title: A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy.
abstract: OBJECTIVE
  To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer.
  
  
  METHODS
  From February 2004 to December 2006, 25 patients with gynecologic malignancies were enrolled and treated in a prospective clinical trial of real-time MRI-guided interstitial brachytherapy. This was followed by a confirmatory CT imaging scan. Statistical analyses included Kaplan-Meier estimates for overall and relapse-free survival.
  
  
  RESULTS
  MRI visualization of needles during placement permitted accurate placement with no inadvertent insertions. This prevented unnecessary normal-tissue perforation as confirmed by CT simulation. With a mean followup of 3.8 years (range, 2-6.8), 1-, 2-, and 3-year overall survival rates were 80%, 60% and 43%, respectively; corresponding relapse-free survival rates were 79%, 65%, and 59%, respectively. Actuarial acute toxicity rates for any grade were 0% at 0-14 days and 80% (all grade 1) at 14-90 days. Long-term (>180 days) actuarial toxicity rates were 8% gastrointestinal, 4% bladder and 4% vaginal.
  
  
  CONCLUSIONS
  Real-time MRI guidance during insertion of interstitial needles followed by 3D-planning maximized opportunities for tumor targeting and sparing of normal tissues. Although image guidance requires additional anesthesia time, clinical outcomes indicate potential for a successful reduction in toxicity using 3D image-guided in addition to 3D image-planned brachytherapy.
authors: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA 02115, USA. aviswanathan@lroc.harvard.edu
authors: Akila N
authors: AN
authors: Viswanathan
authors: Jackie
authors: J
authors: Szymonifka
authors: Clare M
authors: CM
authors: Tempany-Afdhal
authors: Desmond A
authors: DA
authors: O'Farrell
authors: Robert A
authors: RA
authors: Cormack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000453:epidemiology / Q000532:radiotherapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015995:Prevalence; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome