Value of Magnetic Resonance Imaging Without or with Applicator in Place for Target Definition in Cervix Cancer Brachytherapy

Richard Pötter, Mario Federico, Alina Sturdza, Irina Fotina, Neamat Hegazy, Maximilian Schmid, Christian Kirisits, Nicole Nesvacil

    Research output: Contribution to journalArticlepeer-review

    25 Citations (Scopus)


    Purpose To define, in the setting of cervical cancer, to what extent information from additional pretreatment magnetic resonance imaging (MRI) without the brachytherapy applicator improves conformity of CT-based high-risk clinical target volume (CTVHR) contours, compared with the MRI for various tumor stages (International Federation of Gynecology and Obstetrics [FIGO] stages I-IVA). Methods and Materials The CTVHR was contoured in 39 patients with cervical cancer (FIGO stages I-IVA) (1) on CT images based on clinical information (CTVHR-CTClinical) alone; and (2) using an additional MRI before brachytherapy, without the applicator (CTVHR-CTpre-BT MRI). The CT contours were compared with reference contours on MRI with the applicator in place (CTVHR-MRIref). Width, height, thickness, volumes, and topography were analyzed. Results The CT-MRIref differences hardly varied in stage I tumors (n=8). In limited-volume stage IIB and IIIB tumors (n=19), CTVHR-CTpre-BT MRI-MRIref volume differences (2.6 cm3 [IIB], 7.3 cm3 [IIIB]) were superior to CTVHR-CTClinical-MRIref (11.8 cm3 [IIB], 22.9 cm3 [IIIB]), owing to significant improvement of height and width (PHR-CTpre-BT MRI. In 5 of 12 cases, MRIref contours were partly missed on CT. Conclusions Pre-BT MRI helps to define CTVHR before BT implantation appropriately, if only CT images with the applicator in place are available for BT planning. Significant improvement is achievable in limited-volume stage IIB and IIIB tumors. In more advanced disease (extensive IIB to IVA), improvement of conformity is possible but may be associated with geographic misses. Limited impact on precision of CTVHR-CT is expected in stage IB tumors.

    Original languageEnglish
    Pages (from-to)588-597
    Number of pages10
    JournalInternational Journal of Radiation Oncology Biology Physics
    Issue number3
    Publication statusPublished - 2016

    ASJC Scopus subject areas

    • Oncology
    • Radiology Nuclear Medicine and imaging
    • Radiation
    • Cancer Research

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