title: Magnetic resonance imaging-guided intracavitary brachytherapy for cancer of the cervix.
abstract: OBJECTIVE
  To determine the feasibility and benefits of optimized magnetic resonance imaging (MRI)-guided brachytherapy (BT) for cancer of the cervix.
  
  
  METHODS
  A total of 20 patients with International Federation of Gynecology and Obstetrics Stage IB-IV cervical cancer had an MRI-compatible intrauterine BT applicator inserted after external beam radiotherapy. MRI scans were acquired, and the gross tumor volume at diagnosis and at BT, the high-risk (HR) and intermediate-risk clinical target volume (CTV), and rectal, sigmoid, and bladder walls were delineated. Pulsed-dose-rate BT was planned and delivered in a conventional manner. Optimized MRI-based plans were developed and compared with the conventional plans.
  
  
  RESULTS
  The HR CTV and intermediate-risk CTV were adequately treated (the percentage of volume treated to >or=100% of the intended dose was >95%) in 70% and 85% of the patients with the conventional plans, respectively, and in 75% and 95% of the patients with the optimized plans, respectively. The minimal dose to the contiguous 2 cm(3) of the rectal, sigmoid, and bladder wall volume was 16 +/- 6.2, 25 +/- 8.7, and 31 +/- 9.2 Gy, respectively. With MRI-guided BT optimization, it was possible to maintain coverage of the HR-CTV and reduce the dose to the normal tissues, especially in patients with small tumors at BT. In these patients, the HR percentage of volume treated to >or=100% of the intended dose approached 100% in all cases, and the minimal dose to the contiguous 2-cm(3) of the rectum, sigmoid, and bladder was 12-32% less than with conventional BT planning.
  
  
  CONCLUSIONS
  MRI-based BT for cervical cancer has the potential to optimize primary tumor dosimetry and reduce the dose to critical normal tissues, particularly in patients with small tumors.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital/Ontario Cancer Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zwahlen
authors.forename: John
authors.initials: J
authors.lastname: Jezioranski
authors.forename: Philip
authors.initials: P
authors.lastname: Chan
authors.forename: Masoom A
authors.initials: MA
authors.lastname: Haider
authors.forename: Young-Bin
authors.initials: YB
authors.lastname: Cho
authors.forename: Ivan
authors.initials: I
authors.lastname: Yeung
authors.forename: Wilfred
authors.initials: W
authors.lastname: Levin
authors.forename: Lee
authors.initials: L
authors.lastname: Manchul
authors.forename: Anthony
authors.initials: A
authors.lastname: Fyles
authors.forename: Michael
authors.initials: M
authors.lastname: Milosevic
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D012809:Colon, Sigmoid / Q000033:anatomy & histology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D012007:Rectum / Q000033:anatomy & histology; D047368:Tumor Burden; D001743:Urinary Bladder / Q000033:anatomy & histology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*