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Wang K, Wang J, Jiang P. High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence. Curr Oncol 2023; 31:50-65. [PMID: 38275830 PMCID: PMC10814120 DOI: 10.3390/curroncol31010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background: Brachytherapy (BT) is a critical component of radiotherapy for locally advanced cervical cancer (LACC), and it has rapidly developed in recent decades. Since the advent of three-dimensional image-guided adaptive brachytherapy (3D-IGABT), magnetic resonance imaging (MRI) has emerged as the primary modality for image guidance. Meanwhile, other imaging modalities, such as computed tomography, 18F-fluorodeoxyglucose positron emission tomography, ultrasound, and their combinations have also been widely studied. Materials and methods: We reviewed studies on different imaging modalities utilized for target delineation and planning. Emerging techniques in IGABT like real-time image guidance and 3D printing were also included. We summarized research on their feasibility and concentrated on their clinical outcomes. Results: MRI-guided BT was the gold standard, and CT-guided BT was the most widely applied. Other modalities have shown feasibility and promising efficacy in dosimetry studies and preliminary outcomes. The longer-term clinical outcomes associated with these approaches require further elucidation. Conclusions: As 3D-IGABT was validated by promising clinical outcomes, the future of BT for LACC is expected to progress toward the refinement of more effective image-guided procedures. Moreover, achieving operational consensus and driving technological advancements to mitigate the inherent limitations associated with different imaging modes remain essential.
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Affiliation(s)
| | | | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (K.W.); (J.W.)
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Jacobsen MC, Beriwal S, Dyer BA, Klopp AH, Lee SI, McGinnis GJ, Robbins JB, Rauch GM, Sadowski EA, Simiele SJ, Stafford RJ, Taunk NK, Yashar CM, Venkatesan AM. Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society. Brachytherapy 2022; 21:369-388. [PMID: 35725550 DOI: 10.1016/j.brachy.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.
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Affiliation(s)
- Megan C Jacobsen
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Sushil Beriwal
- Allegheny Health Network, Department of Radiation Oncology, Pittsburgh, PA; Varian Medical Systems, Palo Alto, CA
| | - Brandon A Dyer
- Legacy Health, Department of Radiation Oncology, Portland, OR
| | - Ann H Klopp
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Susanna I Lee
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Gwendolyn J McGinnis
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX
| | | | - Samantha J Simiele
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX
| | - R Jason Stafford
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Neil K Taunk
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | - Catheryn M Yashar
- University of California San Diego, Department of Radiation Oncology, San Diego, CA
| | - Aradhana M Venkatesan
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX.
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3
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Hsu IC, Yoshida E. Ultrasound guidance for cervical implantation. Int J Gynecol Cancer 2022; 32:266-272. [DOI: 10.1136/ijgc-2021-002464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 11/03/2022] Open
Abstract
Ultrasound can provide real-time imagery without the risk of radiation exposure, and it is widely available at a relatively low cost. It can provide updated three-dimensional information that can improve the physician’s spatial awareness during a brachytherapy procedure for cervical cancer. There is mounting evidence demonstrating the numerous benefits of ultrasound-guided brachytherapy in the published literature. This evidence supports its routine use to improve the safety and the effectiveness of cervical brachytherapy. In this report we will review various methods in which ultrasound imaging has been used during cervical brachytherapy. We also include a description of our own institutional approach to ultrasound-guided cervical implementation that has been in use for all cervical brachytherapy procedures over the past two decades.
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Advantages of real-time transabdominal ultrasound guidance in combined interstitial/intracavitary cervical brachytherapy: a case-based review. J Contemp Brachytherapy 2021; 13:211-220. [PMID: 33897796 PMCID: PMC8060964 DOI: 10.5114/jcb.2021.105290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Sub-optimal placement of both intracavitary devices and interstitial needles is a relatively common occurrence in cervical brachytherapy, which may reduce the accuracy of dose distribution and contribute to adverse toxicities. To mitigate complications, improve target dose coverage, and verify proper device placement, implants may be placed under real-time image guidance. Traditionally, transrectal ultrasound has been used for needle guidance. However, we have utilized transabdominal ultrasound (TA-US) in our brachytherapy center. The purpose of this pictorial essay was to provide a pictorial description of TA-US technique, present a retrospective review of our preliminary outcomes adopting TA-US into routine practice, and to discuss the advantages of real-time ultrasound image guidance for placement of intrauterine tandem and interstitial needles.
