1. MRI-Directed Brachytherapy for Cancer of the Uterine Cervix: A Case Report, Review, and Perspective on the Importance of Widespread Use of This Technological Advance in the United States
- Author
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Robert Allbright, Srinivasan Vijayakumar, Hiba Z Ahmed, and William N. Duggar
- Subjects
medicine.medical_specialty ,definitive treatment ,pelvic control ,medicine.medical_treatment ,Population ,Brachytherapy ,030204 cardiovascular system & hematology ,radiation therapy ,concurrent chemoradiation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,locally advanced cervical cancer ,Stage (cooking) ,education ,Cervix ,Cervical cancer ,mri-based brachytherapy ,education.field_of_study ,business.industry ,image-guided brachytherapy ,Gold standard ,General Engineering ,Cancer ,hdr (high dose rate) brachytherapy ,medicine.disease ,Radiation therapy ,3-d brachytherapy ,medicine.anatomical_structure ,Oncology ,local control ,Radiation Oncology ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Europeen de Curietherapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in
- Published
- 2021