Fredman Elisha, Traughber Bryan, Podder Tarun, Colussi Valdir, Zheng Yiran, Russo Suzanne, Herrmann Karin, Paspulati Raj, Waggoner Steven, Zanotti Kristin, Nagel Christa, Nakayama John, Machtay Mitchell, Ellis Rodney
Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH.
Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland Medical Center, Cleveland, OH.
Brachytherapy. 2018 Mar-Apr;17(2):334-344. doi: 10.1016/j.brachy.2017.09.007. Epub 2017 Oct 31.
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.
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.
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 D (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 D (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.
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.
使用一种新型腔内开口环（ICSR）施源器适配器，评估3T磁共振成像（MRI）引导下的自适应高剂量率（HDR）腔内联合组织间近距离放射治疗在宫颈癌中的作用。
我们回顾性分析了2013年至2015年所有使用ICSR施源器的HDR近距离放射治疗病例。在施源器就位的情况下，使用3T多参数MRI（mpMRI）序列进行初始优化。在后续分次治疗前酌情获取mpMRI序列，以便进行可能的靶区适应性调整。必要时，通过新型ICSR适配器或徒手插入组织间针（ISN）。比较各组的剂量学参数、临床结果和毒性反应。
纳入17例患者，平均随访32个月。每次初始分次治疗前均进行mpMRI序列检查，52.9%的患者在≥1次额外的预处理mpMRI检查。在这些后续分次治疗中，有预处理mpMRI检查的患者中，高危临床靶体积减少的比例为80%，而无预处理mpMRI检查的患者为41%。5例患者进行了ISN置入（共7次插入）以改善宫颈外靶区的覆盖。有ISN和无ISN情况下，高危临床靶体积和中危临床靶体积每次分次的平均剂量（Gy）分别为7.51±1.07和6.14±0.52（p=0.028），以及6.35±0.75和5.21±0.49（p=0.007）。危及器官的平均分次剂量（Gy）相当。未报告3 - 4级毒性反应。ICSR - ISN组和单纯ICSR组的无病生存期和局部控制率分别为29.8个月/80.0%和31.2个月/83.3%。
在宫颈癌HDR近距离放射治疗前立即使用就位的ICSR施源器进行mpMRI采集，可成功引导适应性治疗的优化和实施。我们使用新型组织间适配器与开口环施源器的初步经验表明，在不危及器官的情况下能实现良好的靶区覆盖，从而获得良好的局部控制和无病生存期。
