MAGNETIC RESONANCE IMAGING-GUIDED INTRACAVITARY BRACHYTHERAPY FOR CANCER OF THE CERVIX
MAGNETIC RESONANCE IMAGING-GUIDED INTRACAVITARY BRACHYTHERAPY FOR CANCER OF THE CERVIX
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DOI：
10.1016/j.ijrobp.2008.09.010
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发表时间：
2009-07-15
影响因子：
7
通讯作者：
Milosevic, Michael
中科院分区：
文献类型：
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作者：
Zwahlen, Daniel;Jezioranski, John;Milosevic, Michael
目的：为了确定优化的磁共振成像（MRI）引导的近距离放射治疗（BT）的可行性和好处的cancer of the cervice.Methods和Materials：共20例国际妇产科联合会阶段IB-IV宫颈癌有一个MRI兼容的子宫内BT施源器插入后外照射放疗。采集MRI扫描，并描绘诊断时和BT时的大体肿瘤体积、高风险（HR）和中等风险临床靶体积（CTV）以及直肠、乙状结肠和膀胱壁。脉冲剂量率BT计划并以常规方式输送。结果：HR CTV和中危CTV分别有70%和85%的患者接受了常规计划的充分治疗（治疗量>= 100%的预期剂量百分比>95%），而优化计划分别有75%和95%的患者接受了充分治疗。直肠、乙状结肠和膀胱壁连续2 cm 3体积的最小剂量分别为16 +/- 6.2、25 +/- 8.7和31 +/- 9.2戈伊。通过MRI引导的BT优化，可以保持HR-CTV的覆盖范围并减少正常组织的剂量，特别是在BT时具有小肿瘤的患者中。在这些患者中，所有病例中治疗量>= 100%预期剂量的HR百分比接近100%，直肠、乙状结肠和膀胱连续2 cm（3）的最小剂量比传统BT计划少12-32%。基于MRI的宫颈癌BT有可能优化原发肿瘤剂量测定，并减少对关键正常组织的剂量，特别是在小肿瘤患者中。(C)2009 Elsevier Inc.
Purpose: To determine the feasibility and benefits of optimized magnetic resonance imaging (MRI)-guided brachytherapy (BT) for cancer of the cervix.Methods and Materials: A total of 20 patients with International Federation of Gynecology and Obstetrics Stage IB-IV cervical cancer had an M RI-compatible intrauterine BT applicator inserted after external beam radiotherapy. MRI scans were acquired, and the gross tumor volume at diagnosis and at BT, the high-risk (HR) and intermediate-risk clinical target volume (CTV), and rectal, sigmoid, and bladder walls were delineated. Pulsed-dose-rate BT was planned and delivered in a conventional manner. Optimized MRI-based plans were developed and compared with the conventional plans.Results: The HR CTV and intermediate-risk CTV were adequately treated (the percentage of volume treated to >= 100% of the intended dose was >95%) in 70% and 85% of the patients with the conventional plans, respectively, and in 75% and 95% of the patients with the optimized plans, respectively. The minimal dose to the contiguous 2 cm 3 of the rectal, sigmoid, and bladder wall volume was 16 +/- 6.2, 25 +/- 8.7, and 31 +/- 9.2 Gy, respectively. With MRI-guided BT optimization, it was possible to maintain coverage of the HR-CTV and reduce the dose to the normal tissues, especially in patients with small tumors at BT. In these patients, the HR percentage of volume treated to >= 100% of the intended dose approached 100% in all cases, and the minimal dose to the contiguous 2-cm(3) of the rectum, sigmoid, and bladder was 12-32% less than with conventional BT planning.Conclusion: MRI-based BT for cervical cancer has the potential to optimize primary tumor dosimetry and reduce the dose to critical normal tissues, particularly in patients with small tumors. (C) 2009 Elsevier Inc.