MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer

The university of Pittsburgh experience

Beant S. Gill, Hayeon Kim, Christopher J. Houser, Joseph L. Kelley, Paniti Sukumvanich, Robert P. Edwards, John T. Comerci, Alexander B. Olawaiye, Marilyn Huang, Madeleine Courtney-Brooks, Sushil Beriwal

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Purpose Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high-dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD2) with planned HRCTV doses of 75 to 85 Gy. Results From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P90 EQD2 ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions This study constitutes one of the largest reported series of MRI-guided brachytherapy in North America, demonstrating excellent local control with acceptable morbidity. Dose escalation may be warranted when feasible for adenocarcinomas to offset the risk of local failure.

Original languageEnglish (US)
Pages (from-to)540-547
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume91
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Brachytherapy
Uterine Cervical Neoplasms
magnetic resonance
cancer
Magnetic Resonance Imaging
dosage
Radiotherapy
radiation therapy
histology
Histology
Adenocarcinoma
Organs at Risk
Therapeutics
Neoplasms
North America
Cisplatin
Disease-Free Survival
Survival Rate
Tomography
Guidelines

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer : The university of Pittsburgh experience. / Gill, Beant S.; Kim, Hayeon; Houser, Christopher J.; Kelley, Joseph L.; Sukumvanich, Paniti; Edwards, Robert P.; Comerci, John T.; Olawaiye, Alexander B.; Huang, Marilyn; Courtney-Brooks, Madeleine; Beriwal, Sushil.

In: International Journal of Radiation Oncology Biology Physics, Vol. 91, No. 3, 01.03.2015, p. 540-547.

Research output: Contribution to journalArticle

Gill, BS, Kim, H, Houser, CJ, Kelley, JL, Sukumvanich, P, Edwards, RP, Comerci, JT, Olawaiye, AB, Huang, M, Courtney-Brooks, M & Beriwal, S 2015, 'MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: The university of Pittsburgh experience', International Journal of Radiation Oncology Biology Physics, vol. 91, no. 3, pp. 540-547. https://doi.org/10.1016/j.ijrobp.2014.10.053
Gill, Beant S. ; Kim, Hayeon ; Houser, Christopher J. ; Kelley, Joseph L. ; Sukumvanich, Paniti ; Edwards, Robert P. ; Comerci, John T. ; Olawaiye, Alexander B. ; Huang, Marilyn ; Courtney-Brooks, Madeleine ; Beriwal, Sushil. / MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer : The university of Pittsburgh experience. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 91, No. 3. pp. 540-547.
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abstract = "Purpose Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high-dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Europ{\'e}en de Curieth{\'e}rapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD2) with planned HRCTV doses of 75 to 85 Gy. Results From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6{\%}) with a median tumor size of 5 cm, squamous histology (82.8{\%}), and no radiographic nodal involvement (53.1{\%}). Most patients (67.2{\%}) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6{\%}, 81.8{\%}, and 87.6{\%}, respectively. Predictors of local failure included adenocarcinoma histology (P90 EQD2 ≥84 Gy was associated with improved local control (2-year local control rate 100{\%} vs 54.5{\%}, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9{\%}. Conclusions This study constitutes one of the largest reported series of MRI-guided brachytherapy in North America, demonstrating excellent local control with acceptable morbidity. Dose escalation may be warranted when feasible for adenocarcinomas to offset the risk of local failure.",
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AU - Kelley, Joseph L.

AU - Sukumvanich, Paniti

AU - Edwards, Robert P.

AU - Comerci, John T.

AU - Olawaiye, Alexander B.

AU - Huang, Marilyn

AU - Courtney-Brooks, Madeleine

AU - Beriwal, Sushil

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N2 - Purpose Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high-dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD2) with planned HRCTV doses of 75 to 85 Gy. Results From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P90 EQD2 ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions This study constitutes one of the largest reported series of MRI-guided brachytherapy in North America, demonstrating excellent local control with acceptable morbidity. Dose escalation may be warranted when feasible for adenocarcinomas to offset the risk of local failure.

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