Seminars in Radiation Oncology
Volume 20, Issue 2 , Pages 121-129 , April 2010

Adaptive Management of Cervical Cancer Radiotherapy

  • Kari Tanderup, PhD

      Affiliations

    • Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
    • ,
  • Dietmar Georg, DSc

      Affiliations

    • Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
    • Corresponding Author InformationAddress reprint requests to Dietmar Georg, DSc, Department of Radiotherapy, Medical University Vienna, AKH Wien, Währinger Gürtel 18–20, A-1090 Vienna, Austria
    • ,
  • Richard Pötter, MD

      Affiliations

    • Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
    • ,
  • Christian Kirisits, DSc

      Affiliations

    • Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
    • ,
  • Cai Grau, DMSc, MD

      Affiliations

    • Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
    • ,
  • Jacob C. Lindegaard, DMSc, MD

      Affiliations

    • Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

References 

  1. Gerbaulet A, Pötter R, Haie-Meder C. Cervix carcinoma. In:  Gerbaulet A,  Pötter R,  Mazeron JJ, et al. editor. The GEC ESTRO Handbook of Brachytherapy. Brussels, Belgium: ESTRO; 2002;p. 301–364
  2. Dimopoulos JC, Lang S, Kirisits C, et al. Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2009;75:56–63
  3. Pötter R, Dimopoulos J, Georg P, et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol. 2007;83:148–155
  4. Dimopoulos JC, Potter R, Lang S, et al. Dose-effect relationship for local control of cervical cancer by magnetic resonance image-guided brachytherapy. Radiother Oncol. 2009;93;:311–312
  5. Mundt AJ, Lujan AE, Rotmensch J, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;52:1330–1337
  6. Brixey CJ, Roeske JC, Lujan AE, et al. Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;54:1388–1396
  7. Chen MF, Tseng CJ, Tseng CC, et al. Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: Comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67:1438–1444
  8. Mayr NA, Taoka T, Yuh WT, et al. Method and timing of tumor volume measurement for outcome prediction in cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2002;52:14–22
  9. van de Bunt L, Jurgenliemk-Schulz IM, de Kort GA, et al. Motion and deformation of the target volumes during IMRT for cervical cancer: What margins do we need?. Radiother Oncol. 2008;88:233–240
  10. Taylor A, Powell ME. An assessment of interfractional uterine and cervical motion: Implications for radiotherapy target volume definition in gynaecological cancer. Radiother Oncol. 2008;88:250–257
  11. Beadle BM, Jhingran A, Salehpour M, et al. Cervix regression and motion during the course of external beam chemoradiation for cervical cancer. Int J Radiat Oncol Biol Phys. 2009;73:235–241
  12. Chan P, Dinniwell R, Haider MA, et al. Inter- and intrafractional tumor and organ movement in patients with cervical cancer undergoing radiotherapy: A cinematic-MRI point-of-interest study. Int J Radiat Oncol Biol Phys. 2008;70:1507–1515
  13. Georg P, Georg D, Hillbrand M, et al. Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies. Radiother Oncol. 2006;80:19–26
  14. Cozzi L, Dinshaw KA, Shrivastava SK, et al. A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol. 2008;89:180–191
  15. Beriwal S, Gan GN, Heron DE, et al. Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2007;68:166–171
  16. Raaymakers BW, Lagendijk JJ, Overweg J, et al. Integrating a 1.5 T MRI scanner with a 6 MV accelerator: Proof of concept. Phys Med Biol. 2009;54:N229–N237
  17. Kerkhof EM, Raaymakers BW, van der Heide UA, et al. Online MRI guidance for healthy tissue sparing in patients with cervical cancer: An IMRT planning study. Radiother Oncol. 2008;88:241–249
  18. Jhingran A. Potential advantages of intensity-modulated radiation therapy in gynecologic malignancies. Semin Radiat Oncol. 2006;16:144–151
  19. Wolfson AH. Magnetic resonance imaging and positron-emission tomography imaging in the 21st century as tools for the evaluation and management of patients with invasive cervical carcinoma. Semin Radiat Oncol. 2006;16:186–191
  20. Georg D, Kirisits C, Hillbrand M, et al. Image-guided radiotherapy for cervix cancer: High-tech external beam therapy versus high-tech brachytherapy. Int J Radiat Oncol Biol Phys. 2008;71:1272–1278
  21. Assenholt MS, Petersen JB, Nielsen SK, et al. A dose planning study on applicator guided stereotactic IMRT boost in combination with 3D MRI based brachytherapy in locally advanced cervical cancer. Acta Oncol. 2008;47:1337–1343
  22. Lindegaard JC, Tanderup K, Nielsen SK, et al. MRI-guided 3D optimization significantly improves DVH parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71:756–764
  23. Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol. 2005;74:235–245
  24. Pötter R, Haie-Meder C, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol. 2006;78:67–77
  25. Kirisits C, Pötter R, Lang S, et al. Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2005;62:901–911
  26. Kirisits C, Lang S, Dimopoulos J, et al. The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Design, application, treatment planning, and dosimetric results. Int J Radiat Oncol Biol Phys. 2006;65:624–630
