Patients with gynecologic cancers localized to the pelvis may be curatively treated with radiation. The use of brachytherapy, the placement of radioactive seeds directly into the center of the tumor, after external beam radiation, permits dose escalation to the tumor, resulting in successful regression and eradication of the tumor. However, adjacent to the tumor, critical normal tissue structures including the small bowel, sigmoid, rectum, and bladder may rest in regions that can receive high doses of radiation. In most centers in the U.S., simple imaging (X-ray or CT) with doses prescribed to a single point are the standard of care. Normal tissues are not defined by their actual dimensions, rather by points that approximate their location. In order to successfully determine the location of the tumor and its relationship to the normal tissues structures in order to minimize the dose to them, it is necessary to image the pelvis during brachytherapy applicator placement. MRI delineate tumor and OAR in the pelvis with much more precision than other imaging modalities. In this clinical trial, the utility of 3T T2- weighted MRI imaging, in addition to DWI MRI, and how the images correlate with biopsy-confirmed presence of cancer will be studied.

Public Health Relevance

The long term goal of this work is to reduce toxicity due to gynecologic brachytherapy. We will confirm the relationship of MR-detected tumor and biopsy confirmed tumor. This information will guide development of a trial of dose escalation in patients with residual disease based on MR-identified residual tumor and de-escalation with a complete response. Should this trial demonstrate a clearly defined tumor from 3T MR that results in a reduced dose to the normal tissues compared to historical controls, this will result in MR image-guided brachytherapy becoming the standard at the BWH, and in the U.S. We will ultimately develop an imaging-based protocol to determine which patients may benefit the most from MR-based planning. Future studies will explore changes in radiation dose to the tumor and the cervix in order to more determine the minimum required dose to the cervix for curative management.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-SBIB-W (56))
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Vikram, Bhadrasain
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Dana-Farber Cancer Institute
United States
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Manuel, Matthias M; Cho, Linda P; Catalano, Paul J et al. (2016) Outcomes with image-based interstitial brachytherapy for vaginal cancer. Radiother Oncol 120:486-492
Ciris, Pelin A; Balasubramanian, Mukund; Damato, Antonio L et al. (2016) Characterizing gradient echo signal decays in gynecologic cancers at 3T using a Gaussian augmentation of the monoexponential (GAME) model. J Magn Reson Imaging 44:1020-30
Wang, Wei; Viswanathan, Akila N; Damato, Antonio L et al. (2015) Evaluation of an active magnetic resonance tracking system for interstitial brachytherapy. Med Phys 42:7114-21
Bair, Ryan J; Bair, Eric; Viswanathan, Akila N (2015) A radiopaque polymer hydrogel used as a fiducial marker in gynecologic-cancer patients receiving brachytherapy. Brachytherapy 14:876-80
Wang, Wei; Dumoulin, Charles L; Viswanathan, Akila N et al. (2015) Real-time active MR-tracking of metallic stylets in MR-guided radiation therapy. Magn Reson Med 73:1803-11
Damato, Antonio L; Lee, Larissa J; Bhagwat, Mandar S et al. (2015) Redesign of process map to increase efficiency: Reducing procedure time in cervical cancer brachytherapy. Brachytherapy 14:471-80
Viswanathan, Akila N; Moughan, Jennifer; Miller, Brigitte E et al. (2015) NRG Oncology/RTOG 0921: A phase 2 study of postoperative intensity-modulated radiotherapy with concurrent cisplatin and bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer. Cancer 121:2156-63
Wang, Wei (2015) Magnetic Resonance-guided Active Catheter Tracking. Magn Reson Imaging Clin N Am 23:579-89
Mitra, Devarati; Nout, Remi; Catalano, Paul J et al. (2015) Rectal bleeding after radiation therapy for endometrial cancer. Radiother Oncol 115:240-5
Tanderup, Kari; Viswanathan, Akila N; Kirisits, Christian et al. (2014) Magnetic