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• W2166052657 abstract "Purpose/Objective(s)To evaluate the relationship between the 3-month post-therapy FDG cervical metabolic response and DVH parameters derived from the GTV with margins contoured on weekly brachytherapy planning MRI scans.Materials/MethodsBetween December 2007 and July 2011, 80 patients with stage Ib1-IIIb cervical cancer were diagnosed and treated using definitive chemoradiation and weekly HDR brachytherapy. External radiation therapy using IMRT directed to the cervical tumor and pelvic lymph nodes utilizing FDG-PET/CT simulation was performed. All but one patient completed 6 weekly HDR-brachytherapy treatments beginning week 1 of IMRT. MRI simulation was used for each HDR fraction. The GTV from each fraction was delineated using diffusion weighted and/or T2 weighted images. Symmetric expansions of the GTV were created at 3, 5, 7, and 10 mm to define clinical tumor volumes (CTVs) avoiding the rectum, bladder, and sigmoid. Doses in 2 Gy equivalent fractions (EQD2) to the 90% and 100% volumes for each fraction and each CTV expansion were recorded and summed. The total D90 and D100 from the brachytherapy component was summed to the D90 and D100 from the IMRT plan for each CTV expansion. Statistical analysis utilized the Probit method to determine the relationship between likelihood of a complete metabolic response on the 3-month post-therapy FDG-PET and the D90 and D100 values of the GTV and CTV expansions. The Vuong test for non-nested independent models was used to determine statistical significance of different combinations of dosimetric models.ResultsThe median follow up was 20 months. A total of 97.5% of the patients completed treatment as intended. Median prescribed dose to the cervical tumor and lymph nodes from IMRT was 20 Gy and 50.4 Gy in 28 fractions, and the median prescribed dose to point A was 39 Gy in six fractions. Nineteen patients had an incomplete metabolic response on their post-therapy FDG-PET. Probit analysis indicated that the D90 or D100 EQD2 of all CTV expansions demonstrated a significant predictive relationship with 3-month PET/CT outcome (p-values 0.005-0.0176), whereas the D90 or D100 EQD2 for the GTV did not demonstrate a relationship (D90 p=0.2371, D100 p=0.0704). Comparison of the models using the Vuong test demonstrated that they were not statistically different.ConclusionsA significant relationship among DVH parameters based on the GTV and CTV expansions was demonstrated for early metabolic response. Further study will determine whether parameters from specific volumes more reliably predict local control, allowing for dose-volume optimization for treatment planning. Purpose/Objective(s)To evaluate the relationship between the 3-month post-therapy FDG cervical metabolic response and DVH parameters derived from the GTV with margins contoured on weekly brachytherapy planning MRI scans. To evaluate the relationship between the 3-month post-therapy FDG cervical metabolic response and DVH parameters derived from the GTV with margins contoured on weekly brachytherapy planning MRI scans. Materials/MethodsBetween December 2007 and July 2011, 80 patients with stage Ib1-IIIb cervical cancer were diagnosed and treated using definitive chemoradiation and weekly HDR brachytherapy. External radiation therapy using IMRT directed to the cervical tumor and pelvic lymph nodes utilizing FDG-PET/CT simulation was performed. All but one patient completed 6 weekly HDR-brachytherapy treatments beginning week 1 of IMRT. MRI simulation was used for each HDR fraction. The GTV from each fraction was delineated using diffusion weighted and/or T2 weighted images. Symmetric expansions of the GTV were created at 3, 5, 7, and 10 mm to define clinical tumor volumes (CTVs) avoiding the rectum, bladder, and sigmoid. Doses in 2 Gy equivalent fractions (EQD2) to the 90% and 100% volumes for each fraction and each CTV expansion were recorded and summed. The total D90 and D100 from the brachytherapy component was summed to the D90 and D100 from the IMRT plan for each CTV expansion. Statistical analysis utilized the Probit method to determine the relationship between likelihood of a complete metabolic response on the 3-month post-therapy FDG-PET and the D90 and D100 values of the GTV and CTV expansions. The Vuong test for non-nested independent models was used to determine statistical significance of different combinations of dosimetric models. Between December 2007 and July 2011, 80 patients with stage Ib1-IIIb cervical cancer were diagnosed and treated using definitive chemoradiation and weekly HDR brachytherapy. External radiation therapy using IMRT directed to the cervical tumor and pelvic lymph nodes utilizing FDG-PET/CT simulation was performed. All but one patient completed 6 weekly HDR-brachytherapy treatments beginning week 1 of IMRT. MRI simulation was used for each HDR fraction. The GTV from each fraction was delineated using diffusion weighted and/or T2 weighted images. Symmetric expansions of the GTV were created at 3, 5, 7, and 10 mm to define clinical tumor volumes (CTVs) avoiding the rectum, bladder, and sigmoid. Doses in 2 Gy equivalent fractions (EQD2) to the 90% and 100% volumes for each fraction and each CTV expansion were recorded and summed. The total D90 and D100 from the brachytherapy component was summed to the D90 and D100 from the IMRT plan for each CTV expansion. Statistical analysis utilized the Probit method to determine the relationship between likelihood of a complete metabolic response on the 3-month post-therapy FDG-PET and the D90 and D100 values of the GTV and CTV expansions. The Vuong test for non-nested independent models was used to determine statistical significance of different combinations of dosimetric models. ResultsThe median follow up was 20 months. A total of 97.5% of the patients completed treatment as intended. Median prescribed dose to the cervical tumor and lymph nodes from IMRT was 20 Gy and 50.4 Gy in 28 fractions, and the median prescribed dose to point A was 39 Gy in six fractions. Nineteen patients had an incomplete metabolic response on their post-therapy FDG-PET. Probit analysis indicated that the D90 or D100 EQD2 of all CTV expansions demonstrated a significant predictive relationship with 3-month PET/CT outcome (p-values 0.005-0.0176), whereas the D90 or D100 EQD2 for the GTV did not demonstrate a relationship (D90 p=0.2371, D100 p=0.0704). Comparison of the models using the Vuong test demonstrated that they were not statistically different. The median follow up was 20 months. A total of 97.5% of the patients completed treatment as intended. Median prescribed dose to the cervical tumor and lymph nodes from IMRT was 20 Gy and 50.4 Gy in 28 fractions, and the median prescribed dose to point A was 39 Gy in six fractions. Nineteen patients had an incomplete metabolic response on their post-therapy FDG-PET. Probit analysis indicated that the D90 or D100 EQD2 of all CTV expansions demonstrated a significant predictive relationship with 3-month PET/CT outcome (p-values 0.005-0.0176), whereas the D90 or D100 EQD2 for the GTV did not demonstrate a relationship (D90 p=0.2371, D100 p=0.0704). Comparison of the models using the Vuong test demonstrated that they were not statistically different. ConclusionsA significant relationship among DVH parameters based on the GTV and CTV expansions was demonstrated for early metabolic response. Further study will determine whether parameters from specific volumes more reliably predict local control, allowing for dose-volume optimization for treatment planning. A significant relationship among DVH parameters based on the GTV and CTV expansions was demonstrated for early metabolic response. Further study will determine whether parameters from specific volumes more reliably predict local control, allowing for dose-volume optimization for treatment planning." @default.
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• W2166052657 date "2012-11-01" @default.
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• W2166052657 title "Adaptive MRI Image Guided HDR Brachytherapy Treatment Planning for Cervical Cancer" @default.
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