Abstract
Introduction: tumors of the uterine cervix are among the most common carcinomas in women. Intracervical brachytherapy is an indispensable part of curative treatment. Although the tumor is significantly more recognizable in MRI than in CT, the practical application of MRI in brachytherapy planning is still difficult. The present study examines the technical possibilities of merging CT and MRI. Materials and Methods: the treatment files and imaging of all 53 patients who had been irradiated by image-guided adaptive brachytherapy (IGABT) between January 2019 and August 2021 at the Department of Radiotherapy of the Hannover Medical School were evaluated, retrospectively. Patients were treated first with an external beam radiotherapy (EBRT) combined with simultaneous chemotherapy. After an average of 4.2 weeks, the preparation for IGABT began. The clinical target volume (CTV) for brachytherapy was contoured first in an MRI acquired before starting EBRT (MRI 1) and once more in a second MRI just before starting IGABT (MRI 2). Then, after inserting the intravaginal applicator, a CT-scan was acquired, and the CTV was contoured in the CT. Finally, the recordings of MRI 1, MRI 2, and the CT were merged, and the congruence of CTVs was quantitatively evaluated. Results: the CTV delineated in MRI 2 was, on average, 28% smaller than that in MRI 1 after an average applied radiation dose of 42 Gy. The CTV delineated in the CT covered an average of no more than 80.8% of the CTV delineated in MRI 2. The congruence of CTVs was not superior in patients with a smit sleeve in the cervical channel, with a 3D-volumetric MRI or with a contrast-enhanced sequence for MRI. Conclusion: the anatomical shape and position of the uterus is significantly changed by introducing a vaginal applicator. Despite the superior delimitability of the tumor in MRI, brachytherapy cannot be reliably planned by the image fusion of an MRI without a vaginal applicator.
Highlights
Tumors of the uterine cervix are among the most common carcinomas in women and cause fatalities in many cases [1,2]
The tumor is more recognizable in an MRI than in a CT, the practical application of MRIs in planning brachytherapy is still difficult [4,5,6,7,8] for hospitals not equipped for treatment planning on MRI-only
The present study examines the technical possibilities and practical applications of merging CT and MRI in the planning of brachytherapy
Summary
Tumors of the uterine cervix are among the most common carcinomas in women and cause fatalities in many cases [1,2]. While excision is performed for tumors in early stages, intracervical brachytherapy is an indispensable part of curative treatment in locally advanced tumors [3]. The tumor is more recognizable in an MRI than in a CT, the practical application of MRIs in planning brachytherapy is still difficult [4,5,6,7,8] for hospitals not equipped for treatment planning on MRI-only. Missing the target of Brachytherapy can be disastrous for the patient. The present study examines the technical possibilities and practical applications of merging CT and MRI in the planning of brachytherapy
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