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Prevention of uterine perforation during intracavitary brachytherapy of cervical cancer. J Contemp Brachytherapy 2021; 13:167-171. [PMID: 33897790 PMCID: PMC8060953 DOI: 10.5114/jcb.2021.105284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/21/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Intracavitary brachytherapy (ICBT) is a part of standard treatment for loco-regionally advanced cervical cancers. ICBT requires a tandem applicator insertion through cervical canal into uterine cavity. Accurate placement through cervical canal, which is distorted by cancer, is crucial to successful treatment. The objective of this study was to investigate actual complication rate of a Smit sleeve insertion performed by experienced gynecologists in a tertiary referral center. Material and methods Clinical data of 328 patients with cervical cancer treated using ICBT, between January 2013 and August 2019, were retrospectively evaluated. Predisposing factors that could have increased the risk of uterine perforation were recorded. Pre-operative ultrasound was carried out for visualization of uterine curvature and selection of an appropriate Smith sleeve length. All applications were performed by a gynecologic oncology fellow or an expert gynecologist. Results 317 patients were suitable for analysis. Only one (0.3%) applicator placement resulted in uterine perforation. In two patients, Smit sleeve dislocated after first brachytherapy and reinserted. Adequate applicator placement was achieved, and treatment was completed as planned in 316 cases. Conclusions A cervical sleeve technic, which reduced the need for multiple insertions and placement of this instrument by an expert gynecologist minimize the risk of complication relative to historical controls.
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Small W, Kim YS, Joyce C, Surucu M, Leshyk M, Harkenrider MM, Potkul RK, Liotta M, Winder A, Altoos B. Uterine perforation during brachytherapy for cervical cancer: Complications, outcomes, and best practices for forward treatment planning and management. Brachytherapy 2021; 20:557-564. [PMID: 33741275 DOI: 10.1016/j.brachy.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to determine the incidence of uterine perforations, review the associated complications, and propose guidelines for management of perforations after brachytherapy. METHODS AND MATERIALS A retrospective chart review was conducted for all patients with cervical cancer who received single or multiple high-dose-rate brachytherapy implants between April 2006 and May 2017 at a single academic institution. CT and MRI images were retrospectively evaluated to record incidences of uterine perforation of tandem during brachytherapy. Acute and long-term complications during and after treatment were scored using the Common Terminology Criteria for Adverse Events, Version 4.0, of the National Cancer Institute. RESULTS A total of 123 patients were included in the study. Perforations were observed in 22 patients (17.9%) with 31 (6.4%) of the 482 total implants. Of the different categories of adverse events, only the rate of acute infectious complications among those with perforations (n = 3, 13.6%) versus those without perforations (n = 3, 3.0%) was significant (p = 0.040). Two of the three perforated patients with acute infections had mild urinary tract infections, and all resolved without complications or treatment delays. The remaining one patient had a frank perforation of the anterior uterine wall with a subsequent Grade 3 pyometra infection despite administration of prophylactic antibiotics and 1-week treatment delay. This case was eventually resolved with cervical dilation and evacuation of fluid. Long-term complications were not different between the two arms. CONCLUSIONS Patients with cervical cancer with uterine perforations may be able to safely proceed with brachytherapy treatment without delay or need for prophylactic antibiotics in the acute setting. Further validating data would be able to assist in establishing a new standard of care and help prevent unnecessary and harmful breaks during treatment.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL.
