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2. Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography-Based Clinical Target Volume Delineation Guideline for Postprostatectomy Salvage Radiation Therapy: the PERYTON-Guideline

Author

Staal, F H E, Janssen, J, Oprea-Lager, D E, Engelen, A M, van Limbergen, E J, Smeenk, R J, de Jong, M A A, Budiharto, T C G, Jacobs, I, Haverkort, M A D, Brouwer, C L, Siang, K Ng Wei, Langendijk, J A, Verzijlbergen, J F, de Jong, I J, Noordzij, W, Aluwini, S, Staal, F H E, Janssen, J, Oprea-Lager, D E, Engelen, A M, van Limbergen, E J, Smeenk, R J, de Jong, M A A, Budiharto, T C G, Jacobs, I, Haverkort, M A D, Brouwer, C L, Siang, K Ng Wei, Langendijk, J A, Verzijlbergen, J F, de Jong, I J, Noordzij, W, and Aluwini, S

Abstract

Purpose: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) scan is the standard imaging procedure for biochemical recurrent prostate cancer postprostatectomy because of its high detection rate at low serum prostate-specific antigen levels. However, existing guidelines for clinical target volume (CTV) in prostate bed salvage external beam radiation therapy (sEBRT) are primarily based on experience-based clinical consensus and have been validated using conventional imaging modalities. Therefore, this study aimed to optimize CTV definition in sEBRT by using PSMA PET/CT–detected local recurrences (LRs). Methods and Materials: Patients with suspected LR on PSMA PET/CT postprostatectomy were retrospectively enrolled in 9 Dutch centers. Anonymized scans were centrally reviewed by an expert nuclear medicine physician. Each boundary of the CTV guideline from the Groupe Francophone de Radiothérapie en Urologie (GFRU) was evaluated and adapted to improve the accuracy and coverage of the area at risk of LR (CTV) on PSMA PET/CT. The proposed CTV adaptation was discussed with the radiation oncologists of the participating centers, and final consensus was reached. To assess reproducibility, the participating centers were asked to delineate 3 new cases according to the new PERYTON-CTV, and the submitted contours were evaluated using the Dice similarity coefficient (DSC). Results: After central review, 93 LRs were identified on 83 PSMA PET/CTs. The proposed CTV definition improved the coverage of PSMA PET/CT–detected LRs from 67% to 96% compared with the GFRU-CTV, while reducing the GFRU-CTV by 25%. The new CTV was highly reproducible, with a mean DSC of 0.82 (range, 0.81-0.83). Conclusions: This study contributes to the optimization of CTV definition in postprostatectomy sEBRT by using the pattern of LR detected on PSMA PET/CT. The PERYTON-CTV is highly reproducible across the participating centers and ensures coverage of 96% LRs w

Published
2024

3. 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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9. 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

11. 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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24. 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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25. 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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26. 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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28. Long-term Results of Brachytherapy with Iridium-192 Implants

Author

Van Poppel, H., Van Den Heuvel, M., Lievens, Y., Van Limbergen, E., Vanuytsel, L., Baert, L., Baert, A. L., editor, Heuck, F. H. W., editor, Youker, J. E., editor, Brady, L. W., editor, Heilmann, H.-P., editor, Petrovich, Zbigniew, editor, Baert, Luc, editor, and Brady, Luther W., editor

Published
1998
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32. 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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33. 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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34. 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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36. 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

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

Author

Lindegaard, J.C., primary, Petric, P., additional, Schmid, M.P., additional, Haie-Meder, C., additional, Fokdal, L.U., additional, Sturdza, A., additional, Hoskin, P., additional, Mahantshetty, U., 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, Nout, R., additional, de Leeuw, A., additional, Nesvacil, N., additional, Kirchheiner, K., additional, Jürgenliemk-Schultz, I., additional, Tanderup, K., additional, Kirisits, C., additional, Pötter, R., additional, and Collaborative Group, E., additional

Published
2021
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41. OC-0059 Clinical characteristics and risk factors for local failure in cervix cancer patients after MR IGABT

Author

Schmid, M., primary, Mahantshetty, U., additional, Kirisits, C., additional, Tanderup, K., additional, Haie-Meder, C., additional, Fokdal, L., 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., additional, Tan, L.T., additional, Hawaldar, R., additional, Kannan, S., additional, Nout, R., additional, de Leeuw, A., additional, Nesvacil, N., additional, Jürgenliemk-Schulz, I., additional, Lindegaard, J., additional, and Pötter, R., additional

Published
2021
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43. AUTOMATIC QUALITY ASSESSMENT OF TRANSPERINEAL ULTRASOUND IMAGES OF THE MALE PELVIC REGION, USING DEEP LEARNING

Author

Camps, S. M., Houben, T., Carneiro, G., Edwards, C., Antico, M., Dunnhofer, M., Martens, E. G. H. J., Baeza, J. A., Vanneste, B. G. L., van Limbergen, E. J., de With, P. H. N., Verhaegen, F., Fontanarosa, D., Camps, S. M., Houben, T., Carneiro, G., Edwards, C., Antico, M., Dunnhofer, M., Martens, E. G. H. J., Baeza, J. A., Vanneste, B. G. L., van Limbergen, E. J., de With, P. H. N., Verhaegen, F., and Fontanarosa, D.

