3T multiparametric MRI–guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator

Elisha Fredman, Bryan Traughber, Tarun Podder, Valdir Colussi, Yiran Zheng, Suzanne Russo, Karin Herrmann, Raj Paspulati, Steven Waggoner, Kristin Zanotti, Christa Nagel, John Nakayama, Mitchell Machtay, Rodney J. Ellis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To evaluate the role of 3T-MRI–guided adaptive high-dose-rate (HDR) combined intracavitary and interstitial brachytherapy for cervical cancer using a novel intracavitary split-ring (ICSR) applicator adapter. Methods and Materials: We retrospectively reviewed all HDR brachytherapy cases from 2013 to 2015 using an ICSR applicator. Initial optimization was performed using 3T multiparametric MRI (mpMRI) series with an applicator in place. The mpMRI series were discretionarily acquired before subsequent fractions for possible target adaptation. When necessary, interstitial needles (ISNs) were inserted through a novel ICSR adapter or freehand. Dosimetric parameters, clinical outcomes, and toxicities were compared between groups. Results: Seventeen patients were included, with a mean followup of 32 months. An mpMRI series preceded each initial fraction and 52.9% of patients underwent ≥1 additional pretreatment mpMRI. Among these subsequent fractions, the high-risk clinical target volume was reduced in 80% vs. 41% without pretreatment mpMRI. Five patients had ISN placement (seven insertions) to improve extracervical target coverage. Mean D90 (Gy) per fraction to the high-risk clinical target volume and intermediate-risk clinical target volume with and without an ISN were 7.51 ± 1.07 vs. 6.14 ± 0.52 (p = 0.028) and 6.35 ± 0.75 vs. 5.21 ± 0.49 (p = 0.007), respectively. Mean fractional D2cc (Gy) for organs at risk was comparable. No Grades 3–4 toxicity was reported. Disease-free survival and local control for the ICSR-ISN and ICSR-alone groups were 29.8 months/80.0% and 31.2 months/83.3%, respectively. Conclusions: The mpMRI acquisition with ICSR applicator in place immediately before HDR brachytherapy for cervical cancer guided successful adaptive treatment optimization and delivery. Our initial experience with a novel interstitial adapter for the split-ring applicator demonstrated excellent target coverage without compromising organs at risk, resulting in good local control and disease-free survival.

Original languageEnglish (US)
Pages (from-to)334-344
Number of pages11
JournalBrachytherapy
Volume17
Issue number2
DOIs
StatePublished - Mar 1 2018

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Brachytherapy
Uterine Cervical Neoplasms
Needles
Organs at Risk
Disease-Free Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Fredman, Elisha ; Traughber, Bryan ; Podder, Tarun ; Colussi, Valdir ; Zheng, Yiran ; Russo, Suzanne ; Herrmann, Karin ; Paspulati, Raj ; Waggoner, Steven ; Zanotti, Kristin ; Nagel, Christa ; Nakayama, John ; Machtay, Mitchell ; Ellis, Rodney J. / 3T multiparametric MRI–guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator. In: Brachytherapy. 2018 ; Vol. 17, No. 2. pp. 334-344.
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abstract = "Purpose: To evaluate the role of 3T-MRI–guided adaptive high-dose-rate (HDR) combined intracavitary and interstitial brachytherapy for cervical cancer using a novel intracavitary split-ring (ICSR) applicator adapter. Methods and Materials: We retrospectively reviewed all HDR brachytherapy cases from 2013 to 2015 using an ICSR applicator. Initial optimization was performed using 3T multiparametric MRI (mpMRI) series with an applicator in place. The mpMRI series were discretionarily acquired before subsequent fractions for possible target adaptation. When necessary, interstitial needles (ISNs) were inserted through a novel ICSR adapter or freehand. Dosimetric parameters, clinical outcomes, and toxicities were compared between groups. Results: Seventeen patients were included, with a mean followup of 32 months. An mpMRI series preceded each initial fraction and 52.9{\%} of patients underwent ≥1 additional pretreatment mpMRI. Among these subsequent fractions, the high-risk clinical target volume was reduced in 80{\%} vs. 41{\%} without pretreatment mpMRI. Five patients had ISN placement (seven insertions) to improve extracervical target coverage. Mean D90 (Gy) per fraction to the high-risk clinical target volume and intermediate-risk clinical target volume with and without an ISN were 7.51 ± 1.07 vs. 6.14 ± 0.52 (p = 0.028) and 6.35 ± 0.75 vs. 5.21 ± 0.49 (p = 0.007), respectively. Mean fractional D2cc (Gy) for organs at risk was comparable. No Grades 3–4 toxicity was reported. Disease-free survival and local control for the ICSR-ISN and ICSR-alone groups were 29.8 months/80.0{\%} and 31.2 months/83.3{\%}, respectively. Conclusions: The mpMRI acquisition with ICSR applicator in place immediately before HDR brachytherapy for cervical cancer guided successful adaptive treatment optimization and delivery. Our initial experience with a novel interstitial adapter for the split-ring applicator demonstrated excellent target coverage without compromising organs at risk, resulting in good local control and disease-free survival.",
author = "Elisha Fredman and Bryan Traughber and Tarun Podder and Valdir Colussi and Yiran Zheng and Suzanne Russo and Karin Herrmann and Raj Paspulati and Steven Waggoner and Kristin Zanotti and Christa Nagel and John Nakayama and Mitchell Machtay and Ellis, {Rodney J.}",
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Fredman, E, Traughber, B, Podder, T, Colussi, V, Zheng, Y, Russo, S, Herrmann, K, Paspulati, R, Waggoner, S, Zanotti, K, Nagel, C, Nakayama, J, Machtay, M & Ellis, RJ 2018, '3T multiparametric MRI–guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator', Brachytherapy, vol. 17, no. 2, pp. 334-344. https://doi.org/10.1016/j.brachy.2017.09.007

