-effect relationship between the dose-volume parameters of residual gross tumor volume (GTVres) and clinical prognosis in MRI image-guided adaptive brachytherapy (IGABT) of patients with locally advanced cervical cancer in our center. MATERIALS AND METHOD The clinical data of 93 patients with locally advanced cervical squamous cell cancer who received external beam radiotherapy (EBRT) combined with IGABT ± chemotherapy in our center were retrospectively analyzed. The disease stage, overall treatment time (OTT), chemotherapy, and the dose-volume parameters D90, D98, and D100 of GTVres, the intermediate-risk clinical target volume (CTVIR), and the high-risk clinical target volume (CTVHR) of the patients were statistically analyzed. Kaplan-Meier and uni- and multivariable Cox regression analyses were used to analyze 2‑year overall survival (OS), progression-free survival (PFS), and local control rate (LC). A probit model was employed to assess the dose-effect relationship between the volume and dose-volume parameters of GTVres and 2‑year OS, PFS, and LC. RESULTS The median follow-up time was 19.6 months and 2‑year OS, PFS, and LC were 79.6%, 68.8%, and 94.6%, respectively. CTVHR D90 was an independent influencing factor for 2‑year PFS (P = 0.041); GTVresBT1 volume was an independent factor for 2‑year OS, PFS, and LC (P < 0.001). The probit model showed that at GTVresBT1 volume < 32.86 cm3, the expected 2‑year LC was > 90%; at GTVres D98 > 129.12 GyEQD2, the expected 2‑year OS was > 90%. CONCLUSION Both the volume and dose-volume parameters of GTVres are promising predictors in assessment of IGABT prognosis of cervical cancer.
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Markovina S, Rendle KA, Cohen AC, Kuroki LM, Grover S, Schwarz JK. Improving cervical cancer survival-A multifaceted strategy to sustain progress for this global problem. Cancer 2022; 128:4074-4084. [PMID: 36239006 PMCID: PMC10042221 DOI: 10.1002/cncr.34485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/03/2023]
Abstract
Cervical cancer is associated with profound socioeconomic and racial disparities in incidence, mortality, morbidity, and years of life lost. The last standard-of-care treatment innovation for locally advanced cervical cancer occurred in 1999, when cisplatin chemotherapy was added to pelvic radiation therapy (chemoradiation therapy). Chemoradiation therapy is associated with a 30%-50% failure rate, and there is currently no cure for recurrent or metastatic disease. The enormity of the worldwide clinical problem of cervical cancer morbidity and mortality as well as the egregiously unchanged mortality rate over the last several decades are recognized by the National Institutes of Health as urgent priorities. This is reflected within the Office of Research on Women's Health effort to advance National Institutes of Health research on the health of women, as highlighted in a recent symposium. In the current review, the authors address the state of the science and opportunities to improve cervical cancer survival with an emphasis on improving access, using technology in innovative and widely implementable ways, and improving current understanding of cervical cancer biology. LAY SUMMARY: Cervical cancer is associated with profound socioeconomic and racial disparities in incidence, mortality, morbidity, and years of life lost. In this review, the state of the science and opportunities to improve cervical cancer survival are presented with an emphasis on improving access, using technology in innovative and widely implementable ways, and improving current understanding of cervical cancer biology.
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Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis
- Siteman Cancer Center, Washington University School of Medicine in St. Louis
| | - Katharine A. Rendle
- Departments of Family Medicine & Community Health and of Biostatistics, Informatics, and Epidemiology, Perelman School of Medicine, University of Pennsylvania
- Abramson Cancer Center, University of Pennsylvania
| | - Alexander C. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis
| | - Lindsay M. Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis
| | - Surbhi Grover
- Abramson Cancer Center, University of Pennsylvania
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Julie K. Schwarz
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis
- Siteman Cancer Center, Washington University School of Medicine in St. Louis
- Department of Cell Biology and Physiology, Washington University School of Medicine in St. Louis
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Li F, Shi D, Bu M, Lu S, Zhao H. Four-Dimensional Image-Guided Adaptive Brachytherapy for Cervical Cancer: A Systematic Review and Meta-Regression Analysis. Front Oncol 2022; 12:870570. [PMID: 35860574 PMCID: PMC9291247 DOI: 10.3389/fonc.2022.870570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe ICRU/GEC-ESTRO released the ICRU Report No. 89, which introduced the concept of four-dimensional brachytherapy and ushered in a new era of brachytherapy for cervical cancer. The purpose of this study was to evaluate the local control and late toxicity of four-dimensional brachytherapy in cervical cancer through a systematic review and to reveal the dose-response relationship between the volumetric dose paraments and the local control rate via a probit model.Material and MethodsWe identified studies that reported the HR-CTV D90 and local control probabilities by searching the PubMed Database, the Web of Science Core Collection and the Cochrane Library Database through February 1st, 2022. Regression analyses were performed between the HR-CTV D90 and the local control probability using a probit model.ResultsNineteen studies enrolling 3,616 patients were included. The probit model showed a significant relationship between the HR-CTV D90 value and IR-CTV D90 Vs. the local control probability, P < 0.001 and P = 0.003, respectively. The D90 for HR-CTV and IR-CTV corresponding to a probability of 90% local control was 79.1 GyEQD2,10 (95% CI:69.8 – 83.7 GyEQD2,10) and 66.5 GyEQD2,10 (95% CI: 62.8 - 67.9 GyEQD2,10), respectively. The limits for the prescribed dose of 85 GyEQD2,10 for HR-CTV D90 theoretically warranted a 92.1% (95% CI: 90.2% - 95.3%) local control rate, and 87.2% (95% CI: 82.4% - 91.8%) local control probability was expected for 65 GyEQD2,10 to IR-CTV D90. The probit model showed no significant relationship between the D2cc to organs at risk and the probability of grade 3 and above gastrointestinal or genitourinary toxicity.ConclusionsFour-dimensional brachytherapy takes into account uncertain factors such as tumour regression, internal organ motion and organ filling, and provides a more accurate and more therapeutic ratio delivery through adaptive delineation and replanning, replacement of the applicator, and the addition of interstitial needles. The dose volume effect relationship of four-dimensional brachytherapy between the HR-CTV D90 and the local control rate provides an objective planning aim dose.
