Felici Félix, Benkreira Mohamed, Lambaudie Éric, Fau Pierre, Mailleux Hugues, Ferre Marjorie, Tallet Agnès, Gonzague-Casabianca Laurence
Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
Department of Radiation Oncology, Institut Godinot, Reims, France.
Adv Radiat Oncol. 2022 Jun 26;7(6):100999. doi: 10.1016/j.adro.2022.100999. eCollection 2022 Nov-Dec.
Adaptive magnetic resonance (MR)-guided brachytherapy takes an important place as consolidation within the care of cervical malignancies, but may be impracticable in some unusual cases. This work aimed to present the case of adaptive MR-guided external beam radiation therapy (aMRgRT) used as a boost in a recurrence of cervical cancer.
We report on a case of a parametrial recurrence in a 31-year-old patient who already underwent a trachelectomy as treatment for her primary growth. After concomitant radio-chemotherapy, a brachytherapy boost was performed. Because of its position in relation to the left uterine artery after trachelectomy, impeding interstitial catheters set up, the relapse was insufficiently covered. With the aim to refine the coverage of target volumes, aMRgRT treatment was undertaken to allow for achievement of the dosimetric goals.
In clinical circumstances where the brachytherapy step was hindered, aMRgRT presents many advantages. First, daily native MR-imaging outperforms usual x-ray imaging in the pelvis, refining repositioning. Second, its specific workflow allows for the performance of adaptive treatment, with consideration of both the inter- and intrafraction motions of organs at risk and target volumes.
In nonfeasible brachytherapy situations, aMRgRT could be a satisfying substitute. Nevertheless, brachytherapy remains the standard of care as a boost in locally advanced cervical cancer.
自适应磁共振（MR）引导的近距离放射治疗在宫颈癌治疗中作为巩固治疗占据重要地位，但在某些特殊情况下可能不可行。本研究旨在介绍自适应MR引导的外照射放疗（aMRgRT）用于宫颈癌复发增敏治疗的病例。
我们报告了一例31岁患者的宫旁复发病例，该患者已接受宫颈切除术治疗原发性肿瘤。同步放化疗后，进行了近距离放射治疗增敏。由于宫颈切除术后复发部位与左子宫动脉的位置关系，妨碍了组织间插植导管的置入，复发灶未得到充分覆盖。为了优化靶区覆盖，采用aMRgRT治疗以实现剂量学目标。
在近距离放射治疗步骤受阻的临床情况下，aMRgRT具有许多优势。首先，每日的盆腔原生MR成像优于常规X线成像，可优化重新定位。其次，其特定的工作流程允许进行自适应治疗，同时考虑危及器官和靶区的分次间及分次内运动。
在不可行的近距离放射治疗情况下，aMRgRT可能是一种令人满意的替代方法。然而，近距离放射治疗仍然是局部晚期宫颈癌增敏治疗的标准方法。
