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Intensity-Modulated Arc Therapy with Simultaneous Integrated Boost in the Treatment of Primary Irresectable Cervical Cancer

Treatment Planning, Quality Control, and Clinical Implementation

Intensitätsmodulierte Radiotherapie mit simultanem integriertem Boost zur primären Behandlung des inoperablen Zervixkarzinoms. Planung, Qualitätssicherung und klinische Umsetzung

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Purpose:

To report on the planning procedure, quality control, and clinical implementation of intensity-modulated arc therapy (IMAT) delivering a simultaneous integrated boost (SIB) in patients with primary irresectable cervix carcinoma.

Patients and Methods:

Six patients underwent PET-CT (positron emission tomography-computed tomography) and MRI (magnetic resonance imaging) before treatment planning. Prescription (25 fractions) was

(1) a median dose (D50) of 62, 58 and 56 Gy to the primary tumor (GTV_cervix), primary clinical target volume (CTV_cervix) and its planning target volume (PTV_cervix), respectively;

(2) a D50 of 60 Gy to the PET-positive lymph nodes (GTV_nodes);

(3) a minimal dose (D98) of 45 Gy to the planning target volume of the elective lymph nodes (PTV_nodes).

IMAT plans were generated using an anatomy-based exclusion tool with the aid of weight and leaf position optimization. The dosimetric delivery of IMAT was validated preclinically using radiochromic film dosimetry.

Results:

Five to nine arcs were needed to create valid IMAT plans. Dose constraints on D50 were not met in two patients (both GTV_cervix: 1 Gy and 3 Gy less). D98 for PTV_nodes was not met in three patients (1 Gy each). Film dosimetry showed excellent gamma evaluation. There were no treatment interruptions.

Conclusion:

IMAT allows delivering an SIB to the macroscopic tumor without compromising the dose to the elective lymph nodes or the organs at risk. The clinical implementation is feasible.

Ziel:

Evaluation einer intensitätsmodulierten Rotationsbestrahlung (IMAT) mit Applikation eines simultanen integrierten Boosts (SIB) zur primären Behandlung des fortgeschrittenen Zervixkarzinoms.

Patienten und Methodik:

Sechs Patientinnen mit einem fortgeschrittenen Zervixkarzinom wurden einer MRT- (Magnetresonanztomographie) und PET-CT-basierten (Positronenemissionstomographie-Computertomographie) Bestrahlungsplanung für eine IMAT unterzogen und bestrahlt. Das Dosis-Zeit-Muster wurde, bezogen auf die entsprechenden Zielvolumina für 25 Fraktionen, wie folgt festgelegt:

1. Eine mediane Dosis (D50) von 62 Gy, 58 Gy und 56 Gy wurde für das makroskopische Zervixkarzinom (GTV), das klinische Zielvolumen (CTV) und das Planungszielvolumen (PTV) verschrieben.

2. Eine mediane Dosis von 60 Gy wurde für die PET-positiven regionären Lymphknoten festgelegt.

3. Elektiv zu bestrahlende regionäre Lymphknoten sollten eine minimale Dosis (D98) von 45 Gy erhalten.

Die IMAT-Pläne wurden mit Hilfe eines anatomiebasierten Ausschlussalgorithmus durch Optimierung und Wichtung von Leafpositionen erzeugt. Die präklinische Dosimetrie erfolgte mittels Filmdosimetrie.

Ergebnisse:

Insgesamt fünf bis neun Rotationsfelder waren zur Erzeugung geeigneter IMAT-Pläne erforderlich. Bei zwei Patientinnen war die angestrebte Dosis für das makroskopische Zervixkarzinom (GTV) 1 Gy und 3 Gy zu niedrig. In drei Fällen wurde die minimale Dosis (D98) an den elektiv zu behandelnden Lymphknoten um je 1 Gy unterschritten. Die Daten der Filmdosimetrie zeigten eine ausgezeichnete Gammabewertung. Die Bestrahlung konnte in allen Fällen ohne Unterbrechung appliziert werden.

Schlussfolgerung:

Die klinische Umsetzung der IMAT mit SIB des Zervixkarzinoms ist ohne Dosiskompromisse an elektiven Lymphknotenstationen und Risikoorganen möglich.

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Authors and Affiliations

  1. Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium

    Katrien Vandecasteele MD, Wilfried De Neve, Werner De Gersem, Leen Paelinck, Valérie Fonteyne, Carlos De Wagter & Gert De Meerleer

  2. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    Louke Delrue & Geert Villeirs

  3. Department of Gynecology, Ghent University Hospital, Ghent, Belgium

    Amin Makar

  4. Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Katrien Vandecasteele MD

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  1. Katrien Vandecasteele MD
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  2. Wilfried De Neve
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Correspondence to Katrien Vandecasteele MD.

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Vandecasteele, K., De Neve, W., De Gersem, W. et al. Intensity-Modulated Arc Therapy with Simultaneous Integrated Boost in the Treatment of Primary Irresectable Cervical Cancer. Strahlenther Onkol 185, 799–807 (2009). https://doi.org/10.1007/s00066-009-1986-8

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  • DOI: https://doi.org/10.1007/s00066-009-1986-8

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