Diana Guevara Barrera , Silvia Rodríguez Villalba , Luis Suso-Martí , Enrique Sanchis-Sánchez , Jose Perez-Calatayud , Jose Domingo Lago Martín , Francisco Blázquez Molina , Manuel Santos Ortega
{"title":"基于磁共振成像的规划对局部晚期宫颈肿瘤经会阴间质近距离治疗的影响：临床、剂量测定和毒性结果。","authors":"Diana Guevara Barrera , Silvia Rodríguez Villalba , Luis Suso-Martí , Enrique Sanchis-Sánchez , Jose Perez-Calatayud , Jose Domingo Lago Martín , Francisco Blázquez Molina , Manuel Santos Ortega","doi":"10.1016/j.brachy.2024.10.005","DOIUrl":null,"url":null,"abstract":"<div><h3>PURPOSE</h3><div>To compare dosimetric characteristics, clinical outcomes, and toxicity in patients with locally advanced cervical cancer(LACC) treated with transperineal interstitial brachytherapy(P-ISBT), using CT-based planning or MRI-based planning with a monoinstitutional MRI-compatible applicator, Template Benidorm(TB).</div></div><div><h3>MATERIALS AND METHODS</h3><div>We retrospectively analyzed 106 women treated with P-ISBT for LACC from 2006 to 2022. P-ISBT was CT-based, with Martinez Universal Perineal Interstitial Template(MUPIT) between 2006 and 2012, or MRI-based planning (TB) since 2013. Volumetric, clinical, and dosimetric parameters were compared between applicators.</div></div><div><h3>RESULTS</h3><div>Forty-six (43.4%) patients were treated with MUPIT, and 60 (56.6%) with TB. Median follow-up was 42 months (4–188). No significant difference was observed in 5-year local control (LC), regional control (RC), distant failure (DF), overall survival (OS), and disease-specific survival (DSS) between applicators. The TB cohort had fewer needles (<em>p = 0.001</em>), halved median CTV volume (<em>p < 0.001</em>), increased median D<sub>90%</sub>CTV dose (<em>p < 0.005</em>), and lower D<sub>2cc</sub> values in rectum/bladder (<em>p < 0.001</em>). G3 chronic toxicity was 15% in the MUPIT group and 6% in TB (<em>p = 0.15</em>), with no G4 toxicity reported. Rectal hemorrhage was lower in the TB group (<em>p = 0.002</em>). Larger CTV volumes correlated with higher rectal D2cc and rectal hemorrhage (<em>p = 0.001; p = 0.029</em>, respectively), and enterovaginal fistula (<em>p = 0.03; p < 0.001</em>, respectively). Median CTV volume was 152.82 cc (35.3–256.78) in patients with chronic rectal toxicity and 102.9 cc (21.4–329.41) in those without (<em>p = 0.001</em>).</div></div><div><h3>CONCLUSION</h3><div>MRI's superior CTV-volume definition results in smaller treatment volumes, lower D<sub>2cc</sub> for rectum and bladder, and a trend towards higher CTV D<sub>90%</sub>. Rectal hemorrhage was significantly lower in the MRI-based group. A significant correlation was observed between larger CTV-volumes, higher rectal D<sub>2cc</sub> and rectal hemorrhage/enterovaginal fistula.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 134-143"},"PeriodicalIF":1.7000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of MRI-based planning in transperineal interstitial brachytherapy for locally advanced cervix tumors: Clinical, dosimetric and toxicity outcomes\",\"authors\":\"Diana Guevara Barrera , Silvia Rodríguez Villalba , Luis Suso-Martí , Enrique Sanchis-Sánchez , Jose Perez-Calatayud , Jose Domingo Lago Martín , Francisco Blázquez Molina , Manuel Santos Ortega\",\"doi\":\"10.1016/j.brachy.2024.10.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>PURPOSE</h3><div>To compare dosimetric characteristics, clinical outcomes, and toxicity in patients with locally advanced cervical cancer(LACC) treated with transperineal interstitial brachytherapy(P-ISBT), using CT-based planning or MRI-based planning with a monoinstitutional MRI-compatible applicator, Template Benidorm(TB).</div></div><div><h3>MATERIALS AND METHODS</h3><div>We retrospectively analyzed 106 women treated with P-ISBT for LACC from 2006 to 2022. P-ISBT was CT-based, with Martinez Universal Perineal Interstitial Template(MUPIT) between 2006 and 2012, or MRI-based planning (TB) since 2013. Volumetric, clinical, and dosimetric parameters were compared between applicators.