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Late side effects of 3T MRI-guided 3D high-dose rate brachytherapy of cervical cancer

Institutional experiences

Späte Nebenwirkungen der 3T-MRT-gesteuerten 3D-High-Dose-Rate-Brachytherapie bei Gebärmutterhalskrebs

Erfahrungen einer Klinik

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Abstract

Purpose

This article reports experiences with 3T magnetic resonance imaging(MRI)-guided brachytherapy (BT) for cervical cancer focusing on late side effects.

Methods

Between June 2012 and March 2017 a total of 257 uterovaginal BT administrations were performed in 61 consecutive patients with inoperable cervical cancer. All patients were treated with BT combined with external beam radiotherapy.

Results

The mean HR-CTV (high risk-clinical target volume) D90 was 87 ± 5.1 Gy equivalent dose corresponding to the conventional fractionation using 2 Gy per fraction (EQD2, range 70.7–97.9 Gy). The mean doses in OAR (organs at risk), namely rectum, sigmoid and bladder were D2 cm3rectum = 62.6 ± 6.9 Gy EQD2 (range 38.2–77.2 Gy), D2 cm3sigmoid = 66.2 ± 6.8 Gy EQD2 (43.2–78.6 Gy) and D2 cm3bladder = 75.1 ± 8.3 Gy EQD2 (58.2–92.6 Gy). There were no signs of late gastrointestinal (GI) toxicity in 49 patients, grade 3 toxicity was seen in 2 patients and grade 4 toxicity in 3 patients. There were no signs of late genitourinary (GU) toxicity in 41 patients, grade 3 toxicity was seen in 4 patients and no signs of grade 4 toxicity were seen. After the treatment, 60 patients (98.4%) achieved locoregional remission. In 54 patients (88.5%) the remission was complete, whereas in 6 patients (9.8%) remission was partial.

Conclusion

The use of 3T MRI-guided BT leads to achievement of high rates of local control with limited late morbidity as demonstrated in this series of patients.

Zusammenfassung

Zweck

Wir berichten über unsere Erfahrungen mit der 3T-MRT-gesteuerten Brachytherapie (BT) bei Gebärmutterhalskrebs, wobei wir uns auf späte Nebenwirkungen konzentrieren.

Methoden

Zwischen Juni 2012 und März 2017 haben wir bei 61 konsekutiven Patientinnen mit inoperablem Zervixkarzinom insgesamt 257 uterovaginale BT-Behandlungen durchgeführt. Alle Patientinnen wurden mit BT in Kombination mit perkutaner Strahlentherapie behandelt.

Ergebnisse

Die mittlere „high-risk clinical target volume“ (HR-CTV) D90 betrug 87 + 5,1 Gy EQD2 (Spanne 70,7–97,9). Die mittleren Dosen in „organs at risk“ (OAR), nämlich im Rektum, Sigmoideum und Blase, waren D2 cm3Rektum = 62,6 + 6,9 Gy EQD2 (Spanne von 38,2–77,2), D2 cm3Sigmoideum = 66,2 + 6,8 Gy EQD2 (Spanne 43,2–78,6) und D2 cm3Blase = 75,1 + 8,3 EQD2 (Spanne 58,2–92,6). Bei 49 Patientinnen traten keine Anzeichen einer späten gastrointestinalen (GI) Toxizität auf; bei 2 Patientinnen wurden Grad-3-Toxizitäten und bei 3 Patienten Grad-4-Toxizitäten beobachtet. Bei 41 Patientinnen traten keine Anzeichen einer späten urogenitalen (GU) Toxizität auf, bei 4 Patientinnen wurde eine Toxizität vom Grad 3 beobachtet; Anzeichen für eine Toxizität vom Grad 4 ergaben sich nicht. Nach der Behandlung erreichten 60 Patientinnen (98,4 %) lokoregionale Remission. Bei 54 Patientinnen (88,5 %) handelte sich um eine vollständige Remission, bei 6 Patientinnen (9,8 %) um eine partielle lokoregionale Remission.

Schlussfolgerungen

Die Anwendung von 3T-MRT-gesteuerter BT führt zu hohen lokalen Kontrollraten mit begrenzter Spätmorbidität, wie in unserer Patientengruppe gezeigt wurde.

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Authors and Affiliations

  1. Department of Oncology and Radiotherapy, University Hospital in Pilsen, alej Svobody 80, 304 60, Pilsen, Czech Republic

    Radovan Vojtíšek MD, PhD, Emília Sukovská MD, Petra Kovářová MD &  Jindřich Fínek MD, PhD, MHA

  2. Department of Imaging Methods, University Hospital in Pilsen, alej Svobody 80, 304 60, Pilsen, Czech Republic

    Jan Baxa MD, PhD

  3. Department of Mathematics and Statistics, Faculty of Science, Masaryk University in Brno, Kotlářská 2, 611 37, Brno, Czech Republic

    Marie Budíková

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  1. Radovan Vojtíšek MD, PhD
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Correspondence to Radovan Vojtíšek MD, PhD.

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R. Vojtíšek, E. Sukovská, J. Baxa, M. Budíková, P. Kovářová and J. Fínek declare that they have no competing interests.

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Vojtíšek, R., Sukovská, E., Baxa, J. et al. Late side effects of 3T MRI-guided 3D high-dose rate brachytherapy of cervical cancer. Strahlenther Onkol 195, 972–981 (2019). https://doi.org/10.1007/s00066-019-01491-0

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  • DOI: https://doi.org/10.1007/s00066-019-01491-0

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