Article, 2019

Image-guided Adaptive Radiotherapy in Cervical Cancer

Seminars in Radiation Oncology, ISSN 1532-9461, 1053-4296, Volume 29, 3, Pages 284-298, 10.1016/j.semradonc.2019.02.010

Contributors

Tan Mbbs Mrcp Frcr Md, Li Tee [1] Tanderup PhD, Kari [2] Kirisits PhD, Christian [3] de Leeuw PhD, Astrid [4] Nout Md PhD, Remi [5] Duke Mbbs Frcr, Simon [1] Seppenwoolde PhD, Yvette [3] Nesvacil PhD, Nicole [3] Georg PhD, Dietmar [3] Kirchheiner PhD, Kathrin [3] Fokdal Md PhD, Lars [2] Sturdza Md Frcpc, Alina [3] Schmid Md, Maximilian [3] Swamidas PhD, Jamema [6] van Limbergen Md PhD, Erik [7] Haie-Meder Md, Christine [8] Mahantshetty Md, Umesh [6] Jürgenliemk-Schulz Md PhD, Ina [4] Lindegaard Dm DMSc, Jacob C [2] Pötter Md, Richard (Corresponding author) [3]

Affiliations

  1. [1] Cambridge University Hospitals NHS Foundation Trust
    2. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  2. [2] Aarhus University Hospital
    3. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Medical University of Vienna
    4. [NORA names: Austria; Europe, EU; OECD];
  4. [4] University Medical Center Utrecht
    5. [NORA names: Netherlands; Europe, EU; OECD];
  5. [5] Leiden University Medical Center
    6. [NORA names: Netherlands; Europe, EU; OECD];

Abstract

This paper reviews the conceptual, methodological, and technical innovations underpinning strategies for adaptive target volume selection and risk-adapted dose prescription in cervical cancer. An adaptive target volume concept has been developed which reflects tumor shrinkage at the end of initial chemo-radiation, which serves for an image-guided boost delivered through brachytherapy, with a risk-adapted dose prescription to different gross tumor- and clinical target volumes defined at diagnosis and after 40-50Gy external beam radiotherapy, and adaptation of the treatment technique according to the topography of the tumor after response and adjacent organs at risk. Clinical results of these innovations are presented based on prospective and retrospective multi-center trials (IntErnational study on MRI-based BRachytherapy in locally Advanced CErvical cancer [EMBRACE], retroEMBRACE) with large patient cohorts (n = 1416, n = 731). The potential benefit of applying these strategies and using a specific multi-parametric dose prescription protocol are explored (EMBRACE-II) and overall current and future research strategies are outlined. The challenges of dissemination and implementation of these complex new techniques into clinical practice are discussed.

Keywords

EMBRACE-II, New techniques, adaptation, adaptive radiotherapy, adjacent organs, beam radiotherapy, benefits, boost, brachytherapy, cancer, cervical cancer, cervicitis, chemo-radiation, clinical practice, clinical results, clinical target volume, cohort, concept, diagnosis, dissemination, dose prescription, dose prescription protocols, external beam radiotherapy, gross tumor, image-guided adaptive radiotherapy, implementation, innovation, multi-center trial, organization, patient cohort, patients, practice, prescription, prescription protocol, protocol, radiotherapy, research, research strategy, response, results, risk, risk-adapted dose prescription, selection, shrinkage, strategies, target volume, target volume concepts, target volume selection, technical innovations, technique, topography, treatment, treatment techniques, trials, tumor, tumor shrinkage, volume, volume concept, volume selection

Funders

  • Danish Cancer Society

Data Provider: Digital Science

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