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Affiliation(s)
- Fei Li
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dan Shi
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingwei Bu
- Department of Radiation Oncology, Guowen Medical Corporation Changchun Hospital, Changchun, China
| | - Shuangchen Lu
- Department of Radiation Oncology, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Hongfu Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Hongfu Zhao,
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Schiff JP, Mintz R, Cohen AC, Huang Y, Thaker P, Massad LS, Powell M, Mutch D, Schwarz JK, Markovina ST, Grigsby PW. Overall survival in patients with FIGO stage IVA cervical cancer. Gynecol Oncol 2022; 166:292-299. [PMID: 35691754 DOI: 10.1016/j.ygyno.2022.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE FIGO stage IVA cervical cancer is a unique diagnosis that conveys a poor prognosis. Despite the use of PET/CT for staging, concurrent chemotherapy, and image-guided brachytherapy, overall survival (OS) in these patients is low. Treatment requires aggressive use of radiotherapy and chemotherapy. We report results of a prospective observational cohort study for patients with de novo stage IVA cervical cancer treated at a single institution. METHODS Patients with a new diagnosis of stage IVA cervical cancer treated at an academic institution between 1997 and 2020 were prospectively monitored. Staging was retroactively assigned using the 2018 FIGO staging system. All patients had a PET/CT prior to treatment and were treated with definitive intent radiotherapy with or without chemotherapy. The primary outcome of interest was OS. Secondary outcomes were local control, progression-free survival (PFS), and disease-specific survival (DSS). RESULTS 32 patients with de novo stage IVA cervical cancer were treated with definitive intent radiotherapy. Median follow-up time was 4.27 years (1.31-10.35). 22/32 (69%) of patients received brachytherapy as a part of their definitive treatment, and 28/32 (88%) received chemotherapy concurrently with radiotherapy. 14/32 (44%) of patients had no evidence of disease at last follow-up. The 5-year local control, PFS, DFS, and OS estimates were 79%, 49%, 53%, and 48%, respectively. On multivariate analysis, complete metabolic response was associated with a statistically significant improvement in PFS (HR = 0.256, 95% CI = 0.078-0.836, p = 0.024) and OS (HR = 0.273, 95% CI 0.081-0.919). CONCLUSIONS These data demonstrate a robust OS in patients with stage IVA cervical cancer when treated with definitive chemoradiotherapy.
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Affiliation(s)
- Joshua P Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Rachel Mintz
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Alexander C Cohen
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Yi Huang
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Premal Thaker
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Leslie S Massad
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Matthew Powell
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - David Mutch
- Washington University School of Medicine in St. Louis, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 4901 Forest Park Ave Suite 710, St. Louis, MO 63108, USA.
| | - Julie K Schwarz
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Stephanie T Markovina
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
| | - Perry W Grigsby
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
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Prisciandaro J, Zoberi JE, Cohen G, Kim Y, Johnson P, Paulson E, Song W, Hwang KP, Erickson B, Beriwal S, Kirisits C, Mourtada F. AAPM Task Group Report 303 endorsed by the ABS: MRI Implementation in HDR Brachytherapy-Considerations from Simulation to Treatment. Med Phys 2022; 49:e983-e1023. [PMID: 35662032 DOI: 10.1002/mp.15713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
The Task Group (TG) on Magnetic Resonance Imaging (MRI) Implementation in High Dose Rate (HDR) Brachytherapy - Considerations from Simulation to Treatment, TG 303, was constituted by the American Association of Physicists in Medicine's (AAPM's) Science Council under the direction of the Therapy Physics Committee, the Brachytherapy Subcommittee, and the Working Group on Brachytherapy Clinical Applications. The TG was charged with developing recommendations for commissioning, clinical implementation, and on-going quality assurance (QA). Additionally, the TG was charged with describing HDR brachytherapy (BT) workflows and evaluating practical consideration that arise when implementing MR imaging. For brevity, the report is focused on the treatment of gynecologic and prostate cancer. The TG report provides an introduction and rationale for MRI implementation in BT, a review of previous publications on topics including available applicators, clinical trials, previously published BT related TG reports, and new image guided recommendations beyond CT based practices. The report describes MRI protocols and methodologies, including recommendations for the clinical implementation and logical considerations for MR imaging for HDR BT. Given the evolution from prescriptive to risk-based QA,1 an example of a risk-based analysis using MRI-based, prostate HDR BT is presented. In summary, the TG report is intended to provide clear and comprehensive guidelines and recommendations for commissioning, clinical implementation, and QA for MRI-based HDR BT that may be utilized by the medical physics community to streamline this process. This report is endorsed by the American Brachytherapy Society (ABS). This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gil'ad Cohen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | | | | | - Ken-Pin Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sushil Beriwal
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | | | - Firas Mourtada
- Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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SERPINB3 (SCCA1) inhibits cathepsin L and lysoptosis, protecting cervical cancer cells from chemoradiation. Commun Biol 2022; 5:46. [PMID: 35022555 PMCID: PMC8755728 DOI: 10.1038/s42003-021-02893-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
The endogenous lysosomal cysteine protease inhibitor SERPINB3 (squamous cell carcinoma antigen 1, SCCA1) is elevated in patients with cervical cancer and other malignancies. High serum SERPINB3 is prognostic for recurrence and death following chemoradiation therapy. Cervical cancer cells genetically lacking SERPINB3 are more sensitive to ionizing radiation (IR), suggesting this protease inhibitor plays a role in therapeutic response. Here we demonstrate that SERPINB3-deficient cells have enhanced sensitivity to IR-induced cell death. Knock out of SERPINB3 sensitizes cells to a greater extent than cisplatin, the current standard of care. IR in SERPINB3 deficient cervical carcinoma cells induces predominantly necrotic cell death, with biochemical and cellular features of lysoptosis. Rescue with wild-type SERPINB3 or a reactive site loop mutant indicates that protease inhibitory activity is required to protect cervical tumor cells from radiation-induced death. Transcriptomics analysis of primary cervix tumor samples and genetic knock out demonstrates a role for the lysosomal protease cathepsin L in radiation-induced cell death in SERPINB3 knock-out cells. These data support targeting of SERPINB3 and lysoptosis to treat radioresistant cervical cancers. Wang et al. demonstrate the cytoprotective role of SERPINB3 against radiation-induced necrosis, showing that cells lacking SERPINB3 protein both in culture and in mice are more sensitive to radiation and cisplatin-induced cell death. The authors also report that the cell death induced by radiation in SERPINB3-lacking cells is lysoptosis and implicate the lysosomal protease cathepsin L in this process.
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Lin AJ, Dehdashti F, Massad LS, Thaker PH, Powell MA, Mutch DG, Schwarz JK, Markovina S, Siegel BA, Grigsby PW. Long-Term Outcomes of Cervical Cancer Patients Treated With Definitive Chemoradiation Following a Complete Metabolic Response. Clin Oncol (R Coll Radiol) 2021; 33:300-306. [PMID: 33581976 PMCID: PMC8453338 DOI: 10.1016/j.clon.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
AIMS A complete metabolic response (CMR) on early post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a positive prognostic factor for cervical cancer patients treated with definitive chemoradiation, but long-term outcomes of this group of patients are unknown. Patterns of failure and risk subgroups are identified. MATERIALS AND METHODS Patients who received curative-intent chemoradiation from 1998 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IVA cervical cancer and had a CMR on post-treatment FDG-PET within 5 months of treatment completion were included. Cox proportional hazards models determined factors associated with locoregional and distant failure. Kaplan-Meier estimates of freedom from any recurrence (FFR) of patient subgroups were compared with Log-rank tests. RESULTS There were 402 patients with a CMR after chemoradiation on FDG-PET. Initial T stage was T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%); initial FDG-avid nodal status was no nodes (50%)/pelvic lymph nodes (40%)/pelvic and para-aortic lymph nodes (10%). After a median follow-up of 6 years, 109 (27%) recurred. The pattern of recurrence was locoregional (27%), distant (61%) or both (12%). No factors were associated with locoregional failure. Distant recurrence was more likely in patients with T3-4 lesions (hazard ratio = 2.4, 95% confidence interval 1.5-3.8) and involvement of pelvic (hazard ratio = 1.6, 95% confidence interval 1.0-2.7) or para-aortic lymph nodes (hazard ratio = 2.7, 95% confidence interval 1.4-5.0) at diagnosis. The 5-year FFR rates for T1-2 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 85, 76 and 62%, respectively (P = 0.04, none versus para-aortic nodes). The 5-year FFR for T3-4 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 68, 56 and 25%, respectively (P = 0.09, none versus para-aortic nodes). CONCLUSIONS T3-4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation.