Abstract

Ultrasound guidance is not in widespread use in prostate cancer radiotherapy workflows. This can be partially attributed to the need for image interpretation by a trained operator during ultrasound image acquisition. In this work, a one-class regressor, based on DenseNet and Gaussian processes, was implemented to automatically assess the quality of transperineal ultrasound images of the male pelvic region. The implemented deep learning approach was tested on 300 transperineal ultrasound images and it achieved a scoring accuracy of 94%, a specificity of 95% and a sensitivity of 92% with respect to the majority vote of 3 experts, which was comparable with the results of these experts. This is the first step toward a fully automatic workflow, which could potentially remove the need for ultrasound image interpretation and make real-time volumetric organ tracking in the radio- therapy environment using ultrasound more appealing. (C) 2019 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Published
2020

44. Stereotactic ablative body radiotherapy (SABR) combined with immunotherapy (L19-IL2) versus standard of care in stage IV NSCLC patients, ImmunoSABR: A multicentre, randomised controlled open-label phase II trial

Author

Lieverse, R. I. Y., Van Limbergen, E. J., Oberije, C. J. G., Troost, E. G. C., Hadrup, S. R., Dingemans, A. -M. C., Hendriks, L. E. L., Eckert, F., Hiley, C., Dooms, C., Lievens, Y., De Jong, M. C., Bussink, J., Geets, X., Valentini, Vincenzo, Elia, G., Neri, D., Billiet, C., Abdollahi, A., Pasquier, D., Boisselier, P., Yaromina, A., De Ruysscher, D., Dubois, L. J., Lambin, P., Valentini V. (ORCID:0000-0003-4637-6487), Lieverse, R. I. Y., Van Limbergen, E. J., Oberije, C. J. G., Troost, E. G. C., Hadrup, S. R., Dingemans, A. -M. C., Hendriks, L. E. L., Eckert, F., Hiley, C., Dooms, C., Lievens, Y., De Jong, M. C., Bussink, J., Geets, X., Valentini, Vincenzo, Elia, G., Neri, D., Billiet, C., Abdollahi, A., Pasquier, D., Boisselier, P., Yaromina, A., De Ruysscher, D., Dubois, L. J., Lambin, P., and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Background: About 50% of non-small cell lung cancer (NSCLC) patients have metastatic disease at initial diagnosis, which limits their treatment options and, consequently, the 5-year survival rate (15%). Immune checkpoint inhibitors (ICI), either alone or in combination with chemotherapy, have become standard of care (SOC) for most good performance status patients. However, most patients will not obtain long-term benefit and new treatment strategies are therefore needed. We previously demonstrated clinical safety of the tumour-selective immunocytokine L19-IL2, consisting of the anti-ED-B scFv L19 antibody coupled to IL2, combined with stereotactic ablative radiotherapy (SABR). Methods: This investigator-initiated, multicentric, randomised controlled open-label phase II clinical trial will test the hypothesis that the combination of SABR and L19-IL2 increases progression free survival (PFS) in patients with limited metastatic NSCLC. One hundred twenty-six patients will be stratified according to their metastatic load (oligo-metastatic: ≤5 or poly-metastatic: 6 to 10) and randomised to the experimental-arm (E-arm) or the control-arm (C-arm). The C-arm will receive SOC, according to the local protocol. E-arm oligo-metastatic patients will receive SABR to all lesions followed by L19-IL2 therapy; radiotherapy for poly-metastatic patients consists of irradiation of one (symptomatic) to a maximum of 5 lesions (including ICI in both arms if this is the SOC). The accrual period will be 2.5-years, starting after the first centre is initiated and active. Primary endpoint is PFS at 1.5-years based on blinded radiological review, and secondary endpoints are overall survival, toxicity, quality of life and abscopal response. Associative biomarker studies, immune monitoring, CT-based radiomics, stool collection, iRECIST and tumour growth rate will be performed. Discussion: The combination of SABR with or without ICI and the immunocytokine L19-IL2 will be tested as 1st, 2nd or 3rd li

Published
2020

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

Author

Knoth, J, Potter, R, Jurgenliemk-Schulz, IM, 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, BR, Sundset, M, Tan, LT, Nout, Remi, Tanderup, K, Kirisits, C, Nesvacil, N, Lindegaard, JC, Schmid, MP, Knoth, J, Potter, R, Jurgenliemk-Schulz, IM, 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, BR, Sundset, M, Tan, LT, Nout, Remi, Tanderup, K, Kirisits, C, Nesvacil, N, Lindegaard, JC, and Schmid, MP

Published
2020

49. OC-0569: Incidence of severe gastrointestinal and urinary fistulas, bleeding and strictures: EMBRACE results

Author

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

Published
2020
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50. OC-0317: Risk factors for persistent late fatigue after radiochemotherapy in cervical cancer (EMBRACE study)

Author

Smet, S., primary, Tanderup, K., additional, Nout, R., additional, Jürgenliemk-Schulz, I., additional, Spampinato, S., additional, Chargari, C., additional, Lindegaard, J., additional, Mahantshetty, U., additional, Strudza, A., additional, Schmid, M., additional, Hoskin, P., additional, Segedin, B., additional, Bruheim, K., additional, Rai, B., additional, Huang, F., additional, Van Der Steen-Basanik, E., additional, Cooper, R., additional, Van Limbergen, E., additional, Sundset, M., additional, Pötter, R., additional, and Kirchheiner, K., additional

Published
2020
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