TY - JOUR
T1 - A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy
AU - Viswanathan, Akila N.
AU - Szymonifka, Jackie
AU - Tempany-Afdhal, Clare M.
AU - O'Farrell, Desmond A.
AU - Cormack, Robert A.
N1 - Funding Information:
Dr. Viswanathan received support from a Friends of Dana-Farber Cancer Institute Award for this protocol. There are no current external funding sources for this study.
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013
Y1 - 2013
N2 - Purpose: To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer. Methods and Materials: 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.
AB - Purpose: To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer. Methods and Materials: 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.
KW - Gynecologic malignancies
KW - Interstitial brachytherapy
KW - Toxicity
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U2 - 10.1016/j.brachy.2012.08.006
DO - 10.1016/j.brachy.2012.08.006
M3 - Article
C2 - 23415048
AN - SCOPUS:84876710882
SN - 1538-4721
VL - 12
SP - 240
EP - 247
JO - Brachytherapy
JF - Brachytherapy
IS - 3
ER -