title: MRI-based low dose-rate brachytherapy experience in locally advanced cervical cancer patients initially treated by concomitant chemoradiotherapy.
abstract: OBJECTIVE
  To retrospectively assess the physics contributions and the clinical outcome with preliminary 3D MRI-guided low dose-rate (LDR) intracavitary brachytherapy (BT) experience in locally advanced cervical cancer patients.
  
  
  METHODS
  Eighty-four patients with primary locally advanced cervical carcinoma were analyzed. The median tumoral cervical volume was 48.0 cc (range 1-468 cc). Twenty-four patients (53%) had histological and/or radiological pelvic involvement. After pelvic+/-paraaortic concomitant chemoradiation, a LDR BT boost was delivered to a 3D MRI-based clinical target volume taking into account dose volume constraints for critical organs and optimization of target volume coverage.
  
  
  RESULTS
  With a median follow-up of 53 months (range 31-79 months), the 4-year overall survival and disease-free survival rates were 57 (95%CI, 43-69) and 52% (95%CI, 40-64), respectively. Adding EBRT and LDR using EQD2 model, the median D(100) and D(90) for the IR-CTV were 56.5 Gy(alpha/beta10) (range 37-83 Gy(alpha/beta10)) and 69 Gy(alpha/beta10) (range 52-113 Gy(alpha/beta10)), respectively. For HR-CTV, the median D(100) and D(90) were 67 Gy(alpha/beta10) (range 47-119 Gy(alpha/beta10)) and 79 Gy(alpha/beta10) (range 53-122 Gy(alpha/beta10)), respectively. Thirty-nine late complications were observed in 28 patients (33.3%): 13 bladder, 7 rectal, 5 small bowel, 4 urethral, 3 colic, 2 vaginal, 1 pelvic fibrosis, and 4 others. Four grade 3 delayed complications were observed and no grade 4 complication occurred.
  
  
  CONCLUSIONS
  Applying an individual treatment planning with 3D MRI-guided LDR brachytherapy appears to be feasible and efficient for patients with locally advanced cervical cancer in routine clinical practice.
authors.affiliation: Department of Radiotherapy - Brachytherapy Service, Institut Gustave Roussy, Villejuif, France. christine.haie@igr.fr
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Annie
authors.initials: A
authors.lastname: Rey
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*