A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy

Akila Viswanathan, Jackie Szymonifka, Clare M. Tempany-Afdhal, Desmond A. O'Farrell, Robert A. Cormack

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)240-247
Number of pages8
JournalBrachytherapy
Volume12
Issue number3
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Brachytherapy
Magnetic Resonance Spectroscopy
Catheters
Needles
Survival Rate
Recurrence
Neoplasms
Kaplan-Meier Estimate
Urinary Bladder
Anesthesia
Clinical Trials
Survival

Keywords

  • Gynecologic malignancies
  • Interstitial brachytherapy
  • Toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy. / Viswanathan, Akila; Szymonifka, Jackie; Tempany-Afdhal, Clare M.; O'Farrell, Desmond A.; Cormack, Robert A.

In: Brachytherapy, Vol. 12, No. 3, 2013, p. 240-247.

Research output: Contribution to journalArticle

Viswanathan, Akila ; Szymonifka, Jackie ; Tempany-Afdhal, Clare M. ; O'Farrell, Desmond A. ; Cormack, Robert A. / A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy. In: Brachytherapy. 2013 ; Vol. 12, No. 3. pp. 240-247.
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abstract = "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.",
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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.

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