Purpose: To present an institutional experience with MRI-based intracavitary brachytherapy planning for cervix cancer treatments using the EMBRACE protocol and to evaluate maximum HR-CTV doses that can be achieved when OAR (bladder, rectum, and sigmoid) doses are allowed to equal GECESTRO recommended thresholds.
Method: Dose metrics from treatment plans for 20 patients created using MR images (for contouring HR-CTV and OARs) fused with CT images (for applicator reconstruction) are presented. Starting with a standard Manchester loading, plans were manually optimized (MO) by adjusting dwell positions and times to obtain the desired HR-CTV D90 target coverage of 35 Gy while limiting OAR doses to below recommended tolerances. In addition, retrospective planning was done using: (i) volume optimization (VO) to compare differences with MO in obtaining the desired target coverage; and (ii) MO and VO techniques to get the highest possible HR-CTV coverage by allowing OAR doses to equal tolerance values. The latter plans are referred to as MAX plans.
Results And Conclusions: 3D MRI-guided treatment planning for cervix brachytherapy was shown to improve dose-volume coverage of the target and OARs. MO could conform HR-CTV D90 to the prescribed dose similar to the VO technique. Sigmoid was often the dose limiting structure. With respect to the prescribed HR-CTV D90 dose of 35 Gy, MAX plans could increase the prescribed dose by about 22% and 30% for MO and VO plans, respectively, without exceeding OAR thresholds. Consequently, dose escalation for MRI-guided cervix brachytherapy appears feasible should clinical circumstances warrant.
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