Abstract
Objective:To assess the feasibility of targeting recurrent gynaecological tumours with MR guided high intensity focused ultrasound (MRgHIFU).Methods:20 patients with recurrent gynaecological tumours were prospectively scanned on a Philips/Profound 3 T Achieva MR/ Sonalleve HIFU system. Gross tumour volume (GTV) and planning target volume (PTV) were delineated on T 2W and diffusion-weighted imaging (DWI). Achievable treatment volumes that (i) assumed bowel and/or urogenital tract preparation could be used to reduce risk of damage to organs-at-risk (TVoptimal), or (ii) assumed no preparations were possible (TVno-prep) were compared with PTV on virtual treatment plans. Patients were considered treatable if TVoptimal ≥ 50 % PTV.Results:11/20 patients (55%) were treatable if preparation strategies were used: nine had central pelvic recurrences, two had tumours in metastatic locations. Treatable volume ranged from 3.4 to 90.3 ml, representing 70 ± 17 % of PTVs. Without preparation, 6/20 (30%) patients were treatable (four central recurrences, two metastatic lesions). Limiting factors were disease beyond reach of the HIFU transducer, and bone obstructing tumour access. DWI assisted tumour outlining, but differences from T 2W imaging in GTV size (16.9 ± 23.0%) and PTV location (3.8 ± 2.8 mm in phase-encode direction) limited its use for treatment planning.Conclusions:Despite variation in size and location within the pelvis, ≥ 50 % of tumour volumes were considered targetable in 55 % patients while avoiding adjacent critical structures. A prospective treatment study will assess safety and symptom relief in a second patient cohort.Advances in knowledge:Target size, location and access make MRgHIFU a viable treatment modality for treating symptomatic recurrent gynaecological tumours within the pelvis.
Highlights
IntroductionPatients with recurrent gynaecological malignancies frequently have symptomatic localised pelvic disease and high morbidity and mortality.[1,2,3] If uncontrolled, symptoms (e.g. pain, vaginal bleeding and/or discharge, bladder and/or bowel symptoms, fistulae, lymphoedema4) are progressive, and adversely impact quality of life, in those previously treated with external beam radiotherapy (EBRT) or brachytherapy.[5]
Symptoms are progressive, and adversely impact quality of life, in those previously treated with external beam radiotherapy (EBRT) or brachytherapy.[5]
One patient with disease in an inguinal node who had undergone a prior wide local excision had scar tissue in the High intensity focused ultrasound (HIFU) beam path, which would have increased the risk of skin burn if she had gone on to have treatment
Summary
Patients with recurrent gynaecological malignancies frequently have symptomatic localised pelvic disease and high morbidity and mortality.[1,2,3] If uncontrolled, symptoms (e.g. pain, vaginal bleeding and/or discharge, bladder and/or bowel symptoms, fistulae, lymphoedema4) are progressive, and adversely impact quality of life, in those previously treated with external beam radiotherapy (EBRT) or brachytherapy.[5]. Pelvic exenteration may potentially be curative, but carries high (40–80%) morbidity, with a 20–40% 5-year survival.[7,8] Used palliatively, radiotherapy and surgery may achieve symptomatic control, but induce acute bowel and bladder problems, while palliative chemotherapy is
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