title: Magnetic resonance image-guided brachytherapy for cervical cancer : Prognostic factors for survival.
abstract: OBJECTIVE
  The purpose of this work was to identify prognostic factors for survival after magnetic resonance image (MRI)-guided brachytherapy combined with external beam radiotherapy for cervical cancer.
  
  
  METHODS
  External beam radiotherapy of 45-50.4 Gy was delivered by either three-dimensional conformal radiotherapy or helical tomotherapy. Patients also received high-dose-rate MRI-guided brachytherapy of 5 Gy in 6 fractions.
  
  
  RESULTS
  We analyzed 128 patients with International Federation of Gynecology and Obstetrics stage IB-IVB cervical cancer who underwent MRI-guided brachytherapy. Most patients (96 %) received concurrent chemotherapy. Pelvic lymph node metastases and para-aortic lymphadenopathies were found in 62 % and 14 % of patients, respectively. The median follow-up time was 44 months. Complete remission was achieved in 119 of 128 patients (93 %). The 5‑year local recurrence-free, cancer-specific, and overall survival rates were 94, 89, and 85 %, respectively. Negative pelvic lymphadenopathy, gross tumor volume (GTV) dose covering 90 % of the target (GTV D90) of >110 Gy, and treatment duration ≤56 days were associated with better overall survival in univariate analyses. Multivariable analysis showed that GTV D90 of >110 Gy and treatment duration ≤56 days were possibly associated with overall survival with near-significant P-values of 0.062 and 0.073, respectively.
  
  
  CONCLUSIONS
  The outcome of MRI-guided brachytherapy combined with external beam radiotherapy in patients with cervical cancer was excellent. GTV D90 of >110 Gy and treatment duration ≤56 days were potentially associated with overall survival.
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.|Center for Uterine Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Yeon-Joo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea. jooyoungcasa@ncc.re.kr.|Center for Uterine Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea. jooyoungcasa@ncc.re.kr.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Youngkyong
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Lim
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Jonghwi
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.|Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Chiyoung
authors.initials: C
authors.lastname: Jeong
authors.affiliation: Proton Therapy Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.|Research center, Dongnam Inst. of Radiology and Medical Sciences, Busan, South Korea.
authors.forename: Meyoung
authors.initials: M
authors.lastname: Kim
authors.affiliation: Center for Uterine Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Myong Cheol
authors.initials: MC
authors.lastname: Lim
authors.affiliation: Center for Uterine Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Seo
authors.affiliation: Center for Uterine Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Goyang, South Korea.
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000401:mortality* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000401:mortality; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality / Q000706:statistics & numerical data; D012002:Rectal Diseases / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*
keywords: Chemotherapy; Conformal radiotherapy; Gynecology; Helical tomotherapy; Lymph nodes