3T multiparametric MRI–guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator. / Fredman, Elisha; Traughber, Bryan; Podder, Tarun; Colussi, Valdir; Zheng, Yiran; Russo, Suzanne; Herrmann, Karin; Paspulati, Raj; Waggoner, Steven; Zanotti, Kristin; Nagel, Christa; Nakayama, John; Machtay, Mitchell; Ellis, Rodney J.

In: Brachytherapy, Vol. 17, No. 2, 01.03.2018, p. 334-344.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 3T multiparametric MRI–guided high-dose-rate combined intracavitary and interstitial adaptive brachytherapy for the treatment of cervical cancer with a novel split-ring applicator

AU - Fredman, Elisha

AU - Traughber, Bryan

AU - Podder, Tarun

AU - Colussi, Valdir

AU - Zheng, Yiran

AU - Russo, Suzanne

AU - Herrmann, Karin

AU - Paspulati, Raj

AU - Waggoner, Steven

AU - Zanotti, Kristin

AU - Nagel, Christa

AU - Nakayama, John

AU - Machtay, Mitchell

AU - Ellis, Rodney J.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Purpose: To evaluate the role of 3T-MRI–guided adaptive high-dose-rate (HDR) combined intracavitary and interstitial brachytherapy for cervical cancer using a novel intracavitary split-ring (ICSR) applicator adapter. Methods and Materials: We retrospectively reviewed all HDR brachytherapy cases from 2013 to 2015 using an ICSR applicator. Initial optimization was performed using 3T multiparametric MRI (mpMRI) series with an applicator in place. The mpMRI series were discretionarily acquired before subsequent fractions for possible target adaptation. When necessary, interstitial needles (ISNs) were inserted through a novel ICSR adapter or freehand. Dosimetric parameters, clinical outcomes, and toxicities were compared between groups. Results: Seventeen patients were included, with a mean followup of 32 months. An mpMRI series preceded each initial fraction and 52.9% of patients underwent ≥1 additional pretreatment mpMRI. Among these subsequent fractions, the high-risk clinical target volume was reduced in 80% vs. 41% without pretreatment mpMRI. Five patients had ISN placement (seven insertions) to improve extracervical target coverage. Mean D90 (Gy) per fraction to the high-risk clinical target volume and intermediate-risk clinical target volume with and without an ISN were 7.51 ± 1.07 vs. 6.14 ± 0.52 (p = 0.028) and 6.35 ± 0.75 vs. 5.21 ± 0.49 (p = 0.007), respectively. Mean fractional D2cc (Gy) for organs at risk was comparable. No Grades 3–4 toxicity was reported. Disease-free survival and local control for the ICSR-ISN and ICSR-alone groups were 29.8 months/80.0% and 31.2 months/83.3%, respectively. Conclusions: The mpMRI acquisition with ICSR applicator in place immediately before HDR brachytherapy for cervical cancer guided successful adaptive treatment optimization and delivery. Our initial experience with a novel interstitial adapter for the split-ring applicator demonstrated excellent target coverage without compromising organs at risk, resulting in good local control and disease-free survival.

AB - Purpose: To evaluate the role of 3T-MRI–guided adaptive high-dose-rate (HDR) combined intracavitary and interstitial brachytherapy for cervical cancer using a novel intracavitary split-ring (ICSR) applicator adapter. Methods and Materials: We retrospectively reviewed all HDR brachytherapy cases from 2013 to 2015 using an ICSR applicator. Initial optimization was performed using 3T multiparametric MRI (mpMRI) series with an applicator in place. The mpMRI series were discretionarily acquired before subsequent fractions for possible target adaptation. When necessary, interstitial needles (ISNs) were inserted through a novel ICSR adapter or freehand. Dosimetric parameters, clinical outcomes, and toxicities were compared between groups. Results: Seventeen patients were included, with a mean followup of 32 months. An mpMRI series preceded each initial fraction and 52.9% of patients underwent ≥1 additional pretreatment mpMRI. Among these subsequent fractions, the high-risk clinical target volume was reduced in 80% vs. 41% without pretreatment mpMRI. Five patients had ISN placement (seven insertions) to improve extracervical target coverage. Mean D90 (Gy) per fraction to the high-risk clinical target volume and intermediate-risk clinical target volume with and without an ISN were 7.51 ± 1.07 vs. 6.14 ± 0.52 (p = 0.028) and 6.35 ± 0.75 vs. 5.21 ± 0.49 (p = 0.007), respectively. Mean fractional D2cc (Gy) for organs at risk was comparable. No Grades 3–4 toxicity was reported. Disease-free survival and local control for the ICSR-ISN and ICSR-alone groups were 29.8 months/80.0% and 31.2 months/83.3%, respectively. Conclusions: The mpMRI acquisition with ICSR applicator in place immediately before HDR brachytherapy for cervical cancer guided successful adaptive treatment optimization and delivery. Our initial experience with a novel interstitial adapter for the split-ring applicator demonstrated excellent target coverage without compromising organs at risk, resulting in good local control and disease-free survival.

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