  27. De Brabandere M, Mousa AG, Nulens A, et al. Potential of dose optimisation in MRI-based PDR brachytherapy of cervix carcinoma. Radiother Oncol. 2008;88:217–226
  28. Chargari C, Magne N, Dumas I, et al. Physics contributions and clinical outcome with 3D-MRI-based pulsed-dose-rate intracavitary brachytherapy in cervical cancer patients. Int J Radiat Oncol Biol Phys. 2009;74:133–139
  29. Haie-Meder C, Chargari C, Rey A, et al: Preoperative MRI-based low dose-rate brachytherapy followed by surgery in the early cervix cancer patients: Experience of the Institut Gustave Roussy. Radiother Oncol (in press)
  30. Kirisits C, Lang S, Dimopoulos J, et al. Uncertainties when using only one MRI-based treatment plan for subsequent high-dose-rate tandem and ring applications in brachytherapy of cervix cancer. Radiother Oncol. 2006;81:269–275
  31. Beriwal S, Kim H, Coon D, et al. Single magnetic resonance imaging vs magnetic resonance imaging/computed tomography planning in cervical cancer brachytherapy. Clin Oncol (R Coll Radiol). 2009;21:483–487
  32. Dimopoulos JC, Schard G, Berger D, et al. Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: Potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Radiat Oncol Biol Phys. 2006;64:1380–1388
  33. Dimopoulos JC, Kirisits C, Petric P, et al. The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Clinical feasibility and preliminary results. Int J Radiat Oncol Biol Phys. 2006;66:83–90
  34. Pötter R, Kirisits C, Fidarova EF, et al. Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma. Acta Oncol. 2008;47:1325–1336
  35. Tanderup K, Hellebust TP, Lang S, et al. Consequences of random and systematic reconstruction uncertainties in 3D image based brachytherapy in cervical cancer. Radiother Oncol. 2008;89:156–163
  36. De Leeuw AA, Moerland MA, Nomden C, et al. Applicator reconstruction and applicator shifts in 3D MR based PDR brachytherapy of cervical cancer. Radiother Oncol. 2009;93:341–346
  37. Lim K, Kelly V, Stewart J, et al. Pelvic radiotherapy for cancer of the cervix: Is what you plan actually what you deliver?. Int J Radiat Oncol Biol Phys. 2009;74:304–312
  38. Tanderup K, Christensen JJ, Granfeldt J, et al. Geometric stability of intracavitary pulsed dose rate brachytherapy monitored by in vivo rectal dosimetry. Radiother Oncol. 2006;79:87–93
  39. Viswanathan AN, Dimopoulos J, Kirisits C, et al. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: Results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys. 2007;68:491–498
  40. Lin LL, Mutic S, Low DA, et al. Adaptive brachytherapy treatment planning for cervical cancer using FDG-PET. Int J Radiat Oncol Biol Phys. 2007;67:91–96
  41. Van Dyk S, Narayan K, Fisher R, et al. Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound. Int J Radiat Oncol Biol Phys. 2009;75:64–70
  42. Petric P, Dimopoulos J, Kirisits C, et al. Inter- and intraobserver variation in HR-CTV contouring: Intercomparison of transverse and paratransverse image orientation in 3D-MRI assisted cervix cancer brachytherapy. Radiother Oncol. 2008;89:164–171
  43. Kirkpatrick JP, Meyer JJ, Marks LB. The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery. Semin Radiat Oncol. 2008;18:240–243
  44. Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol. 2008;18:234–239
  45. Bentzen SM. Quantitative clinical radiobiology. Acta Oncol. 1993;32:259–275
  46. Roberts SA, Hendry JH, Swindell R, et al. Compensation for changes in dose-rate in radical low-dose-rate brachytherapy: A radiobiological analysis of a randomised clinical trial. Radiother Oncol. 2004;70:63–74
  47. Chemotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: A systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–5812
  48. Barraclough LH, Swindell R, Livsey JE, et al. External beam boost for cancer of the cervix uteri when intracavitary therapy cannot be performed. Int J Radiat Oncol Biol Phys. 2008;71:772–778
  49. Koom WS, Sohn DK, Kim JY, et al. Computed tomography-based high-dose-rate intracavitary brachytherapy for uterine cervical cancer: Preliminary demonstration of correlation between dose-volume parameters and rectal mucosal changes observed by flexible sigmoidoscopy. Int J Radiat Oncol Biol Phys. 2007;68:1446–1454
  50. Georg P, Kirisits C, Goldner G, et al. Correlation of dose-volume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy. Radiother Oncol. 2009;91:173–180

 Competing interests. The Department of Radiotherapy at the Medical University of Vienna received financial and/or equipment support for research and educational purposes from Nucletron BV, Varian Medical Systems, Isodose Control BV, and ELEKTA. The Department of Oncology at Aarhus University Hospital received financial and/or equipment support for research and educational purposes from Varian Medical Systems.

 Aarhus University Hospital was supported by research grants from the Danish Cancer Society, Varian Medical Systems, Palo Alto, California, Danish Council for Strategic Research, and CIRRO—the Lundbeck Foundation Centre for Interventional Research in Radiation Oncology.

PII: S1053-4296(09)00080-0

doi: 10.1016/j.semradonc.2009.11.006

Seminars in Radiation Oncology
Volume 20, Issue 2 , Pages 121-129 , April 2010

Article Tools

* Image Usage & Resolution