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Affiliation(s)
- A J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - F Dehdashti
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - L S Massad
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - P H Thaker
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - M A Powell
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - D G Mutch
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - J K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - S Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - B A Siegel
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - P W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Floberg JM, Zhang J, Muhammad N, DeWees TA, Inkman M, Chen K, Lin AJ, Rashmi R, Jayachandran K, Edelson BT, Siegel BA, Dehdashti F, Grigsby PW, Markovina S, Schwarz JK. Standardized Uptake Value for 18F-Fluorodeoxyglucose Is a Marker of Inflammatory State and Immune Infiltrate in Cervical Cancer. Clin Cancer Res 2021; 27:4245-4255. [PMID: 33820781 DOI: 10.1158/1078-0432.ccr-20-4450] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Chemoradiotherapy for locally advanced cervical cancer fails in over a third of patients. Biomarkers with therapeutic implications are therefore needed. We investigated the relationship between an established prognostic marker, maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography, and the inflammatory and immune state of cervical cancers. EXPERIMENTAL DESIGN An SUVmax most prognostic for freedom from progression (FFP) was identified and compared with known prognostic clinical variables in a cohort of 318 patients treated with definitive radiation with prospectively collected clinical data. Gene set enrichment analysis (GSEA) and CIBERSORT of whole-transcriptome data from 68 patients were used to identify biological pathways and immune cell subpopulations associated with high SUVmax. IHC using a tissue microarray (TMA, N = 82) was used to validate the CIBERSORT findings. The impact of macrophages on cervical cancer glucose metabolism was investigated in coculture experiments. RESULTS SUVmax <11.4 was most prognostic for FFP (P = 0.001). The GSEA showed that high SUVmax is associated with increased gene expression of inflammatory pathways, including JAK/STAT3 signaling. CIBERSORT and CD68 staining of the TMA showed high SUVmax tumors are characterized by a monocyte-predominant immune infiltrate. Coculture of cervical cancer cells with macrophages or macrophage-conditioned media altered glucose uptake, and IL6 and JAK/STAT3 signaling contribute to this effect. CONCLUSIONS SUVmax is a prognostic marker in cervical cancer that is associated with activation of inflammatory pathways and tumor infiltration of myeloid-derived immune cells, particularly macrophages. Macrophages contribute to changes in cervical cancer glucose metabolism.See related commentary by Williamson et al., p. 4136.
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Affiliation(s)
- John M Floberg
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jin Zhang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Naoshad Muhammad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Todd A DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix, Arizona
| | - Matthew Inkman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin Chen
- Washington University School of Medicine, St. Louis, Missouri
| | - Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Ramachandran Rashmi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kay Jayachandran
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Brian T Edelson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. .,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri
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11
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Decazes P, Hinault P, Veresezan O, Thureau S, Gouel P, Vera P. Trimodality PET/CT/MRI and Radiotherapy: A Mini-Review. Front Oncol 2021; 10:614008. [PMID: 33614497 PMCID: PMC7890017 DOI: 10.3389/fonc.2020.614008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Computed tomography (CT) has revolutionized external radiotherapy by making it possible to visualize and segment the tumors and the organs at risk in a three-dimensional way. However, if CT is a now a standard, it presents some limitations, notably concerning tumor characterization and delineation. Its association with functional and anatomical images, that are positron emission tomography (PET) and magnetic resonance imaging (MRI), surpasses its limits. This association can be in the form of a trimodality PET/CT/MRI. The objective of this mini-review is to describe the process of performing this PET/CT/MRI trimodality for radiotherapy and its potential clinical applications. Trimodality can be performed in two ways, either a PET/MRI fused to a planning CT (possibly with a pseudo-CT generated from the MRI for the planning), or a PET/CT fused to an MRI and then registered to a planning CT (possibly the CT of PET/CT if calibrated for radiotherapy). These examinations should be performed in the treatment position, and in the second case, a patient transfer system can be used between the PET/CT and MRI to limit movement. If trimodality requires adapted equipment, notably compatible MRI equipment with high-performance dedicated coils, it allows the advantages of the three techniques to be combined with a synergistic effect while limiting their disadvantages when carried out separately. Trimodality is already possible in clinical routine and can have a high clinical impact and good inter-observer agreement, notably for head and neck cancers, brain tumor, prostate cancer, cervical cancer.
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Affiliation(s)
- Pierre Decazes
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Ovidiu Veresezan
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Sébastien Thureau
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen, France
| | - Pierrick Gouel
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
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12
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Three-dimensional image-guided combined intracavitary and interstitial high-dose-rate brachytherapy in cervical cancer: A systematic review. Brachytherapy 2020; 20:85-94. [PMID: 33039332 DOI: 10.1016/j.brachy.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the local control and toxicities of three-dimensional image-guided combined intracavitary and interstitial (IC/IS) high-dose-rate brachytherapy (BT) in cervical cancer through a systematic review. METHODS AND MATERIALS A systematic review of relevant studies was performed through the PubMed, Web of Science, and Cochrane Library databases through May 10, 2020. Articles reporting on IC/IS technology, volumetric doses to high-risk clinical target volume (HR-CTV) and organs at risk (OARs), tumor control and/or treatment-related side effects were identified. The key information, including the type of applicator, implantation technology, characteristics of implantation, volumetric doses, tumor control, and/or treatment-related side effects, was extracted. A probit model analysis between HR-CTV D90 and tumor local control was performed. RESULTS Twelve studies encompassing 520 patients were included in the probit model between HR-CTV D90 and the local control rate. The probit model showed a significant relationship between the HR-CTV D90 value and the local control probability, p = 0.003. The prescribed dose of 85 GyEQD2,10 would in theory warrant an 87.4% (95% confidence interval 82.5%-90.5%) local control rate. CONCLUSION IC/IS BT is an appropriate method to achieve a high therapeutic ratio for tumors with large volumes or poor responses after external irradiation in cervical cancer. The probit model showed that the dose escalation of HR-CTV D90 was helpful to improve the local tumor control rate.
