Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma

Report from Image-Guided Brachytherapy Working Group

Subir Nag, Higinia Cardenes, Silvia Chang, Indra J. Das, Beth Erickson, Geoffrey S. Ibbott, Jessica Lowenstein, Joye Roll, Bruce Thomadsen, Mahesh Varia

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

Purpose To present issues to be considered in, and make proposals for, image-based brachytherapy for cervical cancer. Methods and materials The Image-Guided Brachytherapy Working Group, consisting of representatives from the Gynecology Oncology Group (GOG), Radiologic Physics Center (RPC), American Brachytherapy Society (ABS), American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN), American Association of Physicists in Medicine (AAPM), Radiation Therapy Oncology Group (RTOG), and American Society for Therapeutic Radiology and Oncology (ASTRO), proposed guidelines for image-based brachytherapy for cervical cancer. This report was based on their aggregate clinical experience and a review of the literature. It reflects only the personal opinions of the authors and is not meant to be an endorsement from any of the above organizations. Results The Group recommended T 2-weighted MRI using a pelvic surface coil with MRI-compatible brachytherapy applicators in place for image-based intracavitary brachytherapy for cervical cancer. Imaging must be performed with the patient in the treatment position, with all other treatment conditions duplicated as closely as possible. Future use of positron emission tomography or positron emission tomography/CT may obviate the need for special applicators. The group proposed the following terminology for image-based brachytherapy. The GTV(I) is defined as the gross tumor volume as defined through imaging, GTV is defined as the GTV(I) plus any clinically visualized or palpable tumor extensions, and GTV + cx is defined as the GTV plus the entire cervix. The dose-volume histograms (DVH) of the GTV, GTV(I), GTV + cx should be performed, and the dose to 100%, 95%, or 90% of the GTV (D100, D 95, and D90, respectively) and the percentage of the GTV covered by Point A dose (V100) should be reported. Similarly, the DVH of the bladder and rectum wall should be performed, and the maximal dose at any point within the bladder and rectal wall should be reported, along with the maximal dose to a contiguous 1, 2, and 5 cm3 volume of the bladder and rectum, respectively. In addition, the dose at the International Commission on Radiation Units and Measurements reference point for the bladder and rectum should be reported. The Group thought that the current dose prescription method in use for cervical cancer brachytherapy (i.e., to prescribe to Point A in most institutions) should not be changed as yet, because image-based dosimetry is not ready for routine practice. The Group proposes that for research purposes, individual centers and cooperative groups (e.g., GOG, RTOG, ACRIN) collect image-based dosimetry information and perform DVHs and correlate these data with the clinical outcome to determine which of the above parameters are relevant. The Group encourages external funding for image-based dosimetry and recommends that brachytherapy manufacturers develop image-compatible applicators. Conclusion Although current institutional brachytherapy prescription for cervical cancer should continue, image-based data collection and analysis are needed to optimize cervical cancer brachytherapy. Proposals are made for research in image-based brachytherapy for cervical cancer.

Original languageEnglish (US)
Pages (from-to)1160-1172
Number of pages13
JournalInternational Journal of Radiation Oncology Biology Physics
Volume60
Issue number4
DOIs
StatePublished - Nov 15 2004
Externally publishedYes

Fingerprint

Brachytherapy
cancer
Guidelines
Carcinoma
Uterine Cervical Neoplasms
dosage
bladder
rectum
radiology
Urinary Bladder
gynecology
Rectum
Radiology
dosimeters
Radiation Oncology
Gynecology
histograms
Positron-Emission Tomography
Prescriptions
proposals

Keywords

  • Brachytherapy
  • Cervical neoplasm
  • CT scan
  • Image-based
  • MRI
  • Treatment guidelines

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma : Report from Image-Guided Brachytherapy Working Group. / Nag, Subir; Cardenes, Higinia; Chang, Silvia; Das, Indra J.; Erickson, Beth; Ibbott, Geoffrey S.; Lowenstein, Jessica; Roll, Joye; Thomadsen, Bruce; Varia, Mahesh.

In: International Journal of Radiation Oncology Biology Physics, Vol. 60, No. 4, 15.11.2004, p. 1160-1172.

