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5. Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging – An analysis from the EMBRACE study

Author

Knoth, J., Pötter, R., Jürgenliemk-Schulz, I.M., Haie-Meder, C., Fokdal, L., Sturdza, A., Hoskin, P., Mahantshetty, U., Segedin, B., Bruheim, K., Wiebe, E., Rai, B., Cooper, R., van der Steen-Banasik, E., van Limbergen, E., Pieters, B.R., Sundset, M., Tan, L.T., Nout, R.A., Tanderup, K., Kirisits, C., Nesvacil, N., Lindegaard, J.C., and Schmid, M.P.

Published
2020
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8. Association between Regular Vaginal Dilation and/or Sexual Activity and Long-Term Vaginal Morbidity in Cervical Cancer Survivors

Author

Kirchheiner, K., primary, Zaharie, A.T., additional, Smet, S., additional, Spampinato, S., additional, Chargari, C., additional, Mahantshetty, U.M., additional, Segedin, B., additional, Bruheim, K., additional, Rai, B., additional, Cooper, R., additional, Van der Steen-Banasik, E., additional, Wiebe, E.M., additional, Potter, R., additional, Kirisits, C., additional, Schmid, M., additional, Haie-Meder, C., additional, Tanderup, K., additional, De Leeuw, A., additional, Jurgenliemk-Schulz, I., additional, and Nout, R.A., additional

Published
2023
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9. Patient-reported sexual frequency and vaginal functioning in patients with locally advanced cervical cancer following definitive radiochemotherapy and image-guided adaptive brachytherapy (EMBRACE study)

Author

Kirchheiner, K, Jürgenliemk-Schulz, I M, Haie-Meder, C, Lindegaard, J C, Sturdza, A, Mahantshetty, U, Segedin, B, Bruheim, K, Rai, B, Cooper, R, van der Steen-Banasik, E, Wiebe, E, Sundset, M, van Limbergen, E, Villafranca, E, Westerveld, H, Tan, L T, Tanderup, K, Pötter, R, and Nout, R A

Published
2019
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13. Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy

Author

MS Radiotherapie, Cancer, Suvaal, I, Kirchheiner, K, Nout, R A, Sturdza, A E, Van Limbergen, E, Lindegaard, J C, Putter, H, Jürgenliemk-Schulz, I M, Chargari, C, Tanderup, K, Pötter, R, Creutzberg, C L, Ter Kuile, M M, MS Radiotherapie, Cancer, Suvaal, I, Kirchheiner, K, Nout, R A, Sturdza, A E, Van Limbergen, E, Lindegaard, J C, Putter, H, Jürgenliemk-Schulz, I M, Chargari, C, Tanderup, K, Pötter, R, Creutzberg, C L, and Ter Kuile, M M

Published
2023

18. OC-0129 Impact of brachytherapy applicator on morbidity and local control in cervix cancer: EMBRACE study

Author

Serban, M., primary, Spampinato, S., additional, de Leeuw, A., additional, Fortin, I., additional, Nevascil, N., additional, Kirisits, C., additional, Schmid, M., additional, Mahantshetty, U., additional, Hoskin, P., additional, Segedin, B., additional, Bruheim, K., additional, Huang, F., additional, Pieters, B., additional, Nout, R., additional, Pötter, R., additional, Kirchheiner, K., additional, Jürgenliemk-Schulz, I., additional, and Tanderup, K., additional

Published
2023
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23. OC-0503 Effect of dose and fractionation de-escalation in low-risk cervix cancer treated with EBRT and BT

Author

Serban, M., Gallois, M., Urtubey, T., Nout, R., de Leeuw, A., Fokdal, L., Assenholt, M., Spampinato, S., Bruheim, K., Segedin, B., Chopra, S., Schmid, M., Nesvacil, N., Ecker, S., Kirchheiner, K., Pötter, R., Westerveld, H., Huang, F., Velema, L., Tan, L.T., Valgma, M., Mathiesen, H., Lindegaard, J., Jürgenliemk-Schulz, I., and Tanderup, K.