</div></div><div><h3>RESULTS</h3><div>Forty-six (43.4%) patients were treated with MUPIT, and 60 (56.6%) with TB. Median follow-up was 42 months (4–188). No significant difference was observed in 5-year local control (LC), regional control (RC), distant failure (DF), overall survival (OS), and disease-specific survival (DSS) between applicators. The TB cohort had fewer needles (<em>p = 0.001</em>), halved median CTV volume (<em>p < 0.001</em>), increased median D<sub>90%</sub>CTV dose (<em>p < 0.005</em>), and lower D<sub>2cc</sub> values in rectum/bladder (<em>p < 0.001</em>). G3 chronic toxicity was 15% in the MUPIT group and 6% in TB (<em>p = 0.15</em>), with no G4 toxicity reported. Rectal hemorrhage was lower in the TB group (<em>p = 0.002</em>). Larger CTV volumes correlated with higher rectal D2cc and rectal hemorrhage (<em>p = 0.001; p = 0.029</em>, respectively), and enterovaginal fistula (<em>p = 0.03; p < 0.001</em>, respectively). Median CTV volume was 152.82 cc (35.3–256.78) in patients with chronic rectal toxicity and 102.9 cc (21.4–329.41) in those without (<em>p = 0.001</em>).</div></div><div><h3>CONCLUSION</h3><div>MRI's superior CTV-volume definition results in smaller treatment volumes, lower D<sub>2cc</sub> for rectum and bladder, and a trend towards higher CTV D<sub>90%</sub>. Rectal hemorrhage was significantly lower in the MRI-based group. A significant correlation was observed between larger CTV-volumes, higher rectal D<sub>2cc</sub> and rectal hemorrhage/enterovaginal fistula.</div></div>\",\"PeriodicalId\":55334,\"journal\":{\"name\":\"Brachytherapy\",\"volume\":\"24 1\",\"pages\":\"Pages 134-143\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brachytherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1538472124004045\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1538472124004045","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Impact of MRI-based planning in transperineal interstitial brachytherapy for locally advanced cervix tumors: Clinical, dosimetric and toxicity outcomes
PURPOSE
To compare dosimetric characteristics, clinical outcomes, and toxicity in patients with locally advanced cervical cancer(LACC) treated with transperineal interstitial brachytherapy(P-ISBT), using CT-based planning or MRI-based planning with a monoinstitutional MRI-compatible applicator, Template Benidorm(TB).
MATERIALS AND METHODS
We retrospectively analyzed 106 women treated with P-ISBT for LACC from 2006 to 2022. P-ISBT was CT-based, with Martinez Universal Perineal Interstitial Template(MUPIT) between 2006 and 2012, or MRI-based planning (TB) since 2013. Volumetric, clinical, and dosimetric parameters were compared between applicators.
RESULTS
Forty-six (43.4%) patients were treated with MUPIT, and 60 (56.6%) with TB. Median follow-up was 42 months (4–188). No significant difference was observed in 5-year local control (LC), regional control (RC), distant failure (DF), overall survival (OS), and disease-specific survival (DSS) between applicators. The TB cohort had fewer needles (p = 0.001), halved median CTV volume (p < 0.001), increased median D90%CTV dose (p < 0.005), and lower D2cc values in rectum/bladder (p < 0.001). G3 chronic toxicity was 15% in the MUPIT group and 6% in TB (p = 0.15), with no G4 toxicity reported. Rectal hemorrhage was lower in the TB group (p = 0.002). Larger CTV volumes correlated with higher rectal D2cc and rectal hemorrhage (p = 0.001; p = 0.029, respectively), and enterovaginal fistula (p = 0.03; p < 0.001, respectively). Median CTV volume was 152.82 cc (35.3–256.78) in patients with chronic rectal toxicity and 102.9 cc (21.4–329.41) in those without (p = 0.001).
CONCLUSION
MRI's superior CTV-volume definition results in smaller treatment volumes, lower D2cc for rectum and bladder, and a trend towards higher CTV D90%. Rectal hemorrhage was significantly lower in the MRI-based group. A significant correlation was observed between larger CTV-volumes, higher rectal D2cc and rectal hemorrhage/enterovaginal fistula.
期刊介绍：
Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.
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