Adaptive Magnetic Resonance-Guided External Beam Radiation Therapy for Consolidation in Recurrent Cervical Cancer

Abstract

Purpose: Adaptive magnetic resonance (MR)-guided brachytherapy takes an important place as consolidation within the care of cervical malignancies, but may be impracticable in some unusual cases. This work aimed to present the case of adaptive MR-guided external beam radiation therapy (aMRgRT) used as a boost in a recurrence of cervical cancer. Methods and Materials: We report on a case of a parametrial recurrence in a 31-year-old patient who already underwent a trachelectomy as treatment for her primary growth. After concomitant radio-chemotherapy, a brachytherapy boost was performed. Because of its position in relation to the left uterine artery after trachelectomy, impeding interstitial catheters set up, the relapse was insufficiently covered. With the aim to refine the coverage of target volumes, aMRgRT treatment was undertaken to allow for achievement of the dosimetric goals. Results: In clinical circumstances where the brachytherapy step was hindered, aMRgRT presents many advantages. First, daily native MR-imaging outperforms usual x-ray imaging in the pelvis, refining repositioning. Second, its specific workflow allows for the performance of adaptive treatment, with consideration of both the inter- and intrafraction motions of organs at risk and target volumes. Conclusion: In nonfeasible brachytherapy situations, aMRgRT could be a satisfying substitute. Nevertheless, brachytherapy remains the standard of care as a boost in locally advanced cervical cancer.