TU-E-213CD-01: Image Guided Adaptive Brachytherapy for Cervical Cancer

Area of Science:

• Radiation Oncology
• Medical Imaging
• Gynecologic Oncology

Background:

• Modern radiation therapy heavily utilizes image guidance, unlike traditional brachytherapy techniques.
• Advancements in afterloading technology, planning systems, and imaging-compatible applicators enable image-guided adaptive brachytherapy (IGABT).
• IGABT allows for more precise target delineation and radiation dose delivery, sparing healthy tissues.

Purpose of the Study:

• To review the role of IGABT in cervical cancer management from a physics perspective.
• To compare different IGABT modalities including MRI, CT, and US, and hybrid approaches.
• To discuss the advantages, challenges, and limitations of MRI in IGABT and explore current debates in planning and delivery.

Main Methods:

• Review of current literature and guidelines (e.g., GEC-ESTRO) for IGABT in cervical cancer.
• Discussion of imaging techniques (MRI, CT, US) and their application in brachytherapy planning.
• Analysis of challenges including image artifacts, applicator reconstruction, and available technology.

Main Results:

• MRI offers superior soft tissue resolution for precise target delineation in IGABT for cervical cancer.
• CT and US provide alternatives when MRI is unavailable, though with limitations in soft tissue visualization.
• Hybrid approaches combining MRI and CT/US are being explored for adaptive planning across fractions.

Conclusions:

• IGABT, particularly MRI-guided, is crucial for optimizing cervical cancer brachytherapy, improving dose control and reducing toxicity.
• Addressing technical challenges in MRI and exploring hybrid approaches are key for wider IGABT implementation.
• Ongoing research and standardization are needed to resolve debates on planning, dose calculation, and adaptive strategies in IGABT.