Research output: Contribution to journalArticle

Nag, Subir ; Cardenes, Higinia ; Chang, Silvia ; Das, Indra J. ; Erickson, Beth ; Ibbott, Geoffrey S. ; Lowenstein, Jessica ; Roll, Joye ; Thomadsen, Bruce ; Varia, Mahesh. / Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma : Report from Image-Guided Brachytherapy Working Group. In: International Journal of Radiation Oncology Biology Physics. 2004 ; Vol. 60, No. 4. pp. 1160-1172.
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abstract = "Purpose To present issues to be considered in, and make proposals for, image-based brachytherapy for cervical cancer. Methods and materials The Image-Guided Brachytherapy Working Group, consisting of representatives from the Gynecology Oncology Group (GOG), Radiologic Physics Center (RPC), American Brachytherapy Society (ABS), American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN), American Association of Physicists in Medicine (AAPM), Radiation Therapy Oncology Group (RTOG), and American Society for Therapeutic Radiology and Oncology (ASTRO), proposed guidelines for image-based brachytherapy for cervical cancer. This report was based on their aggregate clinical experience and a review of the literature. It reflects only the personal opinions of the authors and is not meant to be an endorsement from any of the above organizations. Results The Group recommended T 2-weighted MRI using a pelvic surface coil with MRI-compatible brachytherapy applicators in place for image-based intracavitary brachytherapy for cervical cancer. Imaging must be performed with the patient in the treatment position, with all other treatment conditions duplicated as closely as possible. Future use of positron emission tomography or positron emission tomography/CT may obviate the need for special applicators. The group proposed the following terminology for image-based brachytherapy. The GTV(I) is defined as the gross tumor volume as defined through imaging, GTV is defined as the GTV(I) plus any clinically visualized or palpable tumor extensions, and GTV + cx is defined as the GTV plus the entire cervix. The dose-volume histograms (DVH) of the GTV, GTV(I), GTV + cx should be performed, and the dose to 100{\%}, 95{\%}, or 90{\%} of the GTV (D100, D 95, and D90, respectively) and the percentage of the GTV covered by Point A dose (V100) should be reported. Similarly, the DVH of the bladder and rectum wall should be performed, and the maximal dose at any point within the bladder and rectal wall should be reported, along with the maximal dose to a contiguous 1, 2, and 5 cm3 volume of the bladder and rectum, respectively. In addition, the dose at the International Commission on Radiation Units and Measurements reference point for the bladder and rectum should be reported. The Group thought that the current dose prescription method in use for cervical cancer brachytherapy (i.e., to prescribe to Point A in most institutions) should not be changed as yet, because image-based dosimetry is not ready for routine practice. The Group proposes that for research purposes, individual centers and cooperative groups (e.g., GOG, RTOG, ACRIN) collect image-based dosimetry information and perform DVHs and correlate these data with the clinical outcome to determine which of the above parameters are relevant. The Group encourages external funding for image-based dosimetry and recommends that brachytherapy manufacturers develop image-compatible applicators. Conclusion Although current institutional brachytherapy prescription for cervical cancer should continue, image-based data collection and analysis are needed to optimize cervical cancer brachytherapy. Proposals are made for research in image-based brachytherapy for cervical cancer.",
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author = "Subir Nag and Higinia Cardenes and Silvia Chang and Das, {Indra J.} and Beth Erickson and Ibbott, {Geoffrey S.} and Jessica Lowenstein and Joye Roll and Bruce Thomadsen and Mahesh Varia",
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TY - JOUR

T1 - Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma

T2 - Report from Image-Guided Brachytherapy Working Group

AU - Nag, Subir

AU - Cardenes, Higinia

AU - Chang, Silvia

AU - Das, Indra J.

AU - Erickson, Beth

AU - Ibbott, Geoffrey S.