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Abstract
PURPOSE To identify the 100 most cited research articles on cervical cancer radiotherapy. METHODS The Web of Science and Scopus databases were searched to identify the 100 most cited articles on cervical cancer radiotherapy as of September 29, 2019. Articles were ranked based on the total citations received from 2 databases. One hundred articles about radiotherapy for cervical cancer were identified. The following important information was extracted: author, journal, year and month of publication, country or region, and radiotherapy technologies. RESULTS The 100 most cited articles on cervical cancer radiotherapy were published between 1964 and 2016, and the total citations from 2 databases ranged from 3478 to 211, including a total of 49,262 citations as of September 29, 2019. The index of citations per year ranged from 170.4 to 13.1. These articles were from 16 countries or regions, with most publications being from the United States (n = 38), followed by Austria (n = 15), Canada (n = 8), France (n = 8) and the United Kingdom (n = 7). The International Journal of Radiation Oncology, Biology, Physics produced the most articles (n = 42), followed by Radiotherapy and Oncology (n = 13), Cancer (n = 8) and Journal of Clinical Oncology (n = 7). These articles were categorized as original studies (n = 86), recommendations (n = 5), guidelines (n = 5) and reviews (n = 4). Of the 100 most cited articles, intracavitary brachytherapy (n = 50) and 3-dimensional conformal radiotherapy (n = 34) were the most commonly used treatment techniques. CONCLUSION To the best of our knowledge, this is the first report and analysis of the most cited articles on cervical cancer radiotherapy. This bibliographic study presents the history of technological development in external radiation therapy and brachytherapy. Brachytherapy is an indispensable part of radiotherapy for cervical cancer. The International Journal of Radiation Oncology Biology Physics is the journal with the most publications related to cervical cancer radiotherapy.
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Affiliation(s)
- Zhipeng Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun
| | - Xiaodi Tang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun
| | - Xin MU
- Department of Radiation Oncology, Jilin City Hospital of Chemical Industry, Jilin, Jilin, China
| | - Hongfu Zhao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun
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14
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Lucia F, Bourbonne V, Gujral D, Dissaux G, Miranda O, Mauguen M, Pradier O, Abgral R, Schick U. Impact of suboptimal dosimetric coverage of pretherapeutic 18F-FDG PET/CT hotspots on outcome in patients with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy. Clin Transl Radiat Oncol 2020; 23:50-59. [PMID: 32435702 PMCID: PMC7229342 DOI: 10.1016/j.ctro.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Areas of high uptake on pre-treatment 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), denoted as "hotspots", have been identified as preferential sites of local relapse in locally advanced cervical cancer (LACC). The purpose of this study was to analyze the dosimetric coverage of these hotspots with high dose-rate brachytherapy (BT). METHODS For each patient, a rigid registration of the CT from the pre-treatment PET/CT with the radiotherapy planning CT was performed using 3D SlicerTM, followed by a manual volume correction by translation and deformation if necessary. The fuzzy locally adaptive Bayesian (FLAB) algorithm was applied to PET images to simultaneously define an overall tumour volume and the high-uptake sub-volume V1. The inclusion of V1 in the high-risk clinical target volume (CTV HR) and its dosimetric coverage were evaluated using 3D SlicerTM. The average of the 3-4 BT sessions was reported. RESULTS Forty-two patients with recurrence after chemoradiotherapy (CRT) for LACC were matched to 42 patients without recurrence. Mean ± standard deviation follow-up was 26 ± 11 months. In the recurrence group, V1 was not included in the CTV HR and not covered by the 85 Gy isodose in 17/42 patients (41%) (1/20 with pelvic recurrence and 16/22 with distant recurrence) and not by the 80 Gy isodose in 7/42 patients (17%) (all with distant recurrence). In the non-recurrence group, V1 was not included in CTV HR and not covered by the 85 Gy isodose in 3 patients only (7%). The hotspots coverage by the 85 Gy isodose was significantly better in patients who did not recur, but only when compared to patients with distant relapse (p < 0.0001). CONCLUSION Suboptimal dosimetric coverage of high FDG uptakes on pretherapeutic PET could be associated with an increased risk of recurrence.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
| | | | - Dorothy Gujral
- Clinical Oncology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Hammersmith, London, UK
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Gurvan Dissaux
- Radiation Oncology Department, University Hospital, Brest, France
| | - Omar Miranda
- Radiation Oncology Department, University Hospital, Brest, France
| | - Maelle Mauguen
- Radiation Oncology Department, University Hospital, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France
| | - Ronan Abgral
- Nuclear Medicine Department, University Hospital, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France
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15
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Albuquerque K, Tumati V, Lea J, Ahn C, Richardson D, Miller D, Timmerman R. A Phase II Trial of Stereotactic Ablative Radiation Therapy as a Boost for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2020; 106:464-471. [DOI: 10.1016/j.ijrobp.2019.10.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023]
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16
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Lin AJ, Dehdashti F, Grigsby PW. Molecular Imaging for Radiotherapy Planning and Response Assessment for Cervical Cancer. Semin Nucl Med 2019; 49:493-500. [DOI: 10.1053/j.semnuclmed.2019.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lin AJ, Samson P, Zoberi J, Garcia-Ramirez J, Williamson JF, Markovina S, Schwarz J, Grigsby PW. Concurrent chemoradiation for cervical cancer: Comparison of LDR and HDR brachytherapy. Brachytherapy 2019; 18:353-360. [PMID: 30971370 DOI: 10.1016/j.brachy.2018.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare clinical outcomes between low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy for cervical cancer patients. METHODS AND MATERIALS All consecutive newly diagnosed cervical cancer patients undergoing pretreatment 18-fluorodeoxyglucose positron emission tomography imaging and treated with curative-intent definitive chemoradiation from 1997 to 2016 at a U.S. academic center were included. Brachytherapy boost was LDR or HDR 2D treatment planning from 1997 to 2005 and HDR with MR-based 3D planning from 2005 to 2016. Local control (LC), cancer-specific survival (CSS), and late bowel/bladder complications were evaluated. RESULTS Tumor stages were International Federation of Gynecology and Obstetrics IB1-IIB (n = 457; 75%) and III-IVA (n = 152; 25%). Brachytherapy was LDR for 104 patients and HDR for 505 patients. Concurrent weekly cisplatin was administered to 536 patients (88%). With median followup of 9.4 years, there was no difference in LC (p = 0.24) or CSS (p = 0.50) between LDR and HDR brachytherapy. Cox multivariable regression showed that only International Federation of Gynecology and Obstetrics stage III-IVA (HR=2.4, p = 0.004) was associated with worse LC. A propensity-matched cohort (90 LDR vs. 90 HDR) was created, and the 5-year LC rates were 88% LDR and 82% HDR, p = 0.26; 5-year CSS rates were 66% LDR and 58% HDR, p = 0.19; 5-year grade ≥3 bowel/bladder toxicities were 23% LDR and 16% HDR, p = 0.44. For all patients, the 5-year late toxicity in stage III-IVA patients was higher with LDR 47% vs. HDR 15%, p = 0.03, with no difference in LC, 86% and 75%, respectively (p = 0.09). CONCLUSIONS There was no difference in LC with either LDR or HDR brachytherapy. The late complication rate was reduced with HDR and 3D-planned brachytherapy compared to LDR and 2D-planned brachytherapy.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pamela Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jacqueline Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey F Williamson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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18
