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Increasing Patient Safety and Treatment Quality by Using Intraoperative MRI for Organ-Preserving Tumor Resection and
Andreas Schmidt1, Constantin Roder2,3, Franziska Eckert4,5
1Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
Insights
Intraoperative MRI (iMRI) precisely guided brachytherapy tube placement in pediatric bladder/prostate and perianal rhabdomyosarcoma, improving treatment safety and timeliness. This enhanced radiotherapy planning for organ-preserving care.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical Imaging
Background:
- Bladder/prostate (BP) and perianal rhabdomyosarcoma (RMS) in children require precise treatment.
- Organ-preserving surgery combined with high-dose rate brachytherapy (HDR-BT) offers improved outcomes.
- Accurate placement of HDR-BT tubes is critical for effective radiotherapy planning.
Purpose of the Study:
- To evaluate the utility of intraoperative MRI (iMRI) for controlling HDR-BT tube placement.
- To assess the impact of iMRI on radiotherapy planning and initiation in pediatric BP and perianal RMS.
- To determine if iMRI enhances patient safety and treatment quality in this specific population.
Main Methods:
- Retrospective evaluation of 12 children with BP and perianal RMS treated with organ-preserving resection and HDR-BT since January 2021.
- Utilization of iMRI to visualize and confirm the exact position of HDR-BT tubes.
- Comparison with a historical cohort treated without iMRI.
Main Results:
- iMRI successfully and clearly localized all HDR-BT tubes in 12 pediatric patients.
- No adverse events were associated with the use of iMRI.
- Radiotherapy initiation was timely in all 12 children who underwent iMRI.
- In contrast, 3 out of 20 children in the historical cohort experienced delays in radiotherapy initiation.
Conclusions:
- Intraoperative MRI is a safe and effective tool for precise HDR-BT tube placement in pediatric BP and perianal RMS.
- iMRI improves radiotherapy planning accuracy and ensures timely treatment initiation.
- The integration of iMRI has become a standard procedure, enhancing patient safety and treatment quality.
Abstract:
In children with bladder/prostate (BP) and perianal rhabdomyosarcoma (RMS), we use a hybrid treatment concept for those suitable, combining organ-preserving tumor resection and high-dose rate brachytherapy (HDR-BT). This treatment concept has been shown to improve outcomes. However, it is associated with specific challenges for the clinicians. The exact position of the tubes for BT is a prerequisite for precise radiotherapy. It can finally be determined only with an MRI or CT scan. We evaluated the use of an intraoperative MRI (iMRI) to control the position of the BT tubes and for radiotherapy planning in all patients with BP and perianal RMS who received the above-mentioned combination therapy in our department since January 2021. iMRI was used in 12 children. All tubes were clearly localized. No adverse events occurred. In all 12 children, radiotherapy could be started on time. In a historical cohort without iMRI, this was not possible in 3 out of 20 children. The use of iMRI in children with BP and perianal RMS improved patient safety and treatment quality. This technology has proven to be successful for the patient population we have defined and has become a standard procedure in our institution.