Published
2022
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28. OC-0830 Systemic recurrence after primary chemoradiation in cervical cancer patients – an EMBRACE analysis

Author

Knoth, J., primary, Nout, R., additional, Mahantshetty, U., additional, Jürgenliemk-Schulz, I., additional, Haie-Meder, C., additional, Fokdal, L.U., additional, Sturdza, A., additional, Hoskin, P., additional, Segedin, B., additional, Bruheim, K., additional, Huang, F., additional, Rai, B., additional, Cooper, R., additional, van der Steen-Banasik, E., additional, van Limbergen, E., additional, Pieters, B.R., additional, Tan, L.T., additional, Kannan, S., additional, de Leeuw, A.A., additional, Nesvacil, N., additional, Tanderup, K., additional, Kirisits, C., additional, Lindegaard, J.C., additional, Pötter, R., additional, and Schmid, M.P., additional

Published
2022
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29. PO-1801 Primary standards and measurement methods for X-ray emitting electronic BT devices PRISM-eBT

Author

Schneider, T., primary, Behrens, R., additional, Garcia-Yip, F., additional, Tanderup, K., additional, Kertzscher, G., additional, Johanson, J., additional, Georgi, P., additional, Blideanu, V., additional, Stien, C., additional, Plagnard, J., additional, Solc, J., additional, Sochor, V., additional, Pinto, M., additional, Sander, T., additional, Subiel, A., additional, Gouldstone, C., additional, de Prez, L., additional, Verhaegen, F., additional, Reniers, B., additional, Avilés Lucas, P., additional, Msimang, Z., additional, Eaton, D.J., additional, Weigand, F., additional, and Rivard, M.J., additional

Published
2022
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31. OC-0443 3D-Image-guided brachytherapy plus irradiation in stage-I-III inoperable endometrial cancer.

Author

Rovirosa, A., primary, Zhang, Y., additional, Chargari, C., additional, Van der Steen-Banasik, E., additional, Wojcieszek, P., additional, Stankiewicz, M., additional, Najjari, D., additional, Hoskin, P., additional, Han, K., additional, Segedin, B., additional, Potter, R., additional, Tanderup, K., additional, and Van Limbergen, E., additional

Published
2022
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32. OC-0588 Impact of persistent symptoms on long-term quality of life of cervical cancer survivors in EMBRACE I

Author

Spampinato, S., primary, Tanderup, K., additional, Nout, R., additional, Smet, S., additional, Lindegaard, J.C., additional, Fokdal, L.U., additional, Pötter, R., additional, Sturdza, A., additional, Segedin, B., additional, Jürgenliemk-Schulz, I., additional, Bruheim, K., additional, Mahantshetty, U., additional, Chargari, C., additional, Rai, B., additional, Cooper, R., additional, van der Steen-Banasik, E., additional, Sundset, M., additional, Wiebe, E., additional, Villafranca, E., additional, Van Limbergen, E., additional, Chopra, S., additional, and Kirchheiner, K., additional

Published
2022
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33. Importance of training in external beam treatment planning for locally advanced cervix cancer

Author

Seppenwoolde, Y., Assenholt, M.S., Georg, D., Nout, R., Tan, L.T., Rumpold, T., Leeuw, A. de, Jurgenliemk-Schulz, I., Kirisits, C., Potter, R., Lindegaard, J.C., Tanderup, K., EMBRACE Collaborative Grp, and Radiotherapy

Subjects
medicine.medical_specialty, Dummy run, Computer science, medicine.medical_treatment, Brachytherapy, Uterine Cervical Neoplasms, Plan (drawing), EBRT treatment planning, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, External beam radiotherapy, EMBRACE II, Radiation treatment planning, QA, Accreditation, Protocol (science), Contouring, Radiotherapy Planning, Computer-Assisted, Radiotherapy Dosage, Hematology, 3. Good health, Oncology, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, Median body, Lymph Nodes, Radiotherapy, Image-Guided
Abstract

Background and purpose: The EMBRACE II study combines state-of-the-art Image-Guided Adaptive Brachytherapy in cervix cancer with an advanced protocol for external beam radiotherapy (EBRT) which specifies target volume selection, contouring and treatment planning. In EMBRACE II, well-defined EBRT is an integral part of the overall treatment strategy with the primary aim of improving nodal control and reducing morbidity. The EMBRACE II EBRT planning concept is based on improved conformality through relaxed coverage criteria for all target volumes. For boosting of lymph nodes, a simultaneous integrated boost and coverage probability planning is applied. Before entering EMBRACE II, institutes had to go through accreditation. Material and methods: As part of accreditation, a treatment planning dummy-run included educational blocks and submission of an examination case provided by the study coordinators. Seventy-one centers submitted 123 EBRT dose distributions. Replanning was required if hard constraints were violated or planning concepts were not fully accomplished. Dosimetric parameters of original and revised plans were compared. Results: Only 11 plans violated hard constraints. Twenty-seven centers passed after first submission. 27 needed one and 13 centers needed more revisions. The most common reasons for revisions were low conformality, relatively high OAR doses or insufficient lymph node coverage reduction. Individual feedback on planning concepts improved plan quality considerably, resulting in a median body V43Gy reduction of 158 cm 3 from first plan submission to approved plan. Conclusion: A dummy-run as applied in EMBRACE II, consisting of training and examination cases enabled us to test institutes’ treatment planning capabilities, and improve plan quality.

