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• W4387207059 abstract "MRI is an essential tool in treatment planning for cervical cancer patients undergoing definitive chemoradiation involving brachytherapy. However, due access to MRI for many patients may be limited. We sought to examine the feasibility and quality of treatment planning for organs at risk (OAR) and target volumes of a single treatment planning MRI for a planned two-insertion HDR intracavitary cervical brachytherapy.Eighteen patients with cervical cancer who underwent MRI-based treatment planning for intracavitary brachytherapy were selected for analysis. Patients underwent two intracavitary applicator insertions using a tandem and ring applicator (TnR_1 and TnR_2) with both CT (for digitization only) and MRI following each insertion and two fractions delivered with each insertion (total 7 Gy x 4fx). MRI-based TnR_2 plans were retrospectively replanned with the following procedure: 1) register MRI from TnR_1 to TnR_2 CT, 2) transfer cervix contour (Cx_simul) and plan from TnR_1 to TnR_2 CT, simulating blinding from TnR_2 MRI, 3) crop Cx_simul from TnR_2 OARs, 4) adjust plan only to meet OAR constraints or clinical doses if clinical plan (TnR_2 original MRI plan summed with TnR_1 and EBRT doses) violates constraints. Coverage changes (∆_D90%) in actual MRI defined TnR_2 cervix (Cx_real) was compared to clinical plans and evaluated against our clinical target goal: >85 Gy EQD2 (EBRT+BT). Differences between Cx_simul and Cx_real contours were evaluated with Dice Similarity Coefficient (DSC). Changes in bladder, rectum, rectosigmoid, and bowel D2cc was evaluated. Procedure time was recorded to determine time added by MRI (time between CT and final MRI timestamps; n = 29).Plan modification to meet OAR constraints was required for 5/18 plans. Cx_real target coverage from clinical to simulated plans decreased in 7/18 plans (∆_D90% = 1.7±6%). Composite EQD2 was <85 Gy in 2/18 cases, with ∆_D90% of -1.3% (clinical EQD2<85 Gy for this case also) and -7.3%, which was due to inconsistent cervix shape between insertions 1 and 2. Cervix DSC values between Cx_simul and Cx_real ranged from 0.68-0.88 (mean = 0.78 ± 0.06). Bladder, rectum, rectosigmoid, and bowel D2cc increased on average 4 ± 12%, 3 ± 9%, 5 ± 10%, and 5 ± 17%, respectively. Including planning MRI increased procedure time by 41.8 ± 10.4 min.The proposed method of utilizing TnR_1 MRI contours for TnR_2 CT planning reduces procedure time and provides reasonable target coverage for most cases. OAR assessment varies between imaging modality which likely represents variability in OAR position rather than treatment planning modality. Next steps are to increase patients studied, and implement this technique prospectively while waiting for TnR_2 MRI completion and compare the clinical TnR_2 MRI plan with the TnR_2 CT plan created with Cx_simul. This will provide further confidence in validity of the approach and ensure plan quality is maintained prior to full implementation." @default.
• W4387207059 created "2023-09-30" @default.
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• W4387207059 date "2023-10-01" @default.
• W4387207059 modified "2023-10-17" @default.
• W4387207059 title "Feasibility of Using a Single Planning MRI for Two-Insertion Intracavitary Brachytherapy for Cervical Cancer" @default.
• W4387207059 doi "https://doi.org/10.1016/j.ijrobp.2023.06.2243" @default.
• W4387207059 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/37786117" @default.
• W4387207059 hasPublicationYear "2023" @default.
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