Online MRI guidance for healthy tissue sparing in patients with cervical cancer: An IMRT planning study

Abstract Background and purpose During cervical cancer treatment, target volumes change position and shape due to organ motion and tumour regression. An MRI-accelerator will provide information on these changes by online magnetic resonance imaging (MRI) guidance throughout each treatment fraction. T...

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Bibliographic Details
Published in:Radiotherapy and oncology 2008-08, Vol.88 (2), p.241-249
Main Authors: Kerkhof, Ellen M, Raaymakers, Bas W, van der Heide, Uulke A, van de Bunt, Linda, Jürgenliemk-Schulz, Ina M, Lagendijk, Jan J.W
Format: Article
Language:English
Subjects:
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - radiotherapy
Cervical cancer
Female
Hematology, Oncology and Palliative Medicine
Humans
IGRT
IMRT
Intestines - radiation effects
Magnetic Resonance Imaging
Motion
MRI
Neoplasm Staging
Organ movement
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Intensity-Modulated
Statistics, Nonparametric
Tomography, X-Ray Computed
Treatment Outcome
Urinary Bladder - radiation effects
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - radiotherapy
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Summary:Abstract Background and purpose During cervical cancer treatment, target volumes change position and shape due to organ motion and tumour regression. An MRI-accelerator will provide information on these changes by online magnetic resonance imaging (MRI) guidance throughout each treatment fraction. The purpose of this intensity-modulated radiation therapy (IMRT) planning study is to assess the benefit of online MRI guidance in healthy tissue sparing. Materials and methods Weekly MRI scans of 11 cervical cancer patients were used. We created four IMRT plans per patient, based on these weekly MRI scans, to simulate an online-IMRT approach. We applied a primary and nodal planning target volume (PTV) margin of 4 mm. As reference, we created an IMRT plan based on the pre-treatment MRI scan (pre-IMRT) using a primary and nodal PTV margin of 15 and 10 mm. The weekly defined bladder, rectum, bowel, and sigmoid contours were evaluated on the online-IMRT and pre-IMRT dose distributions at six dose levels (V10Gy , V20Gy , V30Gy , V40Gy , V42.8Gy , and V45Gy ). Results Online-IMRT compared to pre-IMRT significantly reduced the volume of healthy tissue irradiated to all dose levels, except V10Gy. Conclusions Online MRI guidance reduces healthy tissue involvement in patients with cervical cancer.
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2008.04.009