Change in image-guided planning strategies over time impacts oncologic and survival outcomes for intracavitary cervical cancer brachytherapy

Paul D'Cunha, Yesenia Gonzalez, Chika Nwachukwu, Brian Hrycushko, Paul Medin, Amir Owrangi, Xun Jia, Kevin Albuquerque

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

PURPOSE: Intracavitary cervical brachytherapy (BT) has transitioned from a two-dimensional nonvolumetric (NV) dosimetry system to three-dimensional computed tomography (CT) and/or magnetic resonance imaging (MRI)-based planning techniques. The purpose of this study is to retrospectively evaluate the relative improvements in image-guided planning strategies over time with regards to dosimetry, survival, and toxicity. METHODS AND MATERIALS: A single site retrospective review of 95 locally advanced cervical cancer patients treated with concurrent chemoradiation and high dose rate BT from 2009 to 2016 were divided into three BT planning groups: point-A based NV dosimetry using CT imaging (n = 37), CT-based volumetric dosimetry (n = 33), and MRI-based volumetric dosimetry (n = 25). Overall survival (OS), progression free survival (PFS), and pelvic control (PC) at 5 years were plotted using Kaplan–Meier curves. Univariate and multivariate (MVA) cox proportional-hazards models calculated hazard-ratios (HZ). Finally, acute and late grade 3–4 toxicities were compared between the cohorts. RESULTS: Both MRI and CT had significantly less D2cc to bowel (p < 0.001) and sigmoid (p < 0.001) compared to NV-based planning. On MVA, age (<60 vs. ≥60 years) was significant for worse 5-year OS (HZ: 2.48) and PC (HZ: 5.25). MRI, with NV as the reference, had significantly improved 5-year OS (HZ: 0.26), PFS (HZ: 0.34) and PC (HZ: 0.16). There was no significant difference in grade ≥3 toxicities between the cohorts. CONCLUSIONS: CT and MRI-based 3D planning had significantly less D2cc to bowel and sigmoid. MRI-based planning had significant improvement in 5-year OS, PFS, and LC compared to NV on MVA.

Original languageEnglish (US)
JournalBrachytherapy
DOIs
StateAccepted/In press - 2022

Keywords

  • Cervical cancer
  • CT intracavitary cervical brachytherapy
  • Intracavitary cervical brachytherapy
  • Intracavitary cervical brachytherapy outcomes
  • Intracavitary cervical brachytherapy toxicity
  • MRI intracavitary cervical brachytherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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