PMID- 18495372
OWN - NLM
STAT- MEDLINE
DCOM- 20080819
LR  - 20220408
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 71
IP  - 4
DP  - 2008 Jul 15
TI  - Image-guided radiotherapy for cervix cancer: high-tech external beam therapy 
      versus high-tech brachytherapy.
PG  - 1272-8
LID - 10.1016/j.ijrobp.2008.03.032 [doi]
AB  - PURPOSE: Many studies comparing external-beam therapy (EBT) and brachytherapy 
      (BT) are biased because advanced EBT is compared with conventional BT. This study 
      compares high-tech EBT against high-tech BT. METHODS AND MATERIALS: Nine patients 
      were selected with locally advanced cervix cancer, representing typical clinical 
      situations according to initial tumor extension and response after EBT. Patients 
      were treated either with intracavitary, combined interstitial/intracavitary, or 
      complex interstitial BT. Gross tumor volume, high-risk clinical target volume 
      (CTV), intermediate-risk CTV, bladder, rectum, and sigmoid were delineated. 
      Magnetic resonance-guided BT planning was manually optimized with respect to 
      organ dose limits. Margins (3 and 5 mm) were added to BT CTVs to construct 
      planning target volumes (PTVs) for EBT. Inversely planned EBT with photons (IMRT) 
      and protons (IMPT) was challenged to deliver the highest possible doses to PTVs 
      while respecting D(1cc) and D(2cc) limits from BT, assuming the same 
      fractionation (4 x 7 Gy). The D90 for target structures and normal tissue volumes 
      receiving fractionated doses between 3 and 7 Gy were compared. RESULTS: High-risk 
      CTV doses depended on the clinical situation and radiation quality. If IMRT was 
      limited to D(2cc) and D(1cc) from BT, the D90 for high-risk PTV and 
      intermediate-risk PTV was mostly lower. Volumes receiving 60 Gy (in equivalent 
      dose in 20 Gy fractions) were approximately twice as large for IMRT compared with 
      BT. For IMPT, this volume ratio was lower. Planning target volume doses of IMPT 
      plans with 3-mm margins were comparable to those with BT. Gross tumor volume 
      doses were mostly lower for both IMRT and IMPT. CONCLUSION: For benchmarking 
      high-tech EBT, high-tech BT techniques have to be used. For cervix cancer boost 
      treatments, both IMRT and IMPT seem to be inferior to advanced BT.
FAU - Georg, Dietmar
AU  - Georg D
AD  - Division Medical Radiation Physics, Department of Radiotherapy, Medical 
      University Vienna, Vienna, Austria. Dietmar.George@akhwien.at
FAU - Kirisits, Christian
AU  - Kirisits C
FAU - Hillbrand, Martin
AU  - Hillbrand M
FAU - Dimopoulos, Johannes
AU  - Dimopoulos J
FAU - Potter, Richard
AU  - Potter R
LA  - eng
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080519
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adult
MH  - Brachytherapy/*methods
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - Radiotherapy, Computer-Assisted/*methods
MH  - Radiotherapy, Conformal/*methods
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
MH  - Uterine Cervical Neoplasms/*diagnosis/*radiotherapy
EDAT- 2008/05/23 09:00
MHDA- 2008/08/20 09:00
CRDT- 2008/05/23 09:00
PHST- 2008/01/23 00:00 [received]
PHST- 2008/03/05 00:00 [revised]
PHST- 2008/03/11 00:00 [accepted]
PHST- 2008/05/23 09:00 [pubmed]
PHST- 2008/08/20 09:00 [medline]
PHST- 2008/05/23 09:00 [entrez]
AID - S0360-3016(08)00510-5 [pii]
AID - 10.1016/j.ijrobp.2008.03.032 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1272-8. doi: 
      10.1016/j.ijrobp.2008.03.032. Epub 2008 May 19.