Published
2019
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36. OC-0025 Tumor regression of cervical cancer during chemoradiation evaluated by the T-score in EMBRACE I

Author

Lindegaard, J.C., Petric, P., Schmid, M.P., Haie-Meder, C., Fokdal, L.U., Sturdza, A., Hoskin, P., Mahantshetty, U., Segedin, B., Bruheim, K., Huang, F., Rai, B., Cooper, R., van der Steen-Banasik, E., Van Limbergen, E., Pieters, B.R., Tan, L.T., Nout, R., de Leeuw, A., Nesvacil, N., Kirchheiner, K., Jürgenliemk-Schultz, I., Tanderup, K., Kirisits, C., Pötter, R., and Collaborative Group, E.

Published
2021
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37. 3D Image-Guided Brachytherapy as Only Treatment for Stage-I Inoperable Endometrial Cancer: Retrospective Analysis of the Gynecological Cancer GEC-ESTRO Working Group

Author

Rovirosa, A., primary, Zhang, Y., additional, Chargari, C., additional, Cooper, R., additional, Wojcieszek, P., additional, Stankiewicz, M., additional, Hoskin, P., additional, van der Steen-Banas, E., additional, Segedin, B., additional, Najjari, D., additional, Potter, R., additional, Tanderup, K., additional, and van Limbergen, E., additional

Published
2021
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38. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study

Author

Pötter R., Tanderup K., Schmid M.P., Jürgenliemk-Schulz I., Haie-Meder C., Fokdal L.U., Sturdza A.E., Hoskin P., Mahantshetty U., Segedin B., Bruheim K., Huang F., Rai B., Cooper R., van der Steen-Banasik E., Van Limbergen E., Pieters B.R., Tan L.-T., Nout R.A., De Leeuw A.A.C., Ristl R., Petric P., Nesvacil N., Kirchheiner K., Kirisits C., Lindegaard J.C., Chargari C., Dumas I., Lowe G., Swamidas J., Hudej R., Paulsen Hellebust T., Menon G., Oinam A.S., Bownes P., Christiaens M., De Brabandere M., Janssen H., Oosterveld B., Koedooder K., Langeland Marthinsen A.B., Sundset M., Whitney D., Ketelaars M., Lutgens L.C.H.W., Reinniers B., Mora I., Villafranca E., Antal G., Hadjiev J., Bachand F., Batchelar D., Erickson B., Rownd J., Jacobson G., Kim Y., Anttila M., Palmgren J.-E., An J., Assenholt M.S., Banerjee S., Bentzen S., Berger T., Dankulchai P., Diendorfer T., Dilworth I., Dimopoulos J., Dörr E., Ecker S., Federico M., Fidarova E., Fortin I., Georg P., Gora J., Hegazy N., Jastaniyah N., Jensen N.B.K., Liederer T., Majercakova K., Misimovic D., Motisi L., Najjari Jamal D., Nkiwane K., Schwartz-Vittrup A., Serban M., Smet S., Spampinato S., Trnkova P., Valgma M., Westerveld H., Wong J.S.Y., Yoshida K., and EMBRACE Collaborative Group

Subjects
Asia, diagnostic imaging, Brachytherapy, cisplatin, uterine cervix carcinoma, morbidity, image guided radiotherapy, external beam radiotherapy, Article, Disease-Free Survival, multiple cycle treatment, chemoradiotherapy, volumetric modulated arc therapy, cancer control, fistula, follow up, urogenital tract disease, International Federation of Gynecology and Obstetrics, uterine cervix tumor, human, procedures, nuclear magnetic resonance imaging, outcome assessment, disease free survival, lymph node metastasis, cancer staging, adult, clinical trial, cohort analysis, major clinical study, intensity modulated radiation therapy, Europe, aged, multicenter study, female, quality of life, priority journal, North America, observational study, pathology, conformal radiotherapy, radiation dose, image guided adaptive brachytherapy, uterine cervix cancer, prospective study
Abstract

