Végváry Zoltán, Kószó Renáta, Együd Zsófia, Varga Linda, Paczona Viktor Róbert, Cserháti Adrienn, Gal Viorica, Varga Zoltán, Nagy Zoltán, Deák Bence, Borzák Ferenc, Bontovics Julianna, Fodor Emese, Oláh Judit, Kahán Zsuzsanna
Department of Oncotherapy, University of Szeged, Szeged, Hungary.
Pathol Oncol Res. 2025 May 1;31:1612077. doi: 10.3389/pore.2025.1612077. eCollection 2025.
MRI-based image-guided adaptive brachytherapy (IGABT) is a new approach for individual dose escalation and control of organ at risk (OAR) doses and toxicities in the treatment of locally advanced cervical cancer.
Various radiotherapy-related parameters and the feasibility of the treatment based on acute toxicity were analyzed in a total of 50 cases in two cohorts who received a brachytherapy (BT) boost after definitive chemoradiotherapy with either an MRI-based IGABT technique (24 patients) or CT-only image guidance (26 patients). For target volume, OAR delineation, and dose prescription, the EMBRACE II protocol was followed.
The features of the target volumes and dose coverage did not differ between the two groups regarding teletherapy. At BT, however, while the High-Risk Clinical Target Volumes (CTVHR) did not differ the D90 dose coverage was significantly higher in the MRI-based IGABT group than in the non-MRI-based group (7.37 ± 0.55 Gy vs. 6.87 ± 0.84 Gy, p = 0.015). The CTVHR D98 doses showed a strong trend in favor of the MRI-based technique (6.16 ± 0.59 Gy, vs. 5.72 ± 0.95 Gy, p = 0.051). Cumulative doses to the CTVHR by means of both D90 and D98 were significantly higher in the MRI-based treatment group than the other group (86.64 ± 4.76 Gy vs. 81.56 ± 8.29 Gy, p = 0.011 and 77.23 ± 4.39 Gy vs. 73.40 ± 7.80 Gy, p = 0.037, respectively). Regarding OAR exposure, doses to the bladder, rectum, and sigmoid did not differ between the two cohorts.
Our first clinical results support the implementation of IGABT as a key component of image-guided adaptive radiotherapy (IGART) aiming at tumor dose-escalation and OAR protection.
基于磁共振成像（MRI）的图像引导自适应近距离放射治疗（IGABT）是局部晚期宫颈癌治疗中实现个体化剂量递增以及控制危及器官（OAR）剂量和毒性的一种新方法。
对两个队列共50例患者进行分析，这些患者在根治性放化疗后接受近距离放射治疗（BT）增敏，其中24例采用基于MRI的IGABT技术，26例采用仅基于CT图像引导技术。对于靶区体积、OAR勾画和剂量处方，遵循EMBRACE II方案。
两组在远距离放疗方面靶区体积和剂量覆盖特征无差异。然而，在BT时，虽然高危临床靶区体积（CTVHR）无差异，但基于MRI的IGABT组的D90剂量覆盖显著高于非MRI组（7.37±0.55 Gy对6.87±0.84 Gy，p = 0.015）。CTVHR的D98剂量显示出强烈趋势支持基于MRI的技术（6.16±0.59 Gy对5.72±0.95 Gy，p = 0.051）。基于MRI的治疗组通过D90和D98对CTVHR的累积剂量均显著高于另一组（分别为86.64±4.76 Gy对81.56±8.29 Gy，p = 0.011；77.23±4.39 Gy对73.40±7.80 Gy，p = 0.037）。关于OAR暴露，两组对膀胱、直肠和乙状结肠的剂量无差异。
我们的首个临床结果支持将IGABT作为图像引导自适应放疗（IGART）的关键组成部分实施，旨在实现肿瘤剂量递增和保护OAR。
