Abstract
Purpose
We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience.
Materials and methods
The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI.
Results
The median Dice index was 0.879 (range 0.610–0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm3 of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0–10.4), 5.9 (2.3–7.7), 4.0 (1.9–6.7), and 3.8 (0.6–7.2) Gy, respectively.
Conclusion
Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.
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References
Viswanathan AN, Beriwal S, De Los Santos JF, Demanes DJ, Gaffney D, Hansen J, et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix part I: general principles. Brachytherapy. 2012;11:33–6.
Tod M, Meredith WJ. Treatment of cancer of the cervix uteri, a revised Manchester method. Br J Radiol. 1953;26:252–7.
Haie-Meder C, Pötter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, 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;74:235–45.
Pötter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, et al. Recommendations from gynaecological (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, radiobiology. Radiother Oncol. 2006;78:67–77.
Viswanathan AN, Dimopoulos J, Kirisits C, Berger D, Pötter R. 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;68:491–8.
Viswanathan AN, Erickson B, Gaffney DK, Beriwal S, Bhatia SK, Lee Burnett O, et al. Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2014;90:320–8.
Ohno T, Toita T, Tsujino K, Uchida N, Hatano K, Nishimura T, et al. A questionnaire-based survey on 3D image-guided brachytherapy for cervical cancer in Japan: advances and obstacles. J Radiat Res. 2015;56(6):897–903.
Viswanathan AN, Erickson BA. Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys. 2010;76:104–9.
Pavamani S, D’Souza DP, Portelance L, Craighead PS, Pearce AG, Traptow LL, et al. Image-guided brachytherapy for cervical cancer: a Canadian Brachytherapy Group survey. Brachytherapy. 2011;10:345–51.
van Dyk S, Byram D, Bernshaw D. Use of 3D imaging and awareness of GEC-ESTRO recommendations for cervix cancer brachytherapy throughout Australia and New Zealand. J Med Imaging Radiat Oncol. 2010;54:383–7.
Watanabe M, Iwai Y, Togasaki G, Kanazawa A, Kurokawa M, Harada R, et al. Preliminary results of MRI/CT based image guided brachytherapy in cervical carcinoma. Brachytherapy. 2016;15(Suppl):11.
Nemoto MW, Ikeda Y, Ii N, Toita T, Togasaki G, Kanazawa A, et al. Multi-Institutional Comparative Study of MRI technique in cervical cancer image-based brachytherapy (IGBT): 3D MRI with high sampling efficiency versus conventional 2D multiplanar MRI. Int J Radiat Oncol Biol Phys. 2016;96(Suppl):E304–5.
Watanabe Nemoto M, Nozaki-Taguchi N, Togasaki G, Kanazawa A, Kurokawa M, Harada R, et al. New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer. Brachytherapy. 2015;14:642–7.
Viswanathan AN, Beriwal S, De Los Santos JF, Demanes DJ, Gaffney D, Hansen J, et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix Part II: High-dose-rate brachytherapy. Brachytherapy. 2012;11:47–52.
Dimopoulos JC, Petrow P, Tanderup K, Petric P, Berger D, Kirisits C, et al. Recommendations from gynaecological (GYN) GEC-ESTRO working group (IV): basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol. 2012;103:113–22.
Wakatsuki M, Ohno T, Yoshida D, Noda S, Saitoh J, Shibuya K, et al. Intracavitary combined with CT-guided interstitial brachytherapy for locally advanced uterine cervical cancer: introduction of the technique and a case presentation. J Radiat Res. 2011;52:54–8.
Kang H-C, Shin KH, Park S-Y, Kim J-Y. 3D CT-based high-dose-rate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control. Radiother Oncol. 2010;97:507–13.
Nesvacil N, Pötter R, Sturdza A, Hegazy N, Federico M, Kirisits C. Adaptive image guided brachytherapy for cervical cancer: a combined MRI-/CT-planning technique with MRI only at first fraction. Radiother Oncol. 2013;107:75–81.
Acknowledgements
This work was supported by Japan Society for the Promotion of Science Grant-in-Aid for Young Scientists (B) 16K19808.
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Nemoto, M.W., Iwai, Y., Togasaki, G. et al. Preliminary results of a new workflow for MRI/CT-based image-guided brachytherapy in cervical carcinoma. Jpn J Radiol 35, 760–765 (2017). https://doi.org/10.1007/s11604-017-0690-3
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DOI: https://doi.org/10.1007/s11604-017-0690-3