| | - Yo Sup Kim
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Cara Joyce
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Mark Leshyk
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Margaret Liotta
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Abigail Winder
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Basel Altoos
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
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Hsiao YH, Yang SF, Chen YH, Chen TH, Tsai HD, Chou MC, Chou PH. Updated applications of Ultrasound in Uterine Cervical Cancer. J Cancer 2021; 12:2181-2189. [PMID: 33758596 PMCID: PMC7974902 DOI: 10.7150/jca.49479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/31/2021] [Indexed: 12/26/2022] Open
Abstract
Cervical cancer is a common gynecologic malignancy worldwide. It is the fourth for both incidence and mortality. For cervical cancer, imaging and pathology assessments are incorporated in the revised 2018 Federation of Gynecology and Obstetrics (FIGO) staging system. Uses of imaging techniques for the pre-treatment work-up of cervical cancer have been increasing. Among imaging techniques for the evaluation of cervical cancer, ultrasound is cheaper, faster and widely available than other imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Advanced technique in ultrasound, such as three-dimension (3D) ultrasound and color Doppler, have improved the clinical application of ultrasound in cervical cancer. Ultrasound may provide highly accurate information on detecting tumor presence and evaluating local tumor extent if performed by ultrasound-trained gynecologists; the experience of readers is also critical for correct pretreatment staging and assessment of response to treatment. Sonographic images could be useful to predict response of neoadjuvant chemotherapy, radiotherapy, chemotherapy and concurrent chemoradiotherapy in patients with cervical cancer. This review article attempted to present the most updated specific applications of ultrasound in cervical cancer.
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Affiliation(s)
- Yi-Hsuan Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan.,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Hui Chen
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Tze-Ho Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Der Tsai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pang-Hsin Chou
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
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Abstract
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques. Ultrasound (US) is a portable and safe imaging method that uses high frequency sound waves to visualize structures within the body. While most US examinations are done outside the body there is an emerging field which uses US devices within the body during surgery to aid complex procedures. This review examines the published literature on this technique in benign gynecology and in gynecological oncology. This review demonstrates the use of intraoperative US improves visualization and minimizes surgical complications.
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A phase III randomised trial of trans-abdominal ultrasound in improving application quality and dosimetry of intra-cavitary brachytherapy in locally advanced cervical cancer. Gynecol Oncol 2020; 160:375-378. [PMID: 33293047 DOI: 10.1016/j.ygyno.2020.11.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Intra-cavitary brachytherapy (ICB) remains an integral part of radiotherapy treatment in cervical cancer. Two-dimensional X ray point-based planning remains common and blind insertion leads to uterine perforations and higher toxicity. We conducted a randomised controlled trial of using trans-abdominal ultrasound in performing ICB to reduce perforation and organ at risk doses. PATIENT AND METHODS The present study is a phase III open label randomised controlled trial of ultrasound guided ICB conducted on invasive cervical cancer patients. Patients were randomised by a simple computer-generated randomization chart into Arm A (No Ultrasound guidance) and Arm B (ICB with ultrasound guidance). The uterine perforation rates, tandem length change rates, bladder doses, rectal dose and procedure times were compared. Fischer exact test was used to compare the arms and p value <0.05 considered significant. RESULTS A total of 160 patients were randomised. With US assistance, the uterine perforation rate was 1.25% (n = 1). In the non-US assistance arm the perforation rate was 12.5% (n = 10) (p = 0.005). Mean time to complete the entire procedure was significantly shortened from 26 min to 19 min favouring the US arm (p = 0.001). Dosimetric assessment between the two groups showed significant decrease in dose received by the various organs at risk with US assistance. CONCLUSION The present study confirms significant improvement in application quality as well as dosimetry with reduction in procedure time. Trans-Abdominal US should be routinely used for ICB procedures, particularly in resource limited settings.
