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A study to assess the feasibility of using CT (±diagnostic MRI) instead of MRI at brachytherapy in image guided brachytherapy in cervical cancer

Published online by Cambridge University Press:  13 February 2014

Bhavana Rai ,
Firuza D. Patel ,
Parsee Tomar ,
Oinam A. Singh ,
Vijai Simha ,
Bhaswanth Dhanireddy  and
Suresh C. Sharma
Bhavana Rai*
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Firuza D. Patel
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Parsee Tomar
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Oinam A. Singh
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Vijai Simha
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Bhaswanth Dhanireddy
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
Suresh C. Sharma
Affiliation:
Post Graduate Institute of Medical Education and Research, Chandigarh, India
*
Correspondence to: Bhavana Rai, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Tel: +91-9814635706; +91-172-2735451, E-mail: [email protected]
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Abstract

Purpose

To compare the contours and dose volume histograms (DVH) parameters of the high-risk clinical target volume (HRCTV) contoured on computed tomography (CT) using clinical findings at brachytherapy, clinical findings at brachytherapy with magnetic resonance imaging (MRI) at diagnosis and HRCTV defined on MRI at brachytherapy in cervical cancer patients.

Materials and methods

Fifteen patients undergoing MRI-guided image-based brachytherapy underwent both CT and MRI after applicator insertion. Two sets of contours were defined on CT. In the first set, the HRCTV was defined with the help of clinical findings at brachytherapy (CT-HRCTV). In the second set, HRCTV was defined with MRI at diagnosis and clinical findings at brachytherapy (CT-HRCTVdmri). This was compared with the HRCTV defined on MRI at brachytherapy (MR-HRCTV). The doses to the organs at risk (OARs) were compared for CT and MRI.

Results

A significant overestimation of the maximum width and width at point A was observed for CT-HRCTV (p −0·00; 0·00) and CT-HRCTVdmri (p −0·03; 0·01), respectively. The height was underestimated with CT-HRCTV in patients with intrauterine disease extension. For a single fraction, the mean difference in the D90 for the CT contours was <1 Gy. The doses to the OARs were comparable.

Conclusions

CT may be an alternative when facilities for MRI image-based brachytherapy are lacking, provided at least one MRI is available before brachytherapy.

Keywords

cervical cancercomputed tomographyimage-guided brachytherapymagnetic resonance imaging
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 4 , December 2014 , pp. 438 - 446
Copyright
Copyright © Cambridge University Press 2014 

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References

1. Tanderup, K, Nielsen, S K, Nyvang, G B et al. From point A to the sculpted pear: MR image guidance significantly improves tumour dose and sparing of organs at risk in brachytherapy of cervical cancer. Radiother Oncol 2010; 94: 173–180.Google Scholar
2. Boss, E, Barentsz, J, Massugen, L et al. The role of MR imaging in invasive cervical carcinoma. Eur Radiol 2000; 10: 256–270.CrossRefGoogle ScholarPubMed
3. Potter, R, Georg, P, Dimopoulos, J C et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 2011; 100: 116–123.CrossRefGoogle ScholarPubMed
4. Tan, L T. Implementation of image-guided brachytherapy for cervix cancer in the UK: progress update. Clin Oncol (R Coll Radiol) 2011; 23: 681–684.Google Scholar
5. Viswanathan, A N, Erickson, B A. Three dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 2010; 76: 104–109.Google Scholar
6. Viswanathan, A N, Creutzberg, C L, Craighead, P et al. International brachytherapy practice patterns: a survey of the Gynecologic Cancer Intergroup (GCIG). Int J Radiat Oncol Biol Phys 2012; 82: 250–255.Google Scholar
7. Viswanathan, A N, Dimopoulos, J, Kirisits, C et al. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys 2007; 68: 491–498.Google Scholar
8. Krishantry, R, Patel, F D, Singh, P et al. CT or MRI for Image-based brachytherapy in cervical cancer. Jpn J Clin Oncol 2012; 42: 309–313.Google Scholar
9. Dimopoulos, J C, Schard, G, Berger, D et al. Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys 2006; 64: 1380–1388.Google Scholar
10. Haie-Meder, C, Potter, R, Limbergen, E V et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005; 74: 235–245.CrossRefGoogle Scholar
11. Pötter, R, Haie-Meder, C, Limbergen, E V et al. Recommendations from gynecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, and radiobiology. Radiother Oncol 2006; 78: 67–77.Google Scholar
12. Lang, S, Kirisits, C, Dimopoulos, J et al. Treatment planning for MRI assisted brachytherapy of gynaecological malignancies based on total dose constraints. Int J Radiat Oncol Biol Phys 2007; 69: 619–627.CrossRefGoogle ScholarPubMed
13. Pötter, R, Dimopoulos, J, Georg, P et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 2007; 83: 148–155.CrossRefGoogle ScholarPubMed
14. Hegazy, N, Pötter, R, Kirisits, C et al. High-risk clinical target volume delineation in CT-guided cervical cancer brachytherapy: impact of information from FIGO stage with or without systematic inclusion of 3D documentation of clinical gynecological examination. Acta Oncologica 2013: 1–8; (ahead of print).Google Scholar
15. Fedrico, M, Fotina, I, Hegazy, N et al. Analysis of spatial agreement between CT-(+ pre-BT MRI) and MRI-based HRCTV delineation in cevix cancer brachytherapy. Radiother Oncol 2011; 99: S57.CrossRefGoogle Scholar
16. Hellebust, T P, Tanderup, K, Lervåg, C et al. Dosimetric impact of interobserver variability in MRI-based delineation for cervical cancer brachytherapy. Radiother Oncol 2013; 107: 13–19.Google Scholar
17. Xia, D, Roeske, J C, Yu, L et al. A hybrid approach to reducing computed tomography metal artifacts in intracavitary brachytherapy. Brachytherapy 2005; 4: 18–23.Google Scholar