title: The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: clinical feasibility and preliminary results.
abstract: OBJECTIVE
  The aims of this study were to investigate the clinical feasibility and to report on preliminary treatment outcomes of combined intracavitary/interstitial brachytherapy, using a novel applicator and magnetic resonance imaging (MRI)-based treatment planning in patients with locally advanced cervical cancer.
  
  
  METHODS
  A total of 22 cervical cancer patients with insufficient response and/or unfavorable topography after external-beam irradiation were included in this study. Parametrial extent of the disease in these patients was judged to exceed the coverage limit of intracavitary brachytherapy alone. A modified tandem/ring (T/R) applicator for guidance of parametrial needles (N) was used to perform high-dose-rate-brachytherapy with MRI-based treatment planning. Clinical feasibility and preliminary treatment outcomes were assessed.
  
  
  RESULTS
  A total of 44 interstitial needle implants were performed. The spatial relations between the T/R + N applicator, high-risk clinical target volume, and organs at risk were visible clearly in all cases. Accurate and reproducible needle placement could be achieved in the majority of cases. No severe adverse events were caused by the intervention. The mean follow-up period was 20 months (range, 5-35 months). No G3 to G4 early or persistent late side effects were observed. Complete remission was achieved in 21 patients (95%). One local recurrence was observed within the high-risk clinical target volume area during follow-up.
  
  
  CONCLUSIONS
  Our preliminary clinical experience indicates that combined intracavitary and interstitial MRI-based brachytherapy in patients with significant residual disease after external-beam therapy extending up to the distal third of parametria is feasible and allows excellent local control and a low rate of morbidity.
authors.affiliation: Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna, Austria. johannes.dimopoulos@akhwien.at
authors.forename: Johannes C A
authors.initials: JC
authors.lastname: Dimopoulos
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
authors.forename: Primoz
authors.initials: P
authors.lastname: Petric
authors.forename: Petra
authors.initials: P
authors.lastname: Georg
authors.forename: Stefan
authors.initials: S
authors.lastname: Lang
authors.forename: Daniel
authors.initials: D
authors.lastname: Berger
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000556:secondary; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*