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Shanmugam S, Saravanan S, Susikar S, Syed Afroze H, Mendu SK. Role of Ultrasound-Guided Brachytherapy Applicator Placement in Cancer Cervix. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Small bowel dose in subserosal tandem insertion during cervical cancer brachytherapy. Med Dosim 2020; 45:e1-e9. [DOI: 10.1016/j.meddos.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022]
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Kissel M, Silva M, Lequesne J, Grellard JM, Loiseau C, Barraux V, Lerouge D, Lecornu M, Lesaunier F, Haie-Meder C, Chargari C, Thariat J. Impact of suboptimal tandem implantation on local control and complications in intracavitary brachytherapy for cervix cancer. Brachytherapy 2019; 18:753-762. [DOI: 10.1016/j.brachy.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/20/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Abstract
Brachytherapy involves the placement of radioactive sources within or very close to the tumor. This placement allows a high dose of radiotherapy to be delivered to the tumor while sparing the surrounding normal tissue. The delivery of brachytherapy has changed markedly over the years, with newer radioactive sources making delivery safer, image guidance techniques allowing more accurate placement of sources, and advanced planning systems allowing brachytherapy to be truly adaptive. This article explores the most modern techniques and current uses of brachytherapy in the treatment of gynecological, prostate, breast, rectal, and skin cancers.
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Affiliation(s)
- Sophie J Otter
- Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK.
| | | | - Phillip M Devlin
- Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Tsai YL, Yu PC, Nien HH, Sung SY, Kuan YH, Wu CJ. Radiation Dose in the Uterine Perforation by Tandem in 3-Dimensional Cervical Cancer Brachytherapy. Med Dosim 2019; 44:e59-e63. [PMID: 30846216 DOI: 10.1016/j.meddos.2019.01.006] [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: 08/03/2018] [Revised: 12/12/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
Cervical cancer patients may sometimes experience different types of uterine perforation by a tandem during brachytherapy. The purpose of this study was to address possibly different management strategies regarding different tandem positions from a dosimetry aspect by evaluating radiation doses delivered to organs-at-risk (OAR) in order to help medical professionals handle different types of uterine perforation. Images and dosimetry data in cervical cancer brachytherapy with uterine perforation were reviewed. Uterine perforation was classified into anterior and posterior perforation according to their tandem positions. Radiation doses received by OAR, including D2cc and D1cc of the bladder, rectum, and sigmoid colon, were statistically compared with nonperforation. The doses of high-risk clinical target volume (HR-CTV) of cervical tumor and bilateral point A were also compared in order to assure that the plans had not compromised the treatment efficacy. A total of 21 applications were assessed, including 5 with anterior perforation, 4 with posterior perforation, and 12 without perforation. In anterior perforation, the bladder was the only organ that received a significantly increased dose about 30% at D2cc and D1cc. However, in posterior perforation, multiple OAR received significantly excessive doses: approximately 30% for the bladder, 37% for the rectum, and 100% for the sigmoid colon. The OAR dose assessment was based on a statistically equivalent cervical tumor dose. Different management strategies are possible for anterior vs posterior perforation during brachytherapy due to different detrimental extents on OAR dosimetry. The bladder warrants more attention in anterior perforation, without compromising target coverage in treatment planning. On the other hand, repositioning may be considered in posterior perforation due to relatively massive OAR detriments. This concept is a new one and is given for the first time.
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Affiliation(s)
- Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Pei-Chieh Yu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Hua Nien
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Shih-Yu Sung
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Kuan
- Oncology Treatment Center, Sijhih Cathay General Hospital, New Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan; Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan; Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan.
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15
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Sapienza LG, Jhingran A, Kollmeier MA, Lin LL, Calsavara VF, Gomes MJL, Baiocchi G. Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2018; 151:573-578. [PMID: 30333082 DOI: 10.1016/j.ygyno.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance. MATERIALS AND METHODS A systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance. RESULTS A total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35-8.67) and per patient was 7.39% (95%CI: 3.92-13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12-17.57) versus 1.06% (95%CI: 0.41-2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01-26.45) versus 2.54% (95%CI: 1.21-5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management. CONCLUSION Using postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.
