title: Impact of dosimetric parameters on local control for patients treated with three-dimensional pulsed dose-rate brachytherapy for cervical cancer.
abstract: OBJECTIVE
  To investigate the impact of dose-volume histograms parameters on local control of three-dimensional (3D) image-based pulsed dose-rate brachytherapy (BT).
  
  
  METHODS
  Within a French multicentric prospective study, the data of the 110 patients treated for cervical cancer with external beam radiotherapy followed by 3D image-based and optimized pulsed dose-rate BT were analyzed. Delineation procedures were performed on magnetic resonance imaging in a minority of cases and on CT for the majority of cases, adapted from the Gynaecological Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology recommendations. Optimization procedure was left to the discretion of the treating center.
  
  
  RESULTS
  At 2 years, local control rate reached 78%. Dose to Point A, total reference air kerma, and intermediate-risk clinical target volume (IR-CTV) V60 were predictive factors for local control (p = 0.001, p = 0.001, and p = 0.013, respectively). Patients with IR-CTV V60 <75% had a relative risk of local recurrence of 3.8 (95% confidence interval, 1.4-11.1). There was no correlation found between the high-risk clinical target volume dosimetric parameters and local control.
  
  
  CONCLUSIONS
  This multicentric study has shown that 3D image-based BT provides a high local control rate for cervical cancer patients. The V60 for IR-CTV was identified as an important predictive factor for local control.
authors.affiliation: Department of Radiotherapy, Institut Claudius Regaud, Toulouse, France. Electronic address: boyrie.sabrina@claudiusregaud.fr.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Boyrie
authors.affiliation: Department of Radiotherapy, Centre Alexis-Vautrin, Vandoeuvre-les-Nancy, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Charra-Brunaud
authors.affiliation: Department of Biostatistics, Centre Alexis-Vautrin, Vandoeuvre-les-Nancy, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Harter
authors.affiliation: Department of Radiotherapy, Institut Claudius Regaud, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ducassou
authors.affiliation: Department of Radiotherapy, Institut Curie, Paris, France.
authors.forename: Youlia
authors.initials: Y
authors.lastname: Kirova
authors.affiliation: Department of Radiotherapy, Centre GF Leclerc, Dijon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Barillot
authors.affiliation: Department of Radiotherapy, Hopital Sud, Amiens, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Krzisch
authors.affiliation: Department of Radiotherapy, Hopital de la Pitié Salpétrière, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lang
authors.affiliation: Department of Radiotherapy, Hopital J Minjoz, Besançon, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Baron
authors.affiliation: Department of Radiotherapy, Centre Léon Bérard, Lyon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Montbarbon
authors.affiliation: Department of Radiotherapy, Institut Claudius Regaud, Toulouse, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
authors.affiliation: Department of Radiotherapy, Centre Alexis-Vautrin, Vandoeuvre-les-Nancy, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Peiffert
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*
keywords: Cervical cancer; Local control; Pulsed dose-rate brachytherapy; Three-dimensional brachytherapy