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Lin AJ, Kidd E, Dehdashti F, Siegel BA, Mutic S, Thaker PH, Massad LS, Powell MA, Mutch DG, Markovina S, Schwarz J, Grigsby PW. Intensity Modulated Radiation Therapy and Image-Guided Adapted Brachytherapy for Cervix Cancer. Int J Radiat Oncol Biol Phys 2018; 103:1088-1097. [PMID: 30445171 DOI: 10.1016/j.ijrobp.2018.11.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE This study reported long-term outcomes of patients with cervical cancer who were treated with intensity modulated radiation therapy and 3-dimensional (3D) image-guided adapted brachytherapy (IMRT/3D-IGABT) compared with those treated with 2-dimensional (2D) external irradiation and 2D brachytherapy (2D EBRT/BT). METHODS AND MATERIALS This study included patients with newly diagnosed cervical cancer and pretreatment fluorodeoxyglucose positron emission tomography scans who were treated with curative-intent irradiation from 1997 to 2013. The treatment policy changed from using 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer-specific survival (CSS), and overall survival (OS) were evaluated. Late gastrointestinal and genitourinary toxicity were scored with National Cancer Institute Common Terminology Criteria for Adverse Events. RESULTS The median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n = 300) was 15.3 years (range, 10.8-20.5 years). In the IMRT/3D-IGABT group (n = 300), it was 7 years (range, 5-12.4 years). According to the International Federation of Gynecology and Obstetrics, 33% of tumors were stage IB1 to IB2, 41% were stage IIA to IIB, and 26% were stage IIIA to IVA. The results after 5 years for patients treated with 2D EBRT/BT showed that freedom from relapse (FFR) was 57%, CSS was 62%, and OS was 57%. For the IMRT/3D-IGABT group, the 5-year results showed that FFR was 65% (P = .04), CSS was 69% (P = .01), and OS was 61% (P = .04). When stratified by lymph node status according to positron emission tomography scan results, disease control was most improved with IMRT/3D-IGABT versus 2D EBRT/BT in patients with positive pelvic lymph nodes only (P = .02). Cumulatively, 88 of 600 patients (15%) had grade ≥3 late bowel/bladder toxicity. The 2D EBRT/BT group had 55 patients (18%), and the IMRT/3D-IGABT group had 33 patients (11%; P = .02). CONCLUSIONS IMRT/3D-IGABT was associated with improved survival and decreased gastrointestinal and genitourinary toxicity in patients with cervical cancer compared with those who received 2D EBRT/BT.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Premal H Thaker
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Leslie S Massad
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew A Powell
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - David G Mutch
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri.
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19
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Floberg JM, Fowler KJ, Fuser D, DeWees TA, Dehdashti F, Siegel BA, Wahl RL, Schwarz JK, Grigsby PW. Spatial relationship of 2-deoxy-2-[ 18F]-fluoro-D-glucose positron emission tomography and magnetic resonance diffusion imaging metrics in cervical cancer. EJNMMI Res 2018; 8:52. [PMID: 29904822 PMCID: PMC6003894 DOI: 10.1186/s13550-018-0403-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study investigated the spatial relationship of 2-deoxy-2-[18F]-fluoro-D-glucose positron emission tomography ([18F]FDG-PET) standardized uptake values (SUVs) and apparent diffusion coefficients (ADCs) derived from magnetic resonance (MR) diffusion imaging on a voxel level using simultaneously acquired PET/MR data. We performed an institutional retrospective analysis of patients with newly diagnosed cervical cancer who received a pre-treatment simultaneously acquired [18F]FDG-PET/MR. Voxel SUV and ADC values, and global tumor metrics including maximum SUV (SUVmax), mean ADC (ADCmean), and mean tumor-to-muscle ADC ratio (ADCT/M) were compared. The impacts of histology, grade, and tumor volume on the voxel SUV to ADC relationship were also evaluated. The potential prognostic value of the voxel SUV/ADC relationship was evaluated in an exploratory analysis using Kaplan-Meier/log-rank and univariate Cox analysis. Results Seventeen patients with PET/MR scans were identified. There was a significant inverse correlation between SUVmax and ADCmean, and SUVmax and ADCT/M. In the voxelwise analysis, squamous cell carcinomas (SCCAs) and poorly differentiated tumors showed a consistent significant inverse correlation between voxel SUV and ADC values; adenocarcinomas (AdenoCAs) and well/moderately differentiated tumors did not. The strength of the voxel SUV/ADC correlation varied with metabolic tumor volume (MTV). On log-rank analysis, the correlation between voxel SUV/ADC values was prognostic of disease-free survival (DFS). Conclusions In this hypothesis-generating study, a consistent inverse correlation between voxel SUV and ADC values was seen in SCCAs and poorly differentiated tumors. On univariate statistical analysis, correlation between voxel SUV and ADC values was prognostic for DFS. Electronic supplementary material The online version of this article (10.1186/s13550-018-0403-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John M Floberg
- Department of Radiation Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8224, St. Louis, MO, 63110, USA.
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Dominique Fuser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA
| | - Todd A DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard L Wahl
- Department of Radiation Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8224, St. Louis, MO, 63110, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8224, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8224, St. Louis, MO, 63110, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8131, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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20
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Markovina S, Wang S, Henke LE, Luke CJ, Pak SC, DeWees T, Pfeifer JD, Schwarz JK, Liu W, Chen S, Mutch D, Wang X, Powell MA, Siegel BA, Dehdashti F, Silverman GA, Grigsby PW. Serum squamous cell carcinoma antigen as an early indicator of response during therapy of cervical cancer. Br J Cancer 2017; 118:72-78. [PMID: 29112685 PMCID: PMC5765231 DOI: 10.1038/bjc.2017.390] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Pretreatment serum squamous cell carcinoma antigen (SCCA) is a prognostic biomarker in women with cervical cancer. SCCA has not been evaluated as an early indicator of response to chemoradiation therapy (CRT). The molecular role of the two SCCA isoforms, SCCA1 (SERPINB3) and SCCA2 (SERPINB4), in cervical cancer is unknown. We hypothesised that changes in serum SCCA during definitive CRT predicts treatment response, and that SCCA1 mediates radiation resistance. Methods: Patients treated with definitive CRT for cervical squamous carcinoma with serum SCCA measured were included. SCCA immunohistochemistry was performed on tumour biopsies. Post-treatment FDG-PET/CT, recurrence, and overall survival were recorded. Radiation response of cervical tumour cell lines after SCCA1 expression or CRISPR/Cas9 knockout was evaluated by clonogenic survival assay. Results: Persistently elevated serum SCCA during definitive CRT was an independent predictor of positive post-therapy FDG-PET/CT (P=0.043), recurrence (P=0.0046) and death (P=0.015). An SCCA1-expressing vector increased radioresistance, while SCCA knock out increased radiosensitivity of cervical tumour cell lines in vitro. Conclusions: Early response assessment with serum SCCA is a powerful prognostic tool. These findings suggest that escalation of therapy in patients with elevated or sustained serum SCCA and molecular targeting of SCCA1 should be considered.