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Affiliation(s)
- Lucas Gomes Sapienza
- Department of Radiation Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil; Department of Radiation Oncology, Hospital Central do Exército do Rio de Janeiro (HCE-RJ), Rio de Janeiro, RJ, Brazil.
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maria José Leite Gomes
- Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil
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16
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Rangarajan R. Incidence of Suboptimal Applicator Placement and the Resulting Dosimetric Impact in Image-Based Intracavitary Brachytherapy. J Med Phys 2018; 43:168-172. [PMID: 30305774 PMCID: PMC6172860 DOI: 10.4103/jmp.jmp_28_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim With the advent of computed tomography (CT)-based brachytherapy, it is possible to view the appropriate placement of the applicator within the uterine canal and detect uterine perforation. In this study, the incidence of suboptimal placement of the intracavitary applicator and the resulting dosimetric impact were analyzed and compared with a similar set of ideal applicator placement. Materials and Methods CT datasets of 282 (141 patients) high dose rate brachytherapy insertions between January and April 2016 were analyzed. The target volumes and organs at risk (OAR) were contoured as per the Groupe Européen de Curiethérapie European Society of Therapeutic Radiation Oncology guidelines. The position of the applicator in the uterine cavity was analyzed for each application. Results The suboptimal insertion rate was 11.7%. There were 26 perforations and 7 subserosal insertions. The most common site of perforation was through the posterior wall of the uterus (42.4%). Fundus perforation and anterior wall perforation were seen in 24.2% and 12.1% of patients, respectively. The average dose to 90% of the target volume (D90 to high-risk clinical target volume) was the highest (9.15 Gy) with fundal perforation. Average dose to 2 cc (D2cc) bladder was highest for fundus perforation (7.65 Gy). The average dose received by 2 cc of rectum (D2cc) was highest (4.49 Gy) with posterior wall perforation. The average D2cc of the sigmoid was highest with anterior perforation (3.18 Gy). Conclusion In order to achieve better local control and to decrease doses to OAR, it is important to perform a technically accurate applicator placement. A cost-effective, real-time image guidance modality like ultrasound is recommended for all insertions to ensure optimal applicator insertion.
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Affiliation(s)
- Ramya Rangarajan
- Department of Radiation Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu, India
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Chakrabarti B, Pal SK, Sepai HM, Roy SB, Kar SK, Lahiri A, Das S, Bala A. Clinical and dosimetric consequences of imperfect applicator insertion in cervical cancer brachytherapy. J Contemp Brachytherapy 2018; 10:321-336. [PMID: 30237816 PMCID: PMC6142650 DOI: 10.5114/jcb.2018.77954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study analyzes clinical consequences and dosimetric variations after imperfect brachytherapy insertions. It examines treatment decisions after such insertions in patients having difficult anatomy, which leads to good subsequent insertions with acceptable dose volume parameters. MATERIAL AND METHODS We reviewed images of all insertions performed during last one year and sorted faulty ones out. Clinical outcome was assessed, analyzing original treatment records. Repeat three-dimensional planning using identical dose-optimization-technique compared their dosimetry. Statistical analysis using SPSS®-Statistics-software included Fisher's-exact-test to analyze predisposing factors for faulty insertions and predictive factors for subsequent satisfactory insertion. Friedman test was used to compare dose-volume-effects of normalization. RESULTS Eighteen of 292 brachytherapy plans revealed imperfect insertions, including thirteen perforations (4.5%). Lack of pre-planning, obstructing mass, narrow vagina, acute anteversion of uterus, and multi-parity were significant (p ≤ 0.05) predisposing factors for atypical insertions. Satisfactory optimization was possible after correcting acute anteflexion or positioning tandem in retroverted direction in uncorrectable retroverted uterus. Dose normalization at point A shifted optimized dose from contoured volume to point of normalization, often undesirably. This difference, however, was statistically not significant (p = 0.121). In patients having obstructing mass, subsequent insertions were perfect, and dose volume parameters were acceptable only when full prescribed dose was delivered to at least 60% volume of the mass after a faulty insertion (p < 0.001). CONCLUSIONS Pre-planning by imaging is suggested in all cases of brachytherapy. Insertion of adequate length of tandem aligned to uterine axis is warranted for adequate tumor coverage. Whenever detected, acute anteflexion and mobile retroversion should be corrected. Tandem inserted in retroverted direction in uncorrectable retroverted uterus generates acceptable dose volume parameters. In cases with obstructive cervical mass, good subsequent insertion is possible with acceptable dose volume parameters, if planned dose can be delivered to its 60% volume.
