Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer.

Background: To investigate the clinical impact of MRI based cervix cancer brachytherapy combined with external beam radiochemotherapy applying dose volume adaptation and dose escalation in a consecutive group of patients with locally advanced cervix cancer.

Methods: In the period 1998-2003, 145 patients with cervix cancer stages IB-IVA were treated with definitive radiotherapy +/- cisplatin chemotherapy. Median age was 60 years.

Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma.

Background: In advanced vaginal recurrences of cervical and endometrial carcinomas therapeutic options are rare because of preceding therapy.

Patients And Methods: 23 patients developing advanced vaginal recurrences of cervical and endometrial carcinomas were included. 15 patients started with external-beam therapy to the pelvis and eight patients after preceding radiotherapy underwent brachytherapy alone.

Pilot study in the treatment of endometrial carcinoma with 3D image-based high-dose-rate brachytherapy using modified Heyman packing: clinical experience and dose-volume histogram analysis.

Purpose: The aim of this study was to evaluate dose distribution within uterus (clinical target volume [CTV]) and tumor (gross tumor volume [GTV]) and the resulting clinical outcome based on systematic three-dimensional treatment planning with dose-volume adaptation. Dose-volume assessment and adaptation in organs at risk and its impact on side effects were investigated in parallel.

Methods And Materials: Sixteen patients with either locally confined endometrial carcinoma (n = 15) or adenocarcinoma of uterus and ovaries after bilateral salpingo-oophorectomy (n = 1) were included.

Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy.

Background And Purpose: To date, no information is available concerning the impact of spinal anesthesia on the oxygenation status of carcinomas of the uterine cervix. The aim of this study was therefore to determine the influence of spinal anesthesia on the oxygenation status of cervical carcinomas.

Patients And Methods: In ten patients with cervical carcinoma who received spinal anesthesia for a first application of brachytherapy, intratumoral pO2 measurements (pO2 histography system, Eppendorf-Netheler-Hinz, Hamburg, Germany) were performed.

Bladder and rectum dose defined from MRI based treatment planning for cervix cancer brachytherapy: comparison of dose-volume histograms for organ contours and organ wall, comparison with ICRU rectum and bladder reference point.

Purpose: To analyze the correlation between dose-volume histograms based on organ contour and organ wall delineation for bladder and rectum, and to compare the doses to these organs with the absorbed doses at the ICRU bladder and rectum reference points.

Material And Methods: Individual MRI based brachytherapy treatment planning was performed in 15 patients as part of a prospective comparative trial. The external contours and the organ walls were delineated for the bladder and rectum in order to compute the corresponding dose-volume histograms.

The impact of sectional imaging on dose escalation in endocavitary HDR-brachytherapy of cervical cancer: results of a prospective comparative trial.

Purpose: The purpose of this comparative prospective study was to assess the effect of CT and MR based individualisation and adaptation on the dose distribution in the target volume and organs at risk compared to a radiography based procedure.

Material And Methods: In 15 patients MR scans, in 10 patients additional axial CT-scans with compatible tube-ring applicator in situ were performed and digitally transferred to the PLATO(R) planning system. Considering clinical examination and MR-scan before radiotherapy individual 3-D dose distribution was calculated and adapted based on (1) two orthogonal radiographs; (2) isodoses superimposed on the CT images; and (3) isodoses superimposed on the MR images.

Serum VEGF levels in patients undergoing primary radiotherapy for cervical cancer: impact on progression-free survival.

Vascular endothelial growth factor (VEGF) plays an important role in the regulation of tumour growth and metastasis. It was the aim of this study to examine the impact of serum VEGF levels on the likelihood of response to radiotherapy and on the disease-free survival in patients with cervical cancer. Blood was taken before commencing treatment and serum VEGF was assessed by quantitative ELISA in 23 patients with cervical cancer stage IB-IVA undergoing primary radiotherapy.