AU - Lowenstein, Jessica

AU - Roll, Joye

AU - Thomadsen, Bruce

AU - Varia, Mahesh

PY - 2004/11/15

Y1 - 2004/11/15

N2 - Purpose To present issues to be considered in, and make proposals for, image-based brachytherapy for cervical cancer. Methods and materials The Image-Guided Brachytherapy Working Group, consisting of representatives from the Gynecology Oncology Group (GOG), Radiologic Physics Center (RPC), American Brachytherapy Society (ABS), American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN), American Association of Physicists in Medicine (AAPM), Radiation Therapy Oncology Group (RTOG), and American Society for Therapeutic Radiology and Oncology (ASTRO), proposed guidelines for image-based brachytherapy for cervical cancer. This report was based on their aggregate clinical experience and a review of the literature. It reflects only the personal opinions of the authors and is not meant to be an endorsement from any of the above organizations. Results The Group recommended T 2-weighted MRI using a pelvic surface coil with MRI-compatible brachytherapy applicators in place for image-based intracavitary brachytherapy for cervical cancer. Imaging must be performed with the patient in the treatment position, with all other treatment conditions duplicated as closely as possible. Future use of positron emission tomography or positron emission tomography/CT may obviate the need for special applicators. The group proposed the following terminology for image-based brachytherapy. The GTV(I) is defined as the gross tumor volume as defined through imaging, GTV is defined as the GTV(I) plus any clinically visualized or palpable tumor extensions, and GTV + cx is defined as the GTV plus the entire cervix. The dose-volume histograms (DVH) of the GTV, GTV(I), GTV + cx should be performed, and the dose to 100%, 95%, or 90% of the GTV (D100, D 95, and D90, respectively) and the percentage of the GTV covered by Point A dose (V100) should be reported. Similarly, the DVH of the bladder and rectum wall should be performed, and the maximal dose at any point within the bladder and rectal wall should be reported, along with the maximal dose to a contiguous 1, 2, and 5 cm3 volume of the bladder and rectum, respectively. In addition, the dose at the International Commission on Radiation Units and Measurements reference point for the bladder and rectum should be reported. The Group thought that the current dose prescription method in use for cervical cancer brachytherapy (i.e., to prescribe to Point A in most institutions) should not be changed as yet, because image-based dosimetry is not ready for routine practice. The Group proposes that for research purposes, individual centers and cooperative groups (e.g., GOG, RTOG, ACRIN) collect image-based dosimetry information and perform DVHs and correlate these data with the clinical outcome to determine which of the above parameters are relevant. The Group encourages external funding for image-based dosimetry and recommends that brachytherapy manufacturers develop image-compatible applicators. Conclusion Although current institutional brachytherapy prescription for cervical cancer should continue, image-based data collection and analysis are needed to optimize cervical cancer brachytherapy. Proposals are made for research in image-based brachytherapy for cervical cancer.

AB - Purpose To present issues to be considered in, and make proposals for, image-based brachytherapy for cervical cancer. Methods and materials The Image-Guided Brachytherapy Working Group, consisting of representatives from the Gynecology Oncology Group (GOG), Radiologic Physics Center (RPC), American Brachytherapy Society (ABS), American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN), American Association of Physicists in Medicine (AAPM), Radiation Therapy Oncology Group (RTOG), and American Society for Therapeutic Radiology and Oncology (ASTRO), proposed guidelines for image-based brachytherapy for cervical cancer. This report was based on their aggregate clinical experience and a review of the literature. It reflects only the personal opinions of the authors and is not meant to be an endorsement from any of the above organizations. Results The Group recommended T 2-weighted MRI using a pelvic surface coil with MRI-compatible brachytherapy applicators in place for image-based intracavitary brachytherapy for cervical cancer. Imaging must be performed with the patient in the treatment position, with all other treatment conditions duplicated as closely as possible. Future use of positron emission tomography or positron emission tomography/CT may obviate the need for special applicators. The group proposed the following terminology for image-based brachytherapy. The GTV(I) is defined as the gross tumor volume as defined through imaging, GTV is defined as the GTV(I) plus any clinically visualized or palpable tumor extensions, and GTV + cx is defined as the GTV plus the entire cervix. The dose-volume histograms (DVH) of the GTV, GTV(I), GTV + cx should be performed, and the dose to 100%, 95%, or 90% of the GTV (D100, D 95, and D90, respectively) and the percentage of the GTV covered by Point A dose (V100) should be reported. Similarly, the DVH of the bladder and rectum wall should be performed, and the maximal dose at any point within the bladder and rectal wall should be reported, along with the maximal dose to a contiguous 1, 2, and 5 cm3 volume of the bladder and rectum, respectively. In addition, the dose at the International Commission on Radiation Units and Measurements reference point for the bladder and rectum should be reported. The Group thought that the current dose prescription method in use for cervical cancer brachytherapy (i.e., to prescribe to Point A in most institutions) should not be changed as yet, because image-based dosimetry is not ready for routine practice. The Group proposes that for research purposes, individual centers and cooperative groups (e.g., GOG, RTOG, ACRIN) collect image-based dosimetry information and perform DVHs and correlate these data with the clinical outcome to determine which of the above parameters are relevant. The Group encourages external funding for image-based dosimetry and recommends that brachytherapy manufacturers develop image-compatible applicators. Conclusion Although current institutional brachytherapy prescription for cervical cancer should continue, image-based data collection and analysis are needed to optimize cervical cancer brachytherapy. Proposals are made for research in image-based brachytherapy for cervical cancer.

KW - Brachytherapy

KW - Cervical neoplasm

KW - CT scan

KW - Image-based

KW - MRI

KW - Treatment guidelines

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