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Affiliation(s)
- Bikramjit Chakrabarti
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Suparna Kanti Pal
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Harris Mahammad Sepai
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Somapriya Basu Roy
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Sanjay Kr Kar
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Annesha Lahiri
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Sounik Das
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Amit Bala
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
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Akbas T, Ugurluer G, Acil M, Arpaci T, Serin M. Intraoperative sonographic guidance for intracavitary brachytherapy of cervical cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:8-13. [PMID: 28656637 DOI: 10.1002/jcu.22510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/20/2017] [Accepted: 05/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND To describe the role and benefits of intraoperative sonographic (US) guidance in intracavitary brachytherapy of cervical cancer. METHODS The data of 142 patients who received tandem-based intracavitary brachytherapy for cervical cancer between January 2010 and June 2015 were retrospectively reviewed. US guidance was carried out for tandem selection and appropriate application. The complications and applicator conformity were assessed with planning CT. RESULTS Intracavitary brachytherapy was performed under US guidance for 412 insertions in 113 consecutive patients with cervical cancer. Before we started to use US guidance, applications were done in 29 patients: uterine perforation occurred in two patients (6.9%), the tandem length was short in two patients (6.9%), the tandem length was long in four patients (13.8%), and tandem was in myometrium in three patients (10.3%). We then decided to use US guidance routinely. With US guidance, only 1 of 113 patients had uterine perforation (0.9%), tandem length was short in only one patient (0.9%), and tandem was in myometrium in one patient (0.9%). CONCLUSIONS Real-time US provided safe and effective guidance for intracavitary brachytherapy of cervical cancer resulting in decreased rates of perforations and misplacement of applicators. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:8-13, 2018.
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Affiliation(s)
- Tugana Akbas
- Acibadem University, Vocational School of Health Services, Acibadem Adana Hospital, Adana, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
| | - Meltem Acil
- Department of Anesthesiology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
| | - Taner Arpaci
- Acibadem University, Vocational School of Health Services, Acibadem Adana Hospital, Adana, Turkey
| | - Meltem Serin
- Department of Radiation Oncology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
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Otter S, Franklin A, Ajaz M, Stewart A. Improving the efficiency of image guided brachytherapy in cervical cancer. J Contemp Brachytherapy 2016; 8:557-565. [PMID: 28115963 PMCID: PMC5241377 DOI: 10.5114/jcb.2016.64452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/16/2016] [Indexed: 11/21/2022] Open
Abstract
Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. Traditionally, cervical brachytherapy was prescribed to point A but since the GEC-ESTRO guidelines were published in 2005, there has been a move towards prescribing the dose to a 3D volume. Image guided brachytherapy has been shown to reduce local recurrence, and improve survival and is optimally predicated on magnetic resonance imaging. Radiological studies, patient workflow, operative parameters, and intensive therapy planning can represent a challenge to clinical resources. This article explores the ways, in which 3D conformal brachytherapy can be implemented and draws findings from recent literature and a well-developed hospital practice in order to suggest ways to improve the efficiency and efficacy of a brachytherapy service. Finally, we discuss relatively underexploited translational research opportunities.
