Magnetic resonance imaging in cervical cancer interventional radiotherapy (brachytherapy): a pictorial essay focused on radiologist management

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Abstract

The standard treatment for locally advanced cervical cancer (LACC) is platinum-based chemotherapy in association with external beam radiotherapy (EBRT) and brachytherapy (BT), often also called ‘interventional radiotherapy’ (IRT). Magnetic resonance imaging (MRI) is the most accurate imaging modality for both staging and response evaluation; therefore MRI-guided IRT has become the method of choice for planning a radiation boost after EBRT.

The aim of this paper was to describe the MRI radiological workflow currently ongoing at our Institution. In addition, we provided a detailed pictorial essay of our experience, especially for radiologists, to implement MRI-based IRT spread in clinical practice.

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Most cited references 38

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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Ahmedin Jemal, Lindsey A Torre, Rebecca Siegel … (2018)

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

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New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).

E A Eisenhauer, P Therasse, J. Bogaerts … (2009)

Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics: both tumour shrinkage (objective response) and disease progression are useful endpoints in clinical trials. Since RECIST was published in 2000, many investigators, cooperative groups, industry and government authorities have adopted these criteria in the assessment of treatment outcomes. However, a number of questions and issues have arisen which have led to the development of a revised RECIST guideline (version 1.1). Evidence for changes, summarised in separate papers in this special issue, has come from assessment of a large data warehouse (>6500 patients), simulation studies and literature reviews. HIGHLIGHTS OF REVISED RECIST 1.1: Major changes include: Number of lesions to be assessed: based on evidence from numerous trial databases merged into a data warehouse for analysis purposes, the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total (and from five to two per organ, maximum). Assessment of pathological lymph nodes is now incorporated: nodes with a short axis of 15 mm are considered measurable and assessable as target lesions. The short axis measurement should be included in the sum of lesions in calculation of tumour response. Nodes that shrink to <10mm short axis are considered normal. Confirmation of response is required for trials with response primary endpoint but is no longer required in randomised studies since the control arm serves as appropriate means of interpretation of data. Disease progression is clarified in several aspects: in addition to the previous definition of progression in target disease of 20% increase in sum, a 5mm absolute increase is now required as well to guard against over calling PD when the total sum is very small. Furthermore, there is guidance offered on what constitutes 'unequivocal progression' of non-measurable/non-target disease, a source of confusion in the original RECIST guideline. Finally, a section on detection of new lesions, including the interpretation of FDG-PET scan assessment is included. Imaging guidance: the revised RECIST includes a new imaging appendix with updated recommendations on the optimal anatomical assessment of lesions. A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI. It was concluded that, at present, there is not sufficient standardisation or evidence to abandon anatomical assessment of tumour burden. The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression. As is detailed in the final paper in this special issue, the use of these promising newer approaches requires appropriate clinical validation studies.

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Cancer of the cervix uteri

Neerja Bhatla, Daisuke Aoki, Daya Nand Sharma … (2018)

Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

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Author and article information

Contributors

Piotr Wojcieszek: Role: Prof.

Giovanni Scambia: Role: Prof.

Journal

Journal ID (nlm-ta): J Contemp Brachytherapy

Journal ID (iso-abbrev): J Contemp Brachytherapy

Journal ID (publisher-id): JCB

Title: Journal of Contemporary Brachytherapy

Publisher: Termedia Publishing House

ISSN (Print): 1689-832X

ISSN (Electronic): 2081-2841

Publication date (Electronic): 30 June 2022

Publication date (Print): June 2022

Volume: 14

Issue: 3

Pages: 287-298

Affiliations

[1 ]Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,

[2 ]Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,

[3 ]Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain,

[4 ]Department of Radiation Oncology, Hospital Clinic i Universitari, Barcelona, Spain,

[5 ]Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland,

[6 ]UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,

[7 ]Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy,

[8 ]Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy

Author notes

Address for correspondence: Riccardo Manfredi, Largo Agostino Gemelli 8, 00168, Rome, Italy, phone: +39-3392050010, ⌧ e-mail: riccardo.manfredi@ 123456policlinicogemelli.it

[*]

Equal contribution in this study.

Article

Publisher ID: 47383

DOI: 10.5114/jcb.2022.117727

PMC ID: 9528844

SO-VID: e2da7165-72c0-47e3-8e92-58563261b95f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

History

Date received : 04 December 2021

Date accepted : 10 June 2022

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Magnetic resonance imaging in cervical cancer interventional radiotherapy (brachytherapy): a pictorial essay focused on radiologist management

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Most cited references 38

Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).

Cancer of the cervix uteri

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