PURPOSE: To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer. METHODS AND MATERIALS: From February 2004 to December 2006, 25 patients with gynecologic malignancies were enrolled and treated in a prospective clinical trial of real-time MRI-guided interstitial brachytherapy. This was followed by a confirmatory CT imaging scan. Statistical analyses included Kaplan-Meier estimates for overall and relapse-free survival. RESULTS: MRI visualization of needles during placement permitted accurate placement with no inadvertent insertions. This prevented unnecessary normal-tissue perforation as confirmed by CT simulation. With a mean followup of 3.8 years (range, 2-6.8), 1-, 2-, and 3-year overall survival rates were 80%, 60% and 43%, respectively; corresponding relapse-free survival rates were 79%, 65%, and 59%, respectively. Actuarial acute toxicity rates for any grade were 0% at 0-14 days and 80% (all grade 1) at 14-90 days. Long-term (>180 days) actuarial toxicity rates were 8% gastrointestinal, 4% bladder and 4% vaginal. CONCLUSIONS: Real-time MRI guidance during insertion of interstitial needles followed by 3D-planning maximized opportunities for tumor targeting and sparing of normal tissues. Although image guidance requires additional anesthesia time, clinical outcomes indicate potential for a successful reduction in toxicity using 3D image-guided in addition to 3D image-planned brachytherapy.
RCT Entities:
PURPOSE: To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer. METHODS AND MATERIALS: From February 2004 to December 2006, 25 patients with gynecologic malignancies were enrolled and treated in a prospective clinical trial of real-time MRI-guided interstitial brachytherapy. This was followed by a confirmatory CT imaging scan. Statistical analyses included Kaplan-Meier estimates for overall and relapse-free survival. RESULTS: MRI visualization of needles during placement permitted accurate placement with no inadvertent insertions. This prevented unnecessary normal-tissue perforation as confirmed by CT simulation. With a mean followup of 3.8 years (range, 2-6.8), 1-, 2-, and 3-year overall survival rates were 80%, 60% and 43%, respectively; corresponding relapse-free survival rates were 79%, 65%, and 59%, respectively. Actuarial acute toxicity rates for any grade were 0% at 0-14 days and 80% (all grade 1) at 14-90 days. Long-term (>180 days) actuarial toxicity rates were 8% gastrointestinal, 4% bladder and 4% vaginal. CONCLUSIONS: Real-time MRI guidance during insertion of interstitial needles followed by 3D-planning maximized opportunities for tumor targeting and sparing of normal tissues. Although image guidance requires additional anesthesia time, clinical outcomes indicate potential for a successful reduction in toxicity using 3D image-guided in addition to 3D image-planned brachytherapy.
Authors: Sophia C Kamran; Matthias M Manuel; Linda P Cho; Antonio L Damato; Ehud J Schmidt; Clare Tempany; Robert A Cormack; Akila N Viswanathan Journal: Gynecol Oncol Date: 2017-03-18 Impact factor: 5.482
Authors: Guillaume Pernelle; Alireza Mehrtash; Lauren Barber; Antonio Damato; Wei Wang; Ravi Teja Seethamraju; Ehud Schmidt; Robert A Cormack; Williams Wells; Akila Viswanathan; Tina Kapur Journal: Med Image Comput Comput Assist Interv Date: 2013
Authors: Jose de Arcos; Ehud J Schmidt; Wei Wang; Junichi Tokuda; Kamal Vij; Ravi T Seethamraju; Antonio L Damato; Charles L Dumoulin; Robert A Cormack; Akila N Viswanathan Journal: Int J Radiat Oncol Biol Phys Date: 2017-06-07 Impact factor: 7.038
Authors: Wei Wang; Charles L Dumoulin; Akila N Viswanathan; Zion T H Tse; Alireza Mehrtash; Wolfgang Loew; Isaiah Norton; Junichi Tokuda; Ravi T Seethamraju; Tina Kapur; Antonio L Damato; Robert A Cormack; Ehud J Schmidt Journal: Magn Reson Med Date: 2014-06-05 Impact factor: 4.668
Authors: Pelin A Ciris; Mukund Balasubramanian; Antonio L Damato; Ravi T Seethamraju; Clare M Tempany-Afdhal; Robert V Mulkern; Akila N Viswanathan Journal: J Magn Reson Imaging Date: 2016-03-12 Impact factor: 4.813
Authors: Wei Wang; Akila N Viswanathan; Antonio L Damato; Yue Chen; Zion Tse; Li Pan; Junichi Tokuda; Ravi T Seethamraju; Charles L Dumoulin; Ehud J Schmidt; Robert A Cormack Journal: Med Phys Date: 2015-12 Impact factor: 4.071