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Affiliation(s)
- Sophie Otter
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Adrian Franklin
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Mazhar Ajaz
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
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Routine use of ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer - a South Indian institutional experience. J Contemp Brachytherapy 2015; 7:352-6. [PMID: 26622240 PMCID: PMC4663212 DOI: 10.5114/jcb.2014.55115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Intracavitary brachytherapy necessitates the insertion of a tandem applicator through the cervical os into the uterine cavity. Blind insertion of the tandem may result in suboptimal tandem placement. This decreases the control of the tumor locally and may result in uterine perforation. Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practised. The aim of this work is to evaluate the role of routine real-time intraoperative trans-abdominal ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer. MATERIAL AND METHODS This is a prospective single institutional study conducted from April 2013 to May 2015. A total of 96 patients of locally advanced cervical cancer were treated with routine ultrasound guided brachytherapy amounting to a total of 282 intracavitary applications. RESULTS In 78 of the study patients, the cervical os could be easily identified visually, which was then confirmed with ultrasound guidance. In another 12 patients, though the os could be identified visually, uterine sounding was only possible under ultrasound guidance. In another 4 patients, the cervical os could not be identified visually as the cervix was flushed with vagina and ultrasound guidance was necessary for accurate os identification. In 2 of the study patients, intraoperative ultrasound helped in identifying the patients suitable for interstitial brachytherapy rather than intracavitary brachytherapy. Out of the 96 study patients, the length of the uterine canal changed in 15 patients during the subsequent brachytherapy application. CONCLUSIONS This procedure is strongly advocated for proper placement of the tandem applicator and to avoid perforations. It is an accurate, fast, easily available, and cost-effective method. Hence, it can be incorporated in intracavitary applications for cervical cancers even in the developing countries where cost, accessibility, and time are important issues.
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Schwarz JK, Beriwal S, Esthappan J, Erickson B, Feltmate C, Fyles A, Gaffney D, Jones E, Klopp A, Small W, Thomadsen B, Yashar C, Viswanathan A. Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer. Brachytherapy 2015; 14:587-99. [PMID: 26186975 DOI: 10.1016/j.brachy.2015.06.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize recent advances and to generate general guidelines for the management of medically inoperable endometrial cancer patients with radiation therapy. METHODS Recent advances in the literature were summarized and reviewed by a panel of experts. Panel members participated in a series of conference calls and were surveyed to determine their current practices and patterns. This document was reviewed and approved by the full panel, the ABS Board of Directors and the ACR Commission on Radiation Oncology. RESULTS A transition from two-dimensional (2D) to three-dimensional (3D) treatment planning for the definitive treatment of medically inoperable endometrial cancer is described. Magnetic resonance (MR) imaging can be used to define the gross tumor volume (GTV), clinical target volume (CTV), and the organs at risk (OARs). Brachytherapy alone can be used for medically inoperable endometrial cancer patients with clinical Stage I cancer with no lymph node involvement and no evidence of deep invasion of the myometrium on MR imaging. In the absence of MR imaging, a combined approach using external beam and brachytherapy may be considered. CONCLUSIONS Recent advances support the use of MR imaging and 3D planning for brachytherapy treatment for medically inoperable endometrial cancer.
