[Innovation in gynaecological brachytherapy: new technologies, pulse dose-rate brachytherapy, image, definition of new volumes of interest and their impact on dosimetry: application in a clinical research programme "STIC"].
Brachytherapy plays a fundamental role in the therapeutic approach of patients with stage I-IV cervical carcinoma. Technical modalities have evolved during the last decades: stepping source technology, imaging modalities development, specially IMN, treatment planning system integrating 3D images. Images from CT-Scan and MRI have contributed to a better knowledge of tumoral extension and critical organs. CT and/or MRI compatible applicators allow a sectional image based approach with a better definition of tumour volume compared to traditional approaches. The introduction of 3D image based approach for GTV and CTV requires new definitions and a common language. In 2000, a working group within GEC-ESTRO was created to support 3D image based 3D treatment planning approach in cervix cancer BT. The task was to determine a common terminology enabling various groups to use a common language. Recommendations were described and proposed based on clinical experience and dosimetric concepts of different institutions. Two CTVs were described en relation to the risk for recurrence: high-risk CTV and intermediate risk CTV. In order to better define the role of such definitions and their potential impact on the complication incidence in patients with cervical cancer, a special French programme was developed. The aim of this programme is to study the incidence of the severe 2-year complication rate in two comparable patient populations: one population is treated using PDR brachytherapy with CT-Scan or MRI with the applicators in place allowing a 3D dosimetry with optimization, the second population is treated using standard X-rays radiographs without any delineation of the target nor optimisation. Each population arm includes 425 patients. A medicoeconomic assessment is performed, allowing a real cost of the most sophisticated approach compared to a historical dosimetric system.
Haie-Meder
C
C
Service de Curiethérapie, Institut Gustave-Roussy, 39, Rue Camille-Desmoulins, 94805 Villejuif, France. haie@igr.fr
Peiffert
D
D
D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D005836:Genitalia, Female / Q000033:anatomy & histology; D006801:Humans; D007089:Image Enhancement; D011879:Radiotherapy Dosage