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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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abstract:
Original paper

Impact of MRI-based planning in transperineal interstitial brachytherapy for vaginal-involving tumors

Diana Guevara Barrera
1, 2
,
Silvia Rodríguez Villalba
2
,
Luis Suso-Martí
3
,
Enrique Sanchis-Sánchez
,
Jose Perez-Calatayud
2, 4
,
Francisco Blázquez Molina
2
,
Maria Jose Pérez-Calatayud
4
,
Manuel Santos Ortega
2

  1. Universidad Católica de Valencia San Vicente Mártir, Escuela de Doctorado, Ciutat Vella, Valencia, Spain
  2. Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain
  3. Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
  4. Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
J Contemp Brachytherapy 2024; 16
DOI: https://doi.org/10.5114/jcb.2024.144683
Online publish date: 2024/10/30
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Purpose:
The purpose of the study was to analyze patients with vaginal-involving recurrences of gynecological tumors and primary vaginal tumors, treated with transperineal interstitial brachytherapy (P-ISBT). Dosimetric, clinical, and toxicity analysis of these patients was conducted, incorporating MRI in volume definition and dose-volume dosimetry.

Material and methods:
Forty-two patients were retrospectively analyzed. They were treated with radical or adjuvant intent (in hysterectomized patients with high-risk of relapse). P-ISBT was performed with MUPIT (CT-based planning) in 18 patients (42.9%) and with Template Benidorm (TB) (MRI-based planning) in 24 patients (57.1%).

Results:
Median age was 59 years (range, 39-78 years). Median clinical target volume (CTV) was 81.4 cc (range, 33.8-286.2 cc) in MUPIT, and 47.5 cc (range, 10-156.4 cc) in TB-treated patients (p = 0.01). Median EQD2 for EBRT and brachytherapy D90 CTV was 69.2 Gy (range, 27.9-88.8 Gy) in MUPIT, and 77.2 Gy (range, 31-84.3 Gy) in TB. Median rectal D2cc was 69.2 Gy (range, 23.5-82.6 Gy) in MUPIT, and 66.3 Gy (range, 16.4-75 Gy) in TB. Median bladder D2cc was 71.5 Gy (range, 23.6-90.8 Gy) in MUPIT, and 66.9 Gy (range, 18.2-78.3 Gy) in TB. Median follow-up was 36.5 months (range, 4-188 months). Local control was 95% at 3 and 5 years. Overall survival was 77% at 3 years, and 66% at 5 years. Disease-specific survival was 81% at 3 years, and 75% at 5 years. Chronic grade 1-2 proctitis presented in 10 patients (24%; 8 treated with MUPIT and 2 treated with TB; p = 0.01). Grade 3 toxicity was documented in 4 patients (9.6%).

Conclusions:
MRI-based planning is superior to CT-based planning in P-ISBT. It allows for better definition of CTV, resulting in smaller and more selective treatment volumes. Our results show a tendency towards higher D90 CTV dose and lower rectal/bladder D2cc dose, leading to less events of late rectal toxicity.

keywords:

MRI, interstitial, brachytherapy, vagina

  
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