Megan C Jacobsen1, Sushil Beriwal2, Brandon A Dyer3, Ann H Klopp4, Susanna I Lee5, Gwendolyn J McGinnis4, Jessica B Robbins6, Gaiane M Rauch7, Elizabeth A Sadowski6, Samantha J Simiele8, R Jason Stafford1, Neil K Taunk9, Catheryn M Yashar10, Aradhana M Venkatesan11. 1. The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX. 2. Allegheny Health Network, Department of Radiation Oncology, Pittsburgh, PA; Varian Medical Systems, Palo Alto, CA. 3. Legacy Health, Department of Radiation Oncology, Portland, OR. 4. The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX. 5. Massachusetts General Hospital, Department of Radiology, Boston, MA. 6. University of Wisconsin, Department of Radiology, Madison, WI. 7. The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX. 8. The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX. 9. University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA. 10. University of California San Diego, Department of Radiation Oncology, San Diego, CA. 11. The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX. Electronic address: AVenkatesan@mdanderson.org.
Abstract
PURPOSE: To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS: An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS: Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS: Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.
PURPOSE: To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS: An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS: Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS: Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.