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Affiliation(s)
- Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jacqueline Esthappan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Colleen Feltmate
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Anthony Fyles
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, IL
| | - Bruce Thomadsen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, San Diego, CA
| | - Akila Viswanathan
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
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van Dyk S, Schneider M, Kondalsamy-Chennakesavan S, Bernshaw D, Narayan K. Ultrasound use in gynecologic brachytherapy: Time to focus the beam. Brachytherapy 2015; 14:390-400. [DOI: 10.1016/j.brachy.2014.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/22/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
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Uterine perforation during 3-dimensional image-guided brachytherapy in patients with cervical cancer: Baskent University experience. Int J Gynecol Cancer 2014; 24:346-51. [PMID: 24407583 DOI: 10.1097/igc.0000000000000048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to determine the incidence and characteristics of uterine perforation at our department using 3-dimensional computed tomography (CT)-based brachytherapy (BRT). The characteristics of the patients presenting with perforation and impact of the perforation on the treatment course were also analyzed. MATERIALS AND METHODS The clinical and radiologic data of 200 patients with biopsy-proven cervical cancer treated using CT-based BRT were retrospectively evaluated. All patients had undergone tandem-based intracavitary BRT, and 67 patients had undergone magnetic resonance imaging (MRI) before BRT. RESULTS Of the 200 patients, 17 (8.5%) had uterine perforation. Of the 626 applications with CT images, 30 (4.8%) resulted in uterine perforation. The median age of patients with perforation was higher (68 years; range, 44-89 years) than that of the patients without perforation (59 years; range, 21-87 years), and the mean (SD) tumor size at diagnosis was larger in patients with perforation (7.0 [1.5] cm) than in patients without perforation (5.0 [1.5] cm). The most frequent perforation site was the posterior uterine wall (8 patients), followed by the fundus (5 patients) and anterior wall (4 patients). Of the 7 patients with a retroverted uterus, 4 had uterine perforation during BRT. In 67 patients with MRI delivered before BRT, only 3 (4%) had uterine perforation, and 2 of the 3 patients with uterine perforation had a retroverted uterus. However, of the 133 patients with no MRI evaluation before BRT, 14 (11%) had uterine perforation. No life-threatening complications or signs of intraperitoneal tumor cell seeding were observed. CONCLUSIONS Older age, larger tumors, a retroverted uterus, and a stenotic cervical os were all predisposing factors for uterine perforation during BRT. Preoperative MRI is a feasible and safe method to decrease the risks of uterine perforation and could be used preoperatively in centers where intraoperative ultrasonography is not used in routine practice.
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Image-guided brachytherapy for cervical cancer: Analysis of D2 cc hot spot in three-dimensional and anatomic factors affecting D2 cc hot spot in organs at risk. Brachytherapy 2014; 13:203-9. [DOI: 10.1016/j.brachy.2013.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/29/2013] [Accepted: 06/28/2013] [Indexed: 11/17/2022]
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van Dyk S, Kondalsamy-Chennakesavan S, Schneider M, Bernshaw D, Narayan K. Comparison of measurements of the uterus and cervix obtained by magnetic resonance and transabdominal ultrasound imaging to identify the brachytherapy target in patients with cervix cancer. Int J Radiat Oncol Biol Phys 2014; 88:860-5. [PMID: 24462382 DOI: 10.1016/j.ijrobp.2013.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/24/2013] [Accepted: 12/04/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare measurements of the uterus and cervix obtained with magnetic resonance imaging (MRI) and transabdominal ultrasound to determine whether ultrasound can identify the brachytherapy target and be used to guide conformal brachytherapy planning and treatment for cervix cancer. METHODS AND MATERIALS Consecutive patients undergoing curative treatment with radiation therapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were inserted into the uterine canal while patients were anesthetized. Images were obtained by MRI and transabdominal ultrasound in the longitudinal axis of the uterus with the applicator in treatment position. Measurements were taken at the anterior and posterior surface of the uterus at 2.0-cm intervals along the applicator, from the external os to the tip of the applicator. Data were analyzed using Bland Altman plots examining bias and 95% limits of agreement. RESULTS A total of 192 patients contributed 1668 measurements of the cervix and uterus. Mean (± SD) differences of measurements between imaging modalities at the anterior and posterior uterine surface ranged from 1.5 (± 3.353) mm to 3.7 (± 3.856) mm, and -1.46 (± 3.308) mm to 0.47 (± 3.502) mm, respectively. The mean differences were less than 3 mm in the cervix. The mean differences were less than 1.5 mm at all measurement points on the posterior surface. CONCLUSION Differences in the measurements of the cervix and uterus obtained by MRI and ultrasound were within clinically acceptable limits. Transabdominal ultrasound can be substituted for MRI in defining the target volume for conformal brachytherapy treatment of cervix cancer.
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Affiliation(s)
- Sylvia van Dyk
- Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
| | | | - Michal Schneider
- Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Kailash Narayan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
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