Journal of Contemporary Brachytherapy
eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2025
vol. 17
 
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abstract:
Original paper

Clinical and dosimetric outcomes of carcinoma cervix patients treated with MRI only at first fraction, followed by CT-based image-guided brachytherapy for subsequent fractions

Madhup Rastogi
1
,
Ajeet Kumar Gandhi
1
,
Avinash Poojari
1
,
Vachaspati Mishra
1
,
Tenzing Dahla Bhutia
1
,
Rakhi Verma
1
,
Deepika Ramola
1
,
Rohini Khurana
1
,
Anoop K. Srivastava
1
,
Pravin Kumar Das
2
,
Abhishek Chauhan
3
,
Neetu Singh
3
,
Anurag Gupta
4

  1. Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
  2. Department of Anesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
  3. Department of Obstetrics and Gynecology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
  4. Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
J Contemp Brachytherapy 2025; 17, 5: 293–299
DOI: https://doi.org/10.5114/jcb.2025.155220
Online publish date: 2025/10/13
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Introduction
Magnetic resonance (MRI)-based image-guided brachytherapy (IGBT) is the gold standard technique for carcinoma cervix. We aimed to evaluate doses to target and organs at risk (OARs), and report clinical outcomes of locally advanced carcinoma cervix (LACC) patients treated with a hybrid approach of using MRI- and computed tomography (CT)-based IGBT.

Material and methods
Twenty-two LACC patients, after receiving external beam radiotherapy of 50 Gy in 25 frac-tions with concurrent cisplatin 40 mg/m2 weekly, underwent 7 Gy in 3 fractions of IGBT planning with MRI alone at first fraction, and CT at second (CT-1) and third (CT-2) fractions. Dose received by at least 90% of volume (D90) for high-risk clinical target volume (HR-CTV), and dose to 0.1 cm3, 1 cm3, and 2 cm3 for OARs was evaluated during each fraction and compared.

Results
The median age was 50 years. Fourteen (63.6%) patients were FIGO (2010) stage II. HR-CTV volumes (mean ±SD) of MRI, CT-1, and CT-2 were 24.23 cc ±9.26 cc, 27.82 cc ±15.37 cc, and 24.82 cc ±11.14 cc, respectively (p = N.S.). HR-CTV D90 (mean ±SD) was significantly higher in MRI-based plans compared with CT-based plans at second fraction (MRI: 108.86 ±24.21% vs. CT-1: 98 ±23.18%, p = 0.03), but not different than CT-based plans at third fraction (MRI: 108.86 ±24.21% vs. CT-2: 106.86 ±17.36%, p = 0.68). No statistically significant differences in doses to the rectum, bladder, and sigmoid colon were observed between MRI- and CT-based plans (all p > 0.05). 5-year loco-regional control, disease-free survival, and overall survival rates were 85.2%, 80.7%, and 79.0%, respectively.

Conclusions
Hybrid approach in IGBT using MRI at first fraction and CT for subsequent fractions yields comparable dosimetric parameters and decent long-term clinical outcomes. This approach could be considered resource-sparing brachytherapy technique.

keywords:

image-guided brachytherapy, carcinoma cervix, CT-based IGBT

  
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