Background: The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer was introduced 20 years ago. Here, we report on EMBRACE-I, which aimed to evaluate local tumour control and morbidity after chemoradiotherapy and MRI-based IGABT. Methods: EMBRACE-I was a prospective, observational, multicentre cohort study. Data from patients from 24 centres in Europe, Asia, and North America were prospectively collected. The inclusion criteria were patients older than 18 years, with biopsy-proven squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix, The International Federation of Gynecology and Obstetrics (FIGO) stage IB–IVA disease or FIGO stage IVB disease restricted to paraaortic lymph metastasis below the L1–L2 interspace, suitable for curative treatment. Treatment consisted of chemoradiotherapy (weekly intravenous cisplatin 40 mg/m2, 5–6 cycles, 1 day per cycle, plus 45–50 Gy external-beam radiotherapy delivered in 1·8–2 Gy fractions) followed by MRI-based IGABT. The MRI-based IGABT target volume definition and dose reporting was according to Groupe Européen de Curiethérapie European Society for Radiation Oncology recommendations. IGABT dose prescription was open according to institutional practice. Local control and late morbidity were selected as primary endpoints in all patients available for analysis. The study was registered with ClinicalTrials.gov, NCT00920920. Findings: Patient accrual began on July 30, 2008, and closed on Dec 29, 2015. A total of 1416 patients were registered in the database. After exclusion for not meeting patient selection criteria before treatment, being registered but not entered in the database, meeting the exclusion criteria, and being falsely excluded, data from 1341 patients were available for analysis of disease and data from 1251 patients were available for assessment of morbidity outcome. MRI-based IGABT including dose optimisation was done in 1317 (98·2%) of 1341 patients. Median high-risk clinical target volume was 28 cm3 (IQR 20–40) and median minimal dose to 90% of the clinical target volume (D90%) was 90 Gy (IQR 85–94) equi-effective dose in 2 Gy per fraction. At a median follow-up of 51 months (IQR 20–64), actuarial overall 5-year local control was 92% (95% CI 90–93). Actuarial cumulative 5-year incidence of grade 3–5 morbidity was 6·8% (95% CI 5·4–8·6) for genitourinary events, 8·5% (6·9–10·6) for gastrointestinal events, 5·7% (4·3–7·6) for vaginal events, and 3·2% (2·2–4·5) for fistulae. Interpretation: Chemoradiotherapy and MRI-based IGABT result in effective and stable long-term local control across all stages of locally advanced cervical cancer, with a limited severe morbidity per organ. These results represent a positive breakthrough in the treatment of locally advanced cervical cancer, which might be used as a benchmark for clinical practice and all future studies. Funding: Medical University of Vienna, Aarhus University Hospital, Elekta AB, and Varian Medical Systems. © 2021 Elsevier Ltd

Published
2021
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42. OC-0296 Risk factors for severe gastrointestinal morbidity in locally advanced cervix cancer (EMBRACE study)

Author

Spampinato, S., primary, Jensen, N.B., additional, Fokdal, L.U., additional, Pötter, R., additional, Haie-Meder, C., additional, Lindegaard, J.C., additional, Schmid, M.P., additional, Sturdza, A., additional, Jürgenliemk-Schulz, I.M., additional, Mahantshetty, U., additional, Segedin, B., additional, Hoskin, P., additional, Bruheim, K., additional, Rai, B., additional, Wiebe, E., additional, Cooper, R., additional, van der Steen-Banasik, E., additional, Van Limbergen, E., additional, Kirisits, C., additional, Nout, R.A., additional, Chopra, S., additional, Kirchheiner, K., additional, and Tanderup, K., additional

Published
2021
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44. OC-0295 New Prognostic factors in locally advanced cervical cancer treated with MR-IGABT in EMBRACE Study.

