Abstract
High-dose-rate brachytherapy by remote afterloading is now performed under three-dimensional image guidance by CT or MRI. Three-dimensional image-guided brachytherapy in cervical cancer disclosed that the traditional intracavitary brachytherapy by Manchester method cannot deliver an adequate dose to the large tumor with resulting local recurrence. To improve the local control rate, combined interstitial and intracavitary (hybrid) brachytherapy can increase the dose to the large parametrial involvement without increasing the dose to the rectum and bladder. Whether hybrid brachytherapy can be performed safely on a multi-institutional basis remains to be studied. From 2015, phase I/II study of hybrid brachytherapy was launched in Japan, and it was revealed that hybrid brachytherapy can be performed safely and with a high quality of radiation dose distribution in a multi-institutional study. In Japan, the number of patients undergoing hybrid brachytherapy in cervical cancer is rapidly rising. Education and clinical trial are very important to establish hybrid brachytherapy in the management of cervical cancer.
Highlights
Jun Itami 1,2*, Naoya Murakami 2, Miho Watanabe 3, Shuhei Sekii 4, Takahiro Kasamatsu 5, Shingo Kato 6, Hisako Hirowatari 7, Hitoshi Ikushima 8, Ken Ando 9, Tatsuya Ohno 10, Hiroyuki Okamoto 11, Kae Okuma 2 and Hiroshi Igaki 2
Three-dimensional image-guided brachytherapy (3D-IGBT) has been applied in clinical practice since around 2000, where CT or MRI of the treated regions is performed to clarify the 3D anatomy of the gross tumor volume (GTV) and the organs at risk (OARs) using CT/MRI compatible applicators in the treatment position [4]
According to the EMBRACE studies, high-risk clinical target volume (HR-CTV) of brachytherapy is defined as the residual tumor just before intracavitary brachytherapy (ICBT) plus the cervix that are revealed by T2 weighted images (T2WI) of MRI, and ICBT should deliver boost dose to this HR-CTV up to more than 85 Gy in equivalent dose assumed to be delivered by 2 Gy fractions (EQD2) including the dose from external beam radiation therapy (EBRT) [4, 5, 8]
Summary
Three-dimensional image-guided brachytherapy (3D-IGBT) has been applied in clinical practice since around 2000, where CT or MRI of the treated regions is performed to clarify the 3D anatomy of the gross tumor volume (GTV) and the OARs using CT/MRI compatible applicators in the treatment position [4]. According to the EMBRACE studies, high-risk clinical target volume (HR-CTV) of brachytherapy is defined as the residual tumor just before ICBT plus the cervix that are revealed by T2 weighted images (T2WI) of MRI, and ICBT should deliver boost dose to this HR-CTV up to more than 85 Gy in equivalent dose assumed to be delivered by 2 Gy fractions (EQD2) including the dose from EBRT [4, 5, 8].
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