Dose–Volume Histogram Parameters and Local Tumor Control in Magnetic Resonance Image–Guided Cervical Cancer Brachytherapy


      To investigate the value of dose–volume histogram (DVH) parameters for predicting local control in magnetic resonance (MR) image-guided brachytherapy (IGBT) for patients with cervical cancer.

      Methods and Materials

      Our study population consists of 141 patients with cervical cancer (Stages IB–IVA) treated with 45–50 Gy external beam radiotherapy plus four times 7 Gy IGBT with or without cisplatin. Gross tumor volume (GTV), high-risk clinical target volume (HRCTV), and intermediate-risk clinical target volume (IRCTV) were contoured, and DVH parameters (minimum dose delivered to 90% of the volume of interest [D90] and D100) were assessed. Doses were converted to the equivalent dose in 2 Gy (EQD2) by applying the linear quadratic model (α/β = 10 Gy). Groups were defined for patients with or without local recurrence (LR) in the true pelvis for tumor size at diagnosis (GTV at diagnosis [GTVD] of 2–5 cm (Group 1) or greater than 5 cm (Group 2) and for tumor size response at IGBT (HRCTV) of 2–5 cm (Group 2a) or greater than 5 cm (Group 2b).


      Eighteen LRs were observed. The most important DVH parameters correlated with LR were the D90 and D100 for HRCTV. Mean D90 and D100 values for HRCTV were 86 ± 16 and 65 ± 10 Gy, respectively. The D90 for HRCTV greater than 87 Gy resulted in an LR incidence of 4% (3 of 68) compared with 20% (15 of 73) for D90 less than 87 Gy. The effect was most pronounced in the tumor group (Group 2b).