Author

Mahantshetty, U., primary, Schmid, M., additional, Kirisits, C., additional, Tanderup, K., additional, Haie-Meder, C., additional, Fokdal, L., additional, Sturdza, A., additional, Hoskin, P., additional, Segredin, B., additional, Bruheim, K., additional, Huang, F., additional, Rai, B., additional, Cooper, R., additional, van der Steen-Banasik, E., additional, van Limbergen, E., additional, Pieters, B., additional, Tan, L.T., additional, Hawaldar, R., additional, Kannan, S., additional, Nout, R., additional, de Leeuw, A.A.C., additional, Nesvacil, N., additional, Jürgenliemk-Schulz, I., additional, Lindegaard, J., additional, and Pötter, R., additional

Published
2021
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46. PO-1487 Brachytherapy training survey among Radiation Oncology residents in Europe

Author

Sturdza, A., primary, Stephanides, M., additional, Eriksen, J.G., additional, Benstead, K., additional, Hoskin, P., additional, Vlad, S., additional, Escande, A., additional, Corradini, S., additional, Konrad, S., additional, Westerveld, H., additional, Tagliaferri, L., additional, Najjari, D., additional, Konat-Bąska, K., additional, Plesinac Karapandzic, V., additional, Tan, L.T., additional, Nout, R., additional, Peters, B., additional, Tanderup, K., additional, Jürgenliemk-Schulz, I., additional, and Kamrava, M., additional

Published
2021
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48. Phantom-based quality assurance for multicenter quantitative MRI in locally advanced cervical cancer

Author

Houdt, P.J. van, Kallehauge, J.F., Tanderup, K., Nout, R., Zaletelj, M., Tadic, T., Kesteren, Z.J. van, Berg, C.A.T. van den, Georg, D., Cote, J.C., Levesque, I.R., Swamidas, J., Malinen, E., Telliskivi, S., Brynolfsson, P., Mahmood, F., Heide, U.A. van der, Embrace Collaborative Grp, CCA - Imaging and biomarkers, and Radiotherapy

Subjects
Uterine cervical neoplasms, Imaging biomarker, Uterine Cervical Neoplasms, Imaging phantom, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Magnetic resonance imaging, Multicenter trial, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Protocol (science), Reproducibility, medicine.diagnostic_test, Radiotherapy, business.industry, Phantoms, Imaging, Reproducibility of Results, Hematology, Repeatability, Magnetic Resonance Imaging, Diffusion Magnetic Resonance Imaging, Oncology, 030220 oncology & carcinogenesis, Female, business, Nuclear medicine, Quality assurance
Abstract

Background and purpose: A wide variation of MRI systems is a challenge in multicenter imaging biomarker studies as it adds variation in quantitative MRI values. The aim of this study was to design and test a quality assurance (QA) framework based on phantom measurements, for the quantitative MRI protocols of a multicenter imaging biomarker trial of locally advanced cervical cancer.Materials and methods: Fifteen institutes participated (five 1.5 T and ten 3 T scanners). Each institute optimized protocols for T2, diffusion-weighted imaging, T1, and dynamic contrast-enhanced (DCE-)MRI according to system possibilities, institutional preferences and study-specific constraints. Calibration phantoms with known values were used for validation. Benchmark protocols, similar on all systems, were used to investigate whether differences resulted from variations in institutional protocols or from system variations. Bias, repeatability (%RC), and reproducibility (%RDC) were determined. Ratios were used for T2 and T1 values.Results: The institutional protocols showed a range in bias of 0.88-0.98 for T2 (median %RC = 1%; % RDC = 12%), -0.007 to 0.029 x 10(-3) mm(2)/s for the apparent diffusion coefficient (median %RC = 3%; % RDC = 18%), and 0.39-1.29 for T1 (median %RC = 1%; %RDC = 33%). For DCE a nonlinear vendor-specific relation was observed between measured and true concentrations with magnitude data, whereas the relation was linear when phase data was used.Conclusion: We designed a QA framework for quantitative MRI protocols and demonstrated for a multi-center trial for cervical cancer that measurement of consistent T2 and apparent diffusion coefficient values is feasible despite protocol differences. For DCE-MRI and T1 mapping with the variable flip angle method, this was more challenging. (C) 2020 The Authors. Published by Elsevier B.V.

