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The potential value of MRI in external-beam radiotherapy for cervical cancer.
Cree, Anthea Livsey, Jacqueline E Barraclough, Lisa H Dubec, Michael Hambrock, Thomas van Herk, Marcel Choudhury, Ananya McWilliam, Alan
Cree, Anthea
Livsey, Jacqueline E
Barraclough, Lisa H
Dubec, Michael
Hambrock, Thomas
van Herk, Marcel
Choudhury, Ananya
McWilliam, Alan
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Abstract
The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.
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Date
2018-11
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Article
Citation
The potential value of MRI in external-beam radiotherapy for cervical cancer. 2018, 30(11): 737-750 Clin Oncol (R Coll Radiol)