      We showed an increase in local control in IGBT in patients with cervical cancer with the dose delivered, which can be expressed by the D90 and D100 for HRCTV. Local control rates greater than 95% can be achieved if the D90 (EQD2) for HRCTV is 87 Gy or greater.
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        • Lindegaard J.C.
        • Tanderup K.
        • Nielsen S.K.
        • et al.
        MRI-guided 3D-optimization significantly improves DVH-parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer.
        Int J Radiat Oncol Biol Phys. 2008; 7: 756-764
        • De Brabandere M.
        • Mousa A.G.
        • Nulens A.
        • et al.
        Potential of dose optimisation in MRI-based PDR brachytherapy of cervix carcinoma.
        Radiother Oncol. 2007; 88: 217-226
        • Kirisits C.
        • Pötter R.
        • Lang S.
        • et al.
        Dose and volume parameters for MRI based treatment planning in intracavitary brachytherapy of cervix cancer.
        Int J Radiat Oncol Biol Phys. 2005; 62: 901-911
        • Pötter R.
        • Dimopoulos J.
        • Georg P.
        • et al.
        Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer.
        Radiother Oncol. 2007; 83: 148-155
        • Weitmann H.D.
        • Pötter R.
        • Waldhäusl C.
        • et al.
        Pilot study in the treatment of endometrial carcinoma with 3D image-based high-dose-rate brachytherapy using modified Heyman packing: Clinical experience and dose-volume histogram analysis.
        Int J Radiat Oncol Biol Phys. 2005; 62: 468-478
        • Gerbaulet A.
        • Pötter R.
        • Haie-Meder C.
        Cervix cancer.
        in: Gerbaulet A. Pötter R. Mazeron J.J. The GEC ESTRO handbook of brachytherapy. ESTRO, Brussels2002: 301-363
        • Shin K.
        • Kim T.
        • Cho J.
        • et al.
        CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose–volume parameters.
        Int J Radiat Oncol Biol Phys. 2006; 64: 197-204
        • Brooks S.
        • Bownes P.
        • Lowe G.
        • et al.
        Cervical brachytherapy utilizing ring applicator: Comparison of standard and conformal loading.
        Int J Radiat Oncol Biol Phys. 2005; 63: 934-939
        • Chajon E.
        • Dumas I.
        • Touleimat M.
        • et al.
        Inverse planning approach for 3-D MRI-based pulse-dose rate intracavitary brachytherapy in cervix cancer.
        Int J Radiat Oncol Biol Phys. 2007; 69: 955-961
        • Kim R.Y.
        • Pareek P.
        Radiography-based treatment planning compared with computed tomography (CT)-based treatment planning for intracavitary brachytherapy in cancer of the cervix: Analysis of dose-volume histograms.
        Brachytherapy. 2003; 2: 200-206
        • Pelloski C.E.
        • Palmer M.
        • Chronowski G.M.
        • et al.
        Comparison between CT-based volumetric calculations and ICRU reference-point estimates of radiation doses delivered to bladder and rectum during intracavitary brachytherapy for cervical cancer.
        Int J Radiat Oncol Biol Phys. 2005; 62: 131-137
        • Pötter R.
        • Fidarova E.
        • Kirisits C.
        • et al.
        Image-guided adaptive brachytherapy for cervix carcinoma.
        Clin Oncol. 2008; 20: 426-432
        • ICRU
        Report 38. Dose and volume specification for reporting intracavitary therapy in gynaecology.
        International Commission on Radiation Units and Measurements, Bethesda, MD1985
        • Haie-Meder C.
        • Pötter R.
        • van Limbergen E.
        • et al.
        Recommendations from the Gynaecological (GYN) GEC ESTRO Working Group: Concepts and terms in 3D-image based 3D-treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV.
        Radiother Oncol. 2004; 74: 235-245
        • Pötter R.
        • Haie-Meder C.
        • vanLimbergen E.
        • et al.
        Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose-volume parameters and aspects of 3D-image-based anatomy, radiation physics, radiobiology.
        Radiother Oncol. 2006; 78: 67-77
        • Lang S.
        • Nulens A.
        • Briot E.
        • et al.
        Comparison of treatment concepts for MR image assisted brachytherapy of cervical carcinoma based on GYN GEC-ESTRO recommendations.
        Radiother Oncol. 2006; 78: 185-193
        • Pötter R.
        • Dimopoulos J.
        • Bachtiary B.
        • et al.
        3D-conformal HDR brachytherapy and external beam therapy plus simultaneous cisplatin for high-risk cervical cancer: Clinical experience with 3 year follow up.
        Radiother Oncol. 2006; 79: 80-86
        • Dimopoulos J.C.A.
        • Kirisits C.
        • Petric P.
        • et al.
        The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Aspects of clinical feasibility and preliminary results.
        Int J Radiat Oncol Biol Phys. 2006; 66: 83-90
        • Eifel P.J.
        • Thoms Jr., W.W.
        • Smith T.L.
        • et al.
        The relationship between brachytherapy dose and outcome in patients with bulky endocervical tumors treated with radiation alone.
        Int J Radiat Oncol Biol Phys. 1994; 28: 113-118
        • Perez C.A.
        • Grigsby P.W.
        • Chao K.S.
        • et al.
        Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix.
        Int J Radiat Oncol Biol Phys. 1998; 41: 307-317
        • Lang S.
        • Kirisits C.
        • Dimopoulos J.
        • et al.
        Treatment planning for MRI assisted brachytherapy of gynaecological malignancies based on total dose constraints.
        Int J Radiat Oncol Biol Phys. 2007; 69: 619-627
        • Kirisits C.
        • Lang S.
        • Dimopoulos J.
        • et al.
        The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Design, application, treatment planning and dosimetric results.
        Int J Radiat Oncol Biol Phys. 2006; 65: 624-630
        • Dimopoulos J.C.A.
        • Schard G.
        • Berger D.
        • et al.
        Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: Potential of MRI on delineation of target, pathoanatomic structures, and organs at risk.
        Int J Radiat Oncol Biol Phys. 2006; 64: 1380-1388
        • Zelefsky M.J.
        • Kuban D.A.
        • Levy L.B.
        • et al.
        Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation.
        Int J Radiat Oncol Biol Phys. 2007; 67: 327-333
        • Stock R.G.
        • Stone N.N.
        • Tabert A.
        • et al.
        A dose-response study for I-125 prostate implants.
        Int J Radiat Oncol Biol Phys. 1998; 41: 101-108
        • Potters L.
        • Cao Y.
        • Calugaru E.
        • et al.
        A comprehensive review of CT-based dosimetry parameters and biochemical control in patients treated with permanent prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2001; 50: 605-614
        • Papagikos M.A.
        • Deguzman A.F.
        • Rossi P.J.
        • et al.
        Dosimetric quantifiers for low-dose-rate prostate brachytherapy: Is V(100) superior to D(90)?.
        Brachytherapy. 2005; 4: 252-258


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