A novel minimally invasive technique of high-dose rate image-based intracavitary brachytherapy for endometrial cancer using a single fine and soft, flexible applicator.
OBJECTIVE
We report on a minimally invasive computed tomography (CT)/magnetic resonance imaging (MRI)-based image-guided intracavitary brachytherapy (ICBT) for an elder patient with endometrial cancer, who was unfit for anesthesia, using a fine and soft flexible applicator.


METHODS
The patient was an 82-year-old female. She was identified as having T1bN0M0 (stage IB) tumor, and histological findings revealed grade 2 adenocarcinoma. She was contraindicated for surgery because of advanced age and severe pulmonary emphysema; therefore, she was managed with CT/MRI-based ICBT alone. The total treatment dose was 26 Gy (6.5 Gy per fraction). The dose-volume histogram of the gross tumor volume, the clinical target volume, and organs at risk were calculated.


RESULTS
The patient safely completed the ICBT course without pre-medication. Tumor growth was controlled, with complete disappearance after 32 months. No acute or late adverse effects were observed. MRI-guided ICBT can visualize the gross tumor volume in the uterine body, which cannot be detected by CT.


CONCLUSIONS
We successfully and safely performed minimally invasive CT/MRI-based ICBT without pre-medication in a patient with endometrial cancer with high surgical risks, using a fine and soft, flexible applicator.
Department of Radiology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kamigyou-ku, Kyoto-city, Kyoto-prefecture, 602-8566 Japan. mc0515kj@koto.kpu-m.ac.jp.
Koji
K
Masui
Ken
K
Yoshida
Tadashi
T
Takenaka
Tadayuki
T
Kotsuma
Eiichi
E
Tanaka
Keiji
K
Tatsumi
Hideya
H
Yamazaki
Kei
K
Yamada
D000230:Adenocarcinoma / Q000532:radiotherapy*; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation* / Q000379:methods
Intracavitary brachytherapy; endometrial cancer; fine and soft applicator; image-based brachytherapy