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Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA.,Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Songyan Wang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Cliff J Luke
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Stephen C Pak
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA.,Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - John D Pfeifer
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of gynaecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA.,Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Weijun Liu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Shuai Chen
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David Mutch
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of gynaecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Xiaowei Wang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA.,Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Matthew A Powell
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of gynaecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Barry A Siegel
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Gary A Silverman
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110, USA.,Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of gynaecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA.,Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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Fredman E, Traughber B, Podder T, Colussi V, Zheng Y, Russo S, Herrmann K, Paspulati R, Waggoner S, Zanotti K, Nagel C, Nakayama J, Machtay M, Ellis R. 3T multiparametric MRI-guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator. Brachytherapy 2017; 17:334-344. [PMID: 29097137 DOI: 10.1016/j.brachy.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the role of 3T-MRI-guided adaptive high-dose-rate (HDR) combined intracavitary and interstitial brachytherapy for cervical cancer using a novel intracavitary split-ring (ICSR) applicator adapter. METHODS AND MATERIALS We retrospectively reviewed all HDR brachytherapy cases from 2013 to 2015 using an ICSR applicator. Initial optimization was performed using 3T multiparametric MRI (mpMRI) series with an applicator in place. The mpMRI series were discretionarily acquired before subsequent fractions for possible target adaptation. When necessary, interstitial needles (ISNs) were inserted through a novel ICSR adapter or freehand. Dosimetric parameters, clinical outcomes, and toxicities were compared between groups. RESULTS Seventeen patients were included, with a mean followup of 32 months. An mpMRI series preceded each initial fraction and 52.9% of patients underwent ≥1 additional pretreatment mpMRI. Among these subsequent fractions, the high-risk clinical target volume was reduced in 80% vs. 41% without pretreatment mpMRI. Five patients had ISN placement (seven insertions) to improve extracervical target coverage. Mean D90 (Gy) per fraction to the high-risk clinical target volume and intermediate-risk clinical target volume with and without an ISN were 7.51 ± 1.07 vs. 6.14 ± 0.52 (p = 0.028) and 6.35 ± 0.75 vs. 5.21 ± 0.49 (p = 0.007), respectively. Mean fractional D2cc (Gy) for organs at risk was comparable. No Grades 3-4 toxicity was reported. Disease-free survival and local control for the ICSR-ISN and ICSR-alone groups were 29.8 months/80.0% and 31.2 months/83.3%, respectively. CONCLUSIONS The mpMRI acquisition with ICSR applicator in place immediately before HDR brachytherapy for cervical cancer guided successful adaptive treatment optimization and delivery. Our initial experience with a novel interstitial adapter for the split-ring applicator demonstrated excellent target coverage without compromising organs at risk, resulting in good local control and disease-free survival.
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Affiliation(s)
- Elisha Fredman
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH.
| | - Bryan Traughber
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Tarun Podder
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Valdir Colussi
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Yiran Zheng
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Suzanne Russo
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Karin Herrmann
- Department of Radiology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Raj Paspulati
- Department of Radiology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Steven Waggoner
- Department of Gynecologic Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Kristin Zanotti
- Department of Gynecologic Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Christa Nagel
- Department of Gynecologic Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - John Nakayama
- Department of Gynecologic Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Mitchell Machtay
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Rodney Ellis
- Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH
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22
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Wetter A, Grueneisen J, Umutlu L. PET/MR imaging of pelvic malignancies. Eur J Radiol 2017; 94:A44-A51. [DOI: 10.1016/j.ejrad.2017.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 01/03/2023]
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23
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Ohno T, Noda SE, Okonogi N, Murata K, Shibuya K, Kiyohara H, Tamaki T, Ando K, Oike T, Ohkubo Y, Wakatsuki M, Saitoh JI, Nakano T. In-room computed tomography-based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study. JOURNAL OF RADIATION RESEARCH 2017; 58:543-551. [PMID: 27986859 PMCID: PMC5766167 DOI: 10.1093/jrr/rrw121] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/24/2016] [Indexed: 05/20/2023]
Abstract
Herein, we investigate the long-term clinical outcomes for cervical cancer patients treated with in-room computed tomography-based brachytherapy. Eighty patients with Stage IB1-IVA cervical cancer, who had undergone treatment with combined 3D high-dose rate brachytherapy and conformal radiotherapy between October 2008 and May 2011, were retrospectively analyzed. External beam radiotherapy (50 Gy) with central shielding after 20-40 Gy was performed for each patient. Cisplatin-based chemotherapy was administered concurrently to advanced-stage patients aged ≤75 years. Brachytherapy was delivered in four fractions of 6 Gy per week. In-room computed tomography imaging with applicator insertion was performed for treatment planning. Information from physical examinations at diagnosis, and brachytherapy and magnetic resonance imaging at diagnosis and just before the first brachytherapy session, were referred to for contouring of the high-risk clinical target volume. The median follow-up duration was 60 months. The 5-year local control, pelvic progression-free survival and overall survival rates were 94%, 90% and 86%, respectively. No significant differences in 5-year local control rates were observed between Stage I, Stage II and Stage III-IVA patients. Conversely, a significant difference in the 5-year overall survival rate was observed between Stage II and III-IVA patients (97% vs 72%; P = 0.006). One patient developed Grade 3 late bladder toxicity. No other Grade 3 or higher late toxicities were reported in the rectum or bladder. In conclusion, excellent local control rates were achieved with minimal late toxicities in the rectum or bladder, irrespective of clinical stage.
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Affiliation(s)
- Tatsuya Ohno
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
- Corresponding author. Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Tel:
+81-27-220-8378; Fax: +81-27-220-8379;
| | - Shin-Ei Noda
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Noriyuki Okonogi
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
- Research Center for Charged Particle Therapy, National
Institute of Radiological Sciences, 4-9-1 Anagawa,
Chiba 263-8555, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Takahiro Oike
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Yu Ohkubo
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Masaru Wakatsuki
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University
Graduate School of Medicine, 3-39-22 Showa-machi,
Maebashi, Gunma 371-8511,
Japan
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Rao YJ, Zoberi JE, Kadbi M, Grigsby PW, Cammin J, Mackey SL, Garcia-Ramirez J, Goddu SM, Schwarz JK, Gach HM. Metal artifact reduction in MRI-based cervical cancer intracavitary brachytherapy. Phys Med Biol 2017; 62:3011-3024. [DOI: 10.1088/1361-6560/62/8/3011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Maingon P. Argumentaire clinique pour la radiothérapie guidée par imagerie par résonance magnétique. Cancer Radiother 2016; 20:558-63. [DOI: 10.1016/j.canrad.2016.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
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26
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Han K, Croke J, Foltz W, Metser U, Xie J, Shek T, Driscoll B, Ménard C, Vines D, Coolens C, Simeonov A, Beiki-Ardakani A, Leung E, Levin W, Fyles A, Milosevic MF. A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer. Radiother Oncol 2016; 120:519-525. [PMID: 27528120 DOI: 10.1016/j.radonc.2016.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE We examined the utility of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DWI), and FDG-PET imaging for brachytherapy target delineation in patients with locally advanced cervical cancer. MATERIALS AND METHODS Twenty-two patients had DWI, DCE-MRI, and FDG-PET/CT scans after brachytherapy applicator insertion, in addition to standard T2-weighted (T2w) 3T MRI. Gross tumor volume (GTVB) and high-risk clinical target volume (HRCTV) were contoured first on T2w images, and then modified if indicated upon review of DWI/DCE-MRI/FDG-PET images by two observers. The primary endpoint was utility, determined by the number of patients whose volumes were modified, and interobserver variability. RESULTS Eleven patients' T2w-GTVB were modified based on DWI/DCE-MRI/FDG-PET by observer 1, due to clearer demarcation (7) and residual disease not well visualized on T2w MRI (4). GTVB was modified in 17 patients by observer 2 (11 and 6, respectively). Incorporation of functional imaging improved the conformity index (CI) for GTVB from 0.54 (T2w alone) to 0.65 (P=0.003). HRCTV was modified in 3 and 8 patients by observers 1 and 2, respectively, with a trend toward higher CI using functional imaging (0.71 to 0.76, P=0.06). CONCLUSIONS DWI/DCE-MRI/FDG-PET imaging as a supplement to T2w MRI decreased interobserver variability in GTVB delineation.
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Affiliation(s)
- Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Warren Foltz
- Department of Radiation Oncology, University of Toronto, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Department of Medical Imaging, University of Toronto, Canada
| | - Jason Xie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tina Shek
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Brandon Driscoll
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Cynthia Ménard
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Doug Vines
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Anna Simeonov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Akbar Beiki-Ardakani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Eric Leung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Wilfred Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Anthony Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Michael F Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
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Lai YL, Wu CY, Chao KSC. Biological imaging in clinical oncology: radiation therapy based on functional imaging. Int J Clin Oncol 2016; 21:626-632. [PMID: 27384183 DOI: 10.1007/s10147-016-1000-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/29/2016] [Indexed: 12/25/2022]
Abstract
Radiation therapy is one of the most effective tools for cancer treatment. In recent years, intensity-modulated radiation therapy has become increasingly popular in that target dose-escalation can be done while sparing adjacent normal tissues. For this reason, the development of measures to pave the way for accurate target delineation is of great interest. With the integration of functional information obtained by biological imaging with radiotherapy, strategies using advanced biological imaging to visualize metabolic pathways and to improve therapeutic index and predict treatment response are discussed in this article.
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Affiliation(s)
- Yo-Liang Lai
- Department of Radiation Oncology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Yi Wu
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - K S Clifford Chao
- China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
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Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E, Jürgenliemk-Schulz I, Petric P, Hoskin P, Dörr W, Bentzen SM, Kirisits C, Lindegaard JC, Pötter R. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol 2016; 120:441-446. [PMID: 27350396 DOI: 10.1016/j.radonc.2016.05.014] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Currently, there is no consensus on dose prescription in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. The purpose of this study was to provide evidence based recommendations for tumor dose prescription based on results from a multi-center patient series (retroEMBRACE). MATERIALS AND METHODS This study analyzed 488 locally advanced cervical cancer patients treated with external beam radiotherapy±chemotherapy combined with IGABT. Brachytherapy contouring and reporting was according to ICRU/GEC-ESTRO recommendations. The Cox Proportional Hazards model was applied to analyze the effect on local control of dose-volume metrics as well as overall treatment time (OTT), dose rate, chemotherapy, and tumor histology. RESULTS With a median follow up of 46months, 43 local failures were observed. Dose (D90) to the High Risk Clinical Target Volume (CTVHR) (p=0.022, HR=0.967 per Gy) was significant for local control, whereas increasing CTVHR volume (p=0.004, HR=1.017 per cm3), and longer OTT (p=0.004, HR=1.023 per day) were associated with worse local control. Histology (p=0.084), chemotherapy (p=0.49) and dose rate (p=1.00) did not have significant impact on local control. Separate analyses according to stage of disease showed that dose to CTVHR, residual gross tumor volume (GTVres), and Intermediate Risk CTV (CTVIR) has significant impact on local control. CONCLUSION CTVHR dose of ⩾85Gy (D90) delivered in 7weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR. CTVIR and GTVres dose of ⩾60Gy and ⩾95Gy (D98) leads to similar local control. A dose of 5Gy (CTVHR) is required to compensate an increase of OTT by one week. Increased CTVHR volume by 10cm3 requires additional 5Gy for equivalent local control.
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Affiliation(s)
- Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark.
| | | | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Christine Haie-Meder
- Radiation Oncology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Renaud Mazeron
- Radiation Oncology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Erik van Limbergen
- Department of Radiation-Oncology, University Hospitals of Leuven, Belgium
| | | | - Primoz Petric
- Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Qatar; Division of Radiotherapy, National Institute of Oncology, Ljubljana, Slovenia
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Wolfgang Dörr
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Søren M Bentzen
- Greenebaum Cancer Center and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | | | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
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Das S, Samanta S, Mathew M, John R, Peedicayil A, John S. Current Role of Magnetic Resonance Imaging in Evaluation and Radiotherapy in Locally Advanced Carcinoma Cervix. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0063-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Multiparametric [18F]Fluorodeoxyglucose/ [18F]Fluoromisonidazole Positron Emission Tomography/ Magnetic Resonance Imaging of Locally Advanced Cervical Cancer for the Non-Invasive Detection of Tumor Heterogeneity: A Pilot Study. PLoS One 2016; 11:e0155333. [PMID: 27167829 PMCID: PMC4864307 DOI: 10.1371/journal.pone.0155333] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives To investigate fused multiparametric positron emission tomography/magnetic resonance imaging (MP PET/MRI) at 3T in patients with locally advanced cervical cancer, using high-resolution T2-weighted, contrast-enhanced MRI (CE-MRI), diffusion-weighted imaging (DWI), and the radiotracers [18F]fluorodeoxyglucose ([18F]FDG) and [18F]fluoromisonidazol ([18F]FMISO) for the non-invasive detection of tumor heterogeneity for an improved planning of chemo-radiation therapy (CRT). Materials and Methods Sixteen patients with locally advanced cervix were enrolled in this IRB approved and were examined with fused MP [18F]FDG/ [18F]FMISO PET/MRI and in eleven patients complete data sets were acquired. MP PET/MRI was assessed for tumor volume, enhancement (EH)-kinetics, diffusivity, and [18F]FDG/ [18F]FMISO-avidity. Descriptive statistics and voxel-by-voxel analysis of MRI and PET parameters were performed. Correlations were assessed using multiple correlation analysis. Results All tumors displayed imaging parameters concordant with cervix cancer, i.e. type II/III EH-kinetics, restricted diffusivity (median ADC 0.80x10-3mm2/sec), [18F]FDG- (median SUVmax16.2) and [18F]FMISO-avidity (median SUVmax3.1). In all patients, [18F]FMISO PET identified the hypoxic tumor subvolume, which was independent of tumor volume. A voxel-by-voxel analysis revealed only weak correlations between the MRI and PET parameters (0.05–0.22), indicating that each individual parameter yields independent information and the presence of tumor heterogeneity. Conclusion MP [18F]FDG/ [18F]FMISO PET/MRI in patients with cervical cancer facilitates the acquisition of independent predictive and prognostic imaging parameters. MP [18F]FDG/ [18F]FMISO PET/MRI enables insights into tumor biology on multiple levels and provides information on tumor heterogeneity, which has the potential to improve the planning of CRT.
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Zoberi JE, Garcia-Ramirez J, Hu Y, Sun B, Bertelsman CG, Dyk P, Schwarz JK, Grigsby PW. Clinical implementation of multisequence MRI-based adaptive intracavitary brachytherapy for cervix cancer. J Appl Clin Med Phys 2016; 17:121-131. [PMID: 26894342 PMCID: PMC5690214 DOI: 10.1120/jacmp.v17i1.5736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/17/2015] [Accepted: 08/27/2015] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study was to describe the clinical implementation of a magnetic resonance image (MRI)-based approach for adaptive intracavitary brachytherapy (ICBT) of cervix cancer patients. Patients were implanted with titanium tandem and colpostats. MR imaging was performed on a 1.5-T Philips scanner using T2-weighted (T2W), proton-density weighted (PDW), and diffusion-weighted (DW) imaging sequences. Apparent diffusion coefficient (ADC) maps were generated from the DW images. All images were fused. T2W images were used for the definition of organs at risk (OARs) and dose points. ADC maps in conjunction with T2W images were used for target delineation. PDW images were used for applicator definition. Forward treatment planning was performed using standard source distribution rules normalized to Point A. Point doses and dose-volume parameters for the tumor and OARs were exported to an automated dose-tracking application. Brachytherapy doses were adapted for tumor shrinkage and OAR variations during the course of therapy. The MRI-based ICBT approach described here has been clinically implemented and is carried out for each brachytherapy fraction. Total procedure time from patient preparation to delivery of treatment is typically 2 hrs. Implementation of our tech-nique for structure delineation, applicator definition, dose tracking, and adaptation is demonstrated using treated patient examples. Based on published recommendations and our clinical experience in the radiation treatment of cervix cancer patients, we have refined our standard approach to ICBT by 1) incorporating a multisequence MRI technique for improved visualization of the target, OARs, and applicator, and by 2) implementing dose adaptation by use of automated dose tracking tools.
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Resonancia magnética en la planificación de la braquiterapia intracavitaria para el tratamiento del cáncer de cérvix localmente avanzado. RADIOLOGIA 2016; 58:16-25. [DOI: 10.1016/j.rx.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 11/18/2022]
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34
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Oñate Miranda M, Pinho D, Wardak Z, Albuquerque K, Pedrosa I. Magnetic resonance imaging for planning intracavitary brachytherapy for the treatment of locally advanced cervical cancer. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grover S, Harkenrider MM, Cho LP, Erickson B, Small C, Small W, Viswanathan AN. Image Guided Cervical Brachytherapy: 2014 Survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 2015; 94:598-604. [PMID: 26867888 DOI: 10.1016/j.ijrobp.2015.11.024] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE To provide an update of the 2007 American brachytherapy survey on image-based brachytherapy, which showed that in the setting of treatment planning for gynecologic brachytherapy, although computed tomography (CT) was often used for treatment planning, most brachytherapists used point A for dose specification. METHODS AND MATERIALS A 45-question electronic survey on cervical cancer brachytherapy practice patterns was sent to all American Brachytherapy Society members and additional radiation oncologists and physicists based in the United States between January and September 2014. Responses from the 2007 survey and the present survey were compared using the χ(2) test. RESULTS There were 370 respondents. Of those, only respondents, not in training, who treat more than 1 cervical cancer patient per year and practice in the United States, were included in the analysis (219). For dose specification to the target (cervix and tumor), 95% always use CT, and 34% always use MRI. However, 46% use point A only for dose specification to the target. There was a lot of variation in parameters used for dose evaluation of target volume and normal tissues. Compared with the 2007 survey, use of MRI has increased from 2% to 34% (P<.0001) for dose specification to the target. Use of volume-based dose delineation to the target has increased from 14% to 52% (P<.0001). CONCLUSION Although use of image-based brachytherapy has increased in the United States since the 2007 survey, there is room for further growth, particularly with the use of MRI. This increase may be in part due to educational initiatives. However, there is still significant heterogeneity in brachytherapy practice in the United States, and future efforts should be geared toward standardizing treatment.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - Linda P Cho
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Beth Erickson
- Department Radiation Oncology, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christina Small
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - Akila N Viswanathan
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
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Foltz WD, Porter DA, Simeonov A, Aleong A, Jaffray D, Chung P, Han K, Ménard C. Readout-segmented echo-planar diffusion-weighted imaging improves geometric performance for image-guided radiation therapy of pelvic tumors. Radiother Oncol 2015; 117:525-31. [DOI: 10.1016/j.radonc.2015.07.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 07/22/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
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Sun B, Yang D, Esthappan J, Garcia-Ramirez J, Price S, Mutic S, Schwarz JK, Grigsby PW, Tanderup K. Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer. Brachytherapy 2015; 14:481-9. [PMID: 25958039 DOI: 10.1016/j.brachy.2015.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Dose accumulation of split-field external beam radiotherapy (EBRT) and brachytherapy (BT) is challenging because of significant EBRT and BT dose gradients in the central pelvic region. We developed a method to determine biologically effective dose parameters for combined split-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. METHODS AND MATERIALS Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were computed on the 3D combined EQD2 dose based on rigid image registration. The dose accumulation uncertainty introduced by organ deformations between IMRT and BT was evaluated. RESULTS According to International Commission on Radiation Unit and Measurement and GEC European Society for Therapeutic Radiology and Oncology recommendations, D98, D90, D50, and D2cm3 EQD2 dose-volume histogram parameters were computed. GTV D98 was 84.0 ± 26.5 Gy and D2cc was 99.6 ± 13.9 Gy, 67.4 ± 12.2 Gy, 75.0 ± 10.1 Gy, for bladder, rectum, and sigmoid, respectively. The uncertainties induced by organ deformation were estimated to be -1 ± 4 Gy, -3 ± 5 Gy, 2 ± 3 Gy, and -3 ± 5 Gy for bladder, rectum, sigmoid, and GTV, respectively. CONCLUSIONS It is feasible to perform 3D EQD2 dose accumulation to assess high and intermediate dose regions for combined split-field IMRT and BT.
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Affiliation(s)
- Baozhou Sun
- Department of Radiation Oncology, Washington University Saint Louis, MO.
| | - Deshan Yang
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Jackie Esthappan
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | | | - Samantha Price
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Kari Tanderup
- Department of Radiation Oncology, Washington University Saint Louis, MO
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Minkoff D, Gill BS, Kang J, Beriwal S. Cervical cancer outcome prediction to high-dose rate brachytherapy using quantitative magnetic resonance imaging analysis of tumor response to external beam radiotherapy. Radiother Oncol 2015; 115:78-83. [DOI: 10.1016/j.radonc.2015.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
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In regard to Dyk et al. Int J Radiat Oncol Biol Phys 2015; 91:881-2. [PMID: 25752409 DOI: 10.1016/j.ijrobp.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/02/2014] [Accepted: 12/02/2014] [Indexed: 11/21/2022]
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Erickson B. Evolving traditions on the technology journey. Int J Radiat Oncol Biol Phys 2015; 91:14-6. [PMID: 25835618 DOI: 10.1016/j.ijrobp.2014.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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