Imaging Technology News 9/08

ADVERTISEMENT T for the Extended-Field of Cervical Cancer gh Medical Center (UPMC) Cancer Centers and the University of Pittsburgh Cancer Institute Imager® kV imaging system. (Figure 4.) Trilogy also allows respiratory gating of the treatments to compensate for the intrafractional motion of the kidneys in and out of the extended radiation field caused by patient breathing. In this case, our pretreatment 4D CT assessment showed that respiratory gating during the treatment would not be necessary. When the weekly onboard cone-beam CT images, along with physical examination, showed that the tumor had regressed sufficiently, the patient was started on concurrent HDR brachytherapy to her cervix. We prescribed 25 Gy over 5 fractions and conformed the radiation dose so that point A received a total of 70 Gy from the brachytherapy and IMRT combined. The patient received IMRT and brachytherapy treatment on alternating days. Concurrent with the IMRT treatments, this patient received a weekly dose of cisplatin chemotherapy (30 mg/m2). Results By integrating the radiation boost to the lymph nodes into the IG-IMRT plan and overlapping the brachytherapy with the extended-field IG-IMRT treatment, we were able to shorten the duration of the patient’s radiation therapy by three weeks, compared to delivering the treatments sequentially. The patient tolerated the treatment well. The only adverse effect was a self-limited grade 2 GI toxicity that occurred in the last week of treatment and resolved within a week. By the time of her first follow-up examination six weeks after the completion of treatment, her PET scan showed a complete resolution of her pelvic adenopathy as well as normal FDG uptake in the cervix. Subsequent PET/CT scans every 3 to 4 months have remained negative for signs of cancer over 18 months. Furthermore, she has shown no evidence of late treatment-related toxicity. Figure 4. The cone-beam CT with isodose distribution demonstrates the coverage of the extended field. The liver is shown in orange, the right kidney in purple and the left kidney in pink. Image courtesy of the University of Pittsburgh Cancer Institute. Conclusions UPMC Cancer Centers have treated cervical patients, similar to the case presented, for seven years with extended-field radiotherapy. Our experience indicates that this treatment approach is both feasible and desirable, particularly in patients who are at high risk for pelvic and abdominal failure. Image guidance gives us the ability to deliver these treatments with precision, which reduces the risks of gastrointestinal toxicity when the radiation therapy is combined with concurrent chemotherapy. With comprehensive integration of image guidance, we have been able to reduce the high-grade toxicities typically seen with extended-field radiotherapy by 80 percent. We favor selecting candidates for extendedfield treatment carefully by using PET/CT imaging to identify those patients who are at risk for having para-aortic nodal involvement. ITN References 1. Beriwal S, Gan GN, Heron DE, et al. Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2007;63:166–171. 2. Eifel PJ, Winter K, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of Radiation Therapy Oncology Group (RTOG) Trial 90-01. J Clin Oncol. 2004;22:872–880. 3. Heron DE, Gerszten K, et al. Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosi-metric study of dose-volume histograms. Gynecol Oncol. 2003;91:39–45. 4. Gerszten K, Colonello K, Heron DE, et al. Feasibility of concurrent cisplatin and extended field radiation therapy using intensity-modulated radiotherapy for carcinoma of the cervix. Gynecol Oncol. 2006;102:182–188. For More Information Figure 3. This 4D CT with isodose distribution demonstrates coverage of the extended field and shows the treatment field arrangement. Image courtesy of the University of Pittsburgh Cancer Institute. www.varian.com http://www.varian.com

Table of Contents Feed for the Digital Edition of Imaging Technology News 9/08

Imaging Technology News 9/08 Contents IGRT How IGRT Targets the Prostate ASTRO Oncology Information Management Systems (OIMS) Imaging Leading the Intense Race Against Cancer SBRT - The New Treatment of Choice Top IMRT/IGRT Centers to Watch Molecular Imaging: Ready for the Limelight CR or DR in the ER? Have You Hit the Glass Ceiling?

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