Assessing changes to the brachytherapy target for cervical cancer using a single MRI and serial ultrasound

van Dyk, Sylvia, Kondalsamy-Chennakesavan, Srinivas, Schneider, Michal, Bernshaw, David and Narayan, Kailash (2015) Assessing changes to the brachytherapy target for cervical cancer using a single MRI and serial ultrasound. Brachytherapy, 1-9. doi:10.1016/j.brachy.2015.04.011

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Author van Dyk, Sylvia
Kondalsamy-Chennakesavan, Srinivas
Schneider, Michal
Bernshaw, David
Narayan, Kailash
Title Assessing changes to the brachytherapy target for cervical cancer using a single MRI and serial ultrasound
Journal name Brachytherapy   Check publisher's open access policy
ISSN 1873-1449
Publication date 2015-02-04
Sub-type Article (original research)
DOI 10.1016/j.brachy.2015.04.011
Open Access Status Not yet assessed
Start page 1
End page 9
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Purpose: To assess changes to the brachytherapy target over the course of treatment and the impact of these changes on planning and resources.

Methods and Materials: Patients undergoing curative treatment with radiotherapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were positioned in the uterine canal while patients were under anesthesia. Images were obtained by MRI and ultrasound at Fraction 1 and ultrasound alone at Fractions 2, 3, and 4. Cervix and uterine dimensions were measured on MRI and ultrasound and compared using Bland–Altman plots and repeated measures one-way analysis of variance.

Results: Of 192 patients who underwent three fractions of brachytherapy, 141 of them received four fractions. Mean differences and standard error of differences between MRI at Fraction 1 and ultrasound at Fraction 4 for anterior cervix measurements were 2.9 (0.31), 3.5 (0.25), and 4.2 (0.27) mm and for posterior cervix 0.8 (0.3), 0.3 (0.3), and 0.9 (0.3) mm. All differences were within clinically acceptable limits. The mean differences in the cervix over the course of brachytherapy were less than 1 mm at all measurement points on the posterior surface. Replanning occurred in 11 of 192 (5.7%) patients, although changes to the cervix dimensions were not outside clinical limits.

Conclusions: There were small changes to the cervix and uterus over the course of brachytherapy that were not clinically significant. Use of intraoperative ultrasound as a verification aid accurately assesses the target at each insertion, reduces uncertainties in treatment delivery, and improves efficiency of the procedure benefiting both the patient and staff.
Keyword Brachytherapy
Cervical cancer
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes In press, corrected proof

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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