Reporting and Validation of Gynaecological Groupe Euopeen de Curietherapie European Society for Therapeutic Radiology and Oncology (ESTRO) Brachytherapy Recommendations for MR Image-Based Dose Volume Parameters and Clinical Outcome With High Dose-Rate Brachytherapy in Cervical Cancers A Single-Institution Initial Experience

Objective: The objectives are to report the dosimetric analysis, preliminary clinical outcome, and comparison with published data of 3-dimensional magnetic resonance-based high dose rate brachytherapy (BT) in cervical cancer. Materials and Methods: The data set of 24 patients with cervical cancer treated with high dose-rate brachytherapy applications was analyzed. All patients received radiation with or without chemotherapy (10 patients received concomitant chemoradiation). Point A, International Commission on Radiation Units and Measurement (ICRU) point doses, and Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology dose volume parameters, namely, high-risk clinical target volume (HR-CTV), D90 and D100 doses, and dose to D-0.1cc and D-2cc, for rectum, bladder, and sigmoid, were calculated and correlated. Results: Mean +/- SD HR-CTV was 45.2 +/- 15.8 cc. The mean +/- SD point A dose was 73.4 +/- 4.5 Gy (median, 74.3 Gy) total biologically equivalent dose in 2 Gy per fraction (EQD2), whereas mean +/- SD D90 doses were 70.9 +/- 10.6 Gy(EQD2) (median, 68). The mean +/- SD ICRU rectal and bladder points were 63.5 +/- 8.1 and 80.4 +/- 34.4 Gy(EQD2), respectively. The D0.1cc and D2cc for rectum were 66.0 +/- 9.9 Gy(EQD2) (median, 64.5) and 57.8 +/- 7.7 Gy(EQD2) (median, 58.8), for bladder 139.1 +/- 54.7 Gy(EQD2) (median, 131.9) and 93.4 +/- 24.6 Gy(EQD2) (median, 91), and sigmoid were 109.4 +/- 45.2 Gy(EQD2) (median, 91) and 74.6 +/- 19.6 Gy(EQD2) (median, 69.6). With a median follow-up of 24 months, 3 patients had local nodal failure, 1 had right external iliac nodal failure, and 1 had left supraclavicular nodal failure. Conclusions: The 3-D magnetic resonance image-based high dose-rate brachytherapy approach in cervical cancers is feasible. In our experience, the HR-CTV volumes are large, and D-0.1cc and D-2cc doses to bladder and sigmoid are higher than published literature so far.