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

Sophia C. Kamran, Matthias M. Manuel, Linda P. Cho, Antonio L. Damato, Ehud Schmidt, Clare Tempany, Robert A. Cormack, Akila Viswanathan

Research output: Contribution to journalArticle

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 19.7 months (MR group) and 18.4 months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size > 4 cm, 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 2 years, 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.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalGynecologic Oncology
Volume145
Issue number2
DOIs
StatePublished - May 1 2017

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Brachytherapy
Cervix Uteri
Carcinoma
Organs at Risk
Uterine Cervical Neoplasms
Survival
Histology
Phase II Clinical Trials
Multivariate Analysis
Survival Rate
Lymph Nodes
Population
Neoplasms

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix. / Kamran, Sophia C.; Manuel, Matthias M.; Cho, Linda P.; Damato, Antonio L.; Schmidt, Ehud; Tempany, Clare; Cormack, Robert A.; Viswanathan, Akila.

In: Gynecologic Oncology, Vol. 145, No. 2, 01.05.2017, p. 284-290.

Research output: Contribution to journalArticle

Kamran, Sophia C. ; Manuel, Matthias M. ; Cho, Linda P. ; Damato, Antonio L. ; Schmidt, Ehud ; Tempany, Clare ; Cormack, Robert A. ; Viswanathan, Akila. / Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix. In: Gynecologic Oncology. 2017 ; Vol. 145, No. 2. pp. 284-290.
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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{\circledR} & R{\circledR}. Results Median follow-up time was 19.7 months (MR group) and 18.4 months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size > 4 cm, 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 2 years, 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.",
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T1 - Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix

AU - Kamran, Sophia C.

AU - Manuel, Matthias M.

AU - Cho, Linda P.

AU - Damato, Antonio L.

AU - Schmidt, Ehud

AU - Tempany, Clare

AU - Cormack, Robert A.

AU - Viswanathan, Akila

PY - 2017/5/1

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N2 - 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 19.7 months (MR group) and 18.4 months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size > 4 cm, 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 2 years, 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.

AB - 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 19.7 months (MR group) and 18.4 months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size > 4 cm, 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 2 years, 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.

KW - Cervical carcinoma

KW - Interstitial brachytherapy

KW - MR-guidance

KW - Radiation oncology

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