Published
2020
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49. Impact of interfractional target motion in locally advanced cervical cancer patients treated with spot scanning proton therapy using an internal target volume strategy

Author

Niyoteka, S. (Stéphane), Berger, T. (Thomas), Fokdal, L.U. (Lars Ulrik), Petersen, J.B.B. (Jørgen Breede Baltzer), Zolnay, A.G. (Andras), Hoogeman, M.S. (Mischa), Tanderup, K. (Kari), Nystrom, H.U. (Håkan Ulf), Niyoteka, S. (Stéphane), Berger, T. (Thomas), Fokdal, L.U. (Lars Ulrik), Petersen, J.B.B. (Jørgen Breede Baltzer), Zolnay, A.G. (Andras), Hoogeman, M.S. (Mischa), Tanderup, K. (Kari), and Nystrom, H.U. (Håkan Ulf)

Abstract

Background and purpose: The more localized dose deposition of proton therapy (PT) compared to photon therapy might allow a reduction in treatment-related side effects but induces additional challenges to address. The aim of this study was to evaluate the impact of interfractional motion on the target and organs at risk (OARs) in cervical cancer patients treated with spot scanning PT using an internal target volume (ITV) strategy. Methods and materials: For ten locally advanced cervical cancer patients, empty and full bladder planning computed tomography (pCT) as well as 25 daily cone beam CTs (CBCTs) were available. The Clinical Target Volume (CTV), the High Risk CTV (CTVHR) (gross tumor volume and whole cervix), the non-involved uterus as well as the OARs (bowel, bladder and rectum) were contoured on the daily CBCTs and transferred to the pCT through rigid bony match. Using synthetic CTs derived from pCTs, four-beam spot scanning PT plans were generated to target the patient-specific ITV with 45 Gy(RBE) in 25 fractions. This structure was defined based on pre-treatment MRI and CT to anticipate potential target motion throughout the treatment. D98% of the targets and V40Gy(RBE) of the OARs were extracted from the daily anatomies, accumulated and analyzed. In addition, the impact of bladder volume deviations from planning values on target and bowel dose was investigated. Results: The ITV strategy ensured a total accumulated dose >42.75 Gy(RBE) to the CTVHR for all ten patients. Two patients with large bladder-related uterus motion had accumulated dose to the non-involved uterus of 35.7 Gy(RBE) and 41.1 Gy(RBE). Variations in bowel V40Gy(RBE) were found to be correlated (Pearson r = −0.55; p-value <0.0001) with changes in bladder volume during treatment. Conclusion: The ITV concept ensured adequate dose to the CTVHR, but was insufficient for the non-involved uterus of patients subject to large target interfractional motion. CBCT monitoring and occasional replanning is

Published
2021
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50. Impact of interfractional target motion in locally advanced cervical cancer patients treated with spot scanning proton therapy using an internal target volume strategy

Author

Niyoteka, S, Berger, T, Fokdal, LU, Petersen, JBB, Zolnay, A, Hoogeman, Mischa, Tanderup, K, Nystrom, HU, Niyoteka, S, Berger, T, Fokdal, LU, Petersen, JBB, Zolnay, A, Hoogeman, Mischa, Tanderup, K, and Nystrom, HU

Abstract

Background and purpose: The more localized dose deposition of proton therapy (PT) compared to photon therapy might allow a reduction in treatment-related side effects but induces additional challenges to address. The aim of this study was to evaluate the impact of interfractional motion on the target and organs at risk (OARs) in cervical cancer patients treated with spot scanning PT using an internal target volume (ITV) strategy. Methods and materials: For ten locally advanced cervical cancer patients, empty and full bladder planning computed tomography (pCT) as well as 25 daily cone beam CTs (CBCTs) were available. The Clinical Target Volume (CTV), the High Risk CTV (CTVHR) (gross tumor volume and whole cervix), the non-involved uterus as well as the OARs (bowel, bladder and rectum) were contoured on the daily CBCTs and transferred to the pCT through rigid bony match. Using synthetic CTs derived from pCTs, four-beam spot scanning PT plans were generated to target the patient-specific ITV with 45 Gy(RBE) in 25 fractions. This structure was defined based on pre-treatment MRI and CT to anticipate potential target motion throughout the treatment. D98% of the targets and V40Gy(RBE) of the OARs were extracted from the daily anatomies, accumulated and analyzed. In addition, the impact of bladder volume deviations from planning values on target and bowel dose was investigated. Results: The ITV strategy ensured a total accumulated dose >42.75 Gy(RBE) to the CTVHR for all ten patients. Two patients with large bladder-related uterus motion had accumulated dose to the non-involved uterus of 35.7 Gy(RBE) and 41.1 Gy(RBE). Variations in bowel V40Gy(RBE) were found to be correlated (Pearson r = −0.55; p-value <0.0001) with changes in bladder volume during treatment. Conclusion: The ITV concept ensured adequate dose to the CTVHR, but was insufficient for the non-involved uterus of patients subject to large target interfractional motion. CB

Published
2021

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