Shrikiriti S Rajan, Matthew S Ning, Megan Jacobson, Samantha J Simiele, Teresa Bruno, Ramez Kouzy, Kyoko Yoshida-Court, Tatiana Cisneros-Napravnik, Henry Yu, Jason Stafford, Yusung Kim, Geena Mathew, Rauda Alicia Cordova, Maliah Domingo, Anuja Jhingran, Lilie L Lin, Melissa Joyner, Travis T Sims, Lauren Colbert, Aradhana M Venkatesan, Ann Klopp
{"title":"迭代术中3T MRI （iMRI）引导近距离放疗：提高晚期妇科癌症植入精度和剂量学增益的前瞻性研究。","authors":"Shrikiriti S Rajan, Matthew S Ning, Megan Jacobson, Samantha J Simiele, Teresa Bruno, Ramez Kouzy, Kyoko Yoshida-Court, Tatiana Cisneros-Napravnik, Henry Yu, Jason Stafford, Yusung Kim, Geena Mathew, Rauda Alicia Cordova, Maliah Domingo, Anuja Jhingran, Lilie L Lin, Melissa Joyner, Travis T Sims, Lauren Colbert, Aradhana M Venkatesan, Ann Klopp","doi":"10.1016/j.brachy.2025.06.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To report on primary outcomes and dosimetric results of a prospective clinical trial and protocol for use of iterative intraoperative magnetic resonance imaging (iMRI) in gynecologic brachytherapy.</p><p><strong>Methods: </strong>Patients with locally advanced cervical or vaginal cancer (FIGO stages IB2 - IVA, and stage II-IVA, respectively) undergoing pulsed dose rate (PDR) brachytherapy were enrolled in a prospective clinical trial (NCT03634267) using iterative 3T iMRI during brachytherapy implant placement. Applicator and optional interstitial needles were placed under iMRI guidance in a 3T clinical MRI scanner. Imaging, dosimetry and clinical outcomes (local control (LC), recurrence-free survival (RFS), overall survival (OS)), and acute and long-term toxicity were evaluated prospectively and confirmed by chart review. To explore dosimetric gains, an EQD2 estimate comparing iMRI-guidance versus standard of care guidance, as well as a 3-patient analysis of dose changes with iMRI-guided optimization was included.</p><p><strong>Results: </strong>Fourteen patients underwent iMRI-guided brachytherapy. Seventy percent (70%) of patients presented with FIGO stage III disease or higher. Median follow-up was 44 months. . Patients had 2-year median LC, RFS, and OS rates of 83.3%, 76%, and 84.6%, respectively. Acute toxicities were minimal with one (1) case of grade 3 nausea. No grade 3 or higher long-term toxicities were observed. Median operating room (OR) time was 283 minutes (range 174-380 mins). On exploratory analysis, implant placement performed with iMRI guidance demonstrated higher HR-CTV D90 doses (mean difference of +784.7 cGy, p = NS) were achieved compared to US and CT guided implantation in the same patients.</p><p><strong>Discussion: </strong>iMRI-guidance for gynecologic brachytherapy is safe, associated with minimal high-grade toxicity and excellent clinical outcomes. Future studies to optimize resource use, image acquisition efficiency, and identifying predictive imaging features are warranted.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Iterative intraoperative 3T MRI (iMRI)-guided brachytherapy: A prospective study on enhancing implantation precision and dosimetric gains in advanced gynecologic cancers.\",\"authors\":\"Shrikiriti S Rajan, Matthew S Ning, Megan Jacobson, Samantha J Simiele, Teresa Bruno, Ramez Kouzy, Kyoko Yoshida-Court, Tatiana Cisneros-Napravnik, Henry Yu, Jason Stafford, Yusung Kim, Geena Mathew, Rauda Alicia Cordova, Maliah Domingo, Anuja Jhingran, Lilie L Lin, Melissa Joyner, Travis T Sims, Lauren Colbert, Aradhana M Venkatesan, Ann Klopp\",\"doi\":\"10.1016/j.brachy.2025.06.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To report on primary outcomes and dosimetric results of a prospective clinical trial and protocol for use of iterative intraoperative magnetic resonance imaging (iMRI) in gynecologic brachytherapy.</p><p><strong>Methods: </strong>Patients with locally advanced cervical or vaginal cancer (FIGO stages IB2 - IVA, and stage II-IVA, respectively) undergoing pulsed dose rate (PDR) brachytherapy were enrolled in a prospective clinical trial (NCT03634267) using iterative 3T iMRI during brachytherapy implant placement. Applicator and optional interstitial needles were placed under iMRI guidance in a 3T clinical MRI scanner. Imaging, dosimetry and clinical outcomes (local control (LC), recurrence-free survival (RFS), overall survival (OS)), and acute and long-term toxicity were evaluated prospectively and confirmed by chart review. To explore dosimetric gains, an EQD2 estimate comparing iMRI-guidance versus standard of care guidance, as well as a 3-patient analysis of dose changes with iMRI-guided optimization was included.</p><p><strong>Results: </strong>Fourteen patients underwent iMRI-guided brachytherapy. Seventy percent (70%) of patients presented with FIGO stage III disease or higher. Median follow-up was 44 months. . Patients had 2-year median LC, RFS, and OS rates of 83.3%, 76%, and 84.6%, respectively. Acute toxicities were minimal with one (1) case of grade 3 nausea. No grade 3 or higher long-term toxicities were observed. Median operating room (OR) time was 283 minutes (range 174-380 mins). On exploratory analysis, implant placement performed with iMRI guidance demonstrated higher HR-CTV D90 doses (mean difference of +784.7 cGy, p = NS) were achieved compared to US and CT guided implantation in the same patients.</p><p><strong>Discussion: </strong>iMRI-guidance for gynecologic brachytherapy is safe, associated with minimal high-grade toxicity and excellent clinical outcomes. Future studies to optimize resource use, image acquisition efficiency, and identifying predictive imaging features are warranted.</p>\",\"PeriodicalId\":93914,\"journal\":{\"name\":\"Brachytherapy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brachytherapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.brachy.2025.06.010\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.brachy.2025.06.010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：报告一项前瞻性临床试验的主要结果和剂量学结果，以及在妇科近距离治疗中使用迭代术中磁共振成像（iMRI）的方案。方法：局部晚期宫颈癌或阴道癌（FIGO分期分别为IB2 -IVA期和II-IVA期）接受脉冲剂量率（PDR）近距离放疗的患者在近距离治疗植入物放置期间使用迭代3T iMRI纳入前瞻性临床试验（NCT03634267）。在3T临床MRI扫描仪的iMRI引导下放置涂抹器和可选的间质针。影像学、剂量学和临床结果（局部对照（LC）、无复发生存期（RFS）、总生存期（OS））以及急性和长期毒性进行前瞻性评估，并通过图表复习确认。为了探讨剂量学增益，比较了imri指导与标准护理指导的EQD2估计，以及imri指导下优化的3例患者剂量变化分析。结果：14例患者接受了imri引导下的近距离治疗。70%的患者表现为FIGO III期或更高。中位随访时间为44个月。患者2年的中位LC、RFS和OS率分别为83.3%、76%和84.6%。急性毒性很小，有1例3级恶心。未观察到3级或以上的长期毒性。手术室时间中位数为283分钟（范围174-380分钟）。在探索性分析中，iMRI引导下的植入物放置显示，与US和CT引导下的植入相比，相同患者的HR-CTV D90剂量更高（平均差值为+784.7 cGy, p = NS）。讨论：imri指导妇科近距离治疗是安全的，具有最小的高级别毒性和良好的临床结果。未来的研究将优化资源利用、图像采集效率和识别预测成像特征。
Iterative intraoperative 3T MRI (iMRI)-guided brachytherapy: A prospective study on enhancing implantation precision and dosimetric gains in advanced gynecologic cancers.
Purpose: To report on primary outcomes and dosimetric results of a prospective clinical trial and protocol for use of iterative intraoperative magnetic resonance imaging (iMRI) in gynecologic brachytherapy.
Methods: Patients with locally advanced cervical or vaginal cancer (FIGO stages IB2 - IVA, and stage II-IVA, respectively) undergoing pulsed dose rate (PDR) brachytherapy were enrolled in a prospective clinical trial (NCT03634267) using iterative 3T iMRI during brachytherapy implant placement. Applicator and optional interstitial needles were placed under iMRI guidance in a 3T clinical MRI scanner. Imaging, dosimetry and clinical outcomes (local control (LC), recurrence-free survival (RFS), overall survival (OS)), and acute and long-term toxicity were evaluated prospectively and confirmed by chart review. To explore dosimetric gains, an EQD2 estimate comparing iMRI-guidance versus standard of care guidance, as well as a 3-patient analysis of dose changes with iMRI-guided optimization was included.
Results: Fourteen patients underwent iMRI-guided brachytherapy. Seventy percent (70%) of patients presented with FIGO stage III disease or higher. Median follow-up was 44 months. . Patients had 2-year median LC, RFS, and OS rates of 83.3%, 76%, and 84.6%, respectively. Acute toxicities were minimal with one (1) case of grade 3 nausea. No grade 3 or higher long-term toxicities were observed. Median operating room (OR) time was 283 minutes (range 174-380 mins). On exploratory analysis, implant placement performed with iMRI guidance demonstrated higher HR-CTV D90 doses (mean difference of +784.7 cGy, p = NS) were achieved compared to US and CT guided implantation in the same patients.
Discussion: iMRI-guidance for gynecologic brachytherapy is safe, associated with minimal high-grade toxicity and excellent clinical outcomes. Future studies to optimize resource use, image acquisition efficiency, and identifying predictive imaging features are warranted.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
