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Gynecol Oncol. 2017 May;145(2):284-290. doi: 10.1016/j.ygyno.2017.03.004. Epub 2017 Mar 18.

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix.

Author information

1
Harvard Radiation Oncology Program, Boston, MA, United States. Electronic address: sophia_kamran@post.harvard.edu.
2
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Bronx-Lebanon Hospital Center, Bronx, NY, United States.
3
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
4
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
5
Department of Radiology, Brigham and Women's Hospital, Boston, Boston, MA, United States.
6
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.
7
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States. Electronic address: anv@jhu.edu.

Abstract

OBJECTIVE:

The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT).

METHODS:

56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005-2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®.

RESULTS:

Median follow-up time was 19.7months (MR group) and 18.4months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size >4cm, grade, FIGO stage or lymph node involvement between the groups. Patients in the MR group had more lymphovascular involvement compared to patients in the CT group (p<0.01). When evaluating plans generated, there were no statistically significant differences in median cumulative dose to the high-risk clinical target volume or the OAR. 2-year K-M LC rates for MR-based and CT-based treatments were 96% and 87%, respectively (log-rank p=0.65). At 2years, OS was significantly better in the MR-guided cohort (84% vs. 56%, p=0.036). On multivariate analysis, squamous histology was associated with longer OS (HR 0.23, 95% CI 0.07-0.72) in a model with MR BT (HR 0.35, 95% CI 0.08-1.18). There was no difference in toxicities between CT and MR BT.

CONCLUSION:

In this population of locally advanced cervical-cancer patients, MR-guided HDR BT resulted in estimated 96% 2-year local control and excellent survival and toxicity rates.

KEYWORDS:

Cervical carcinoma; Interstitial brachytherapy; MR-guidance; Radiation oncology

PMID:
28318644
PMCID:
PMC5422203
DOI:
10.1016/j.ygyno.2017.03.004
[Indexed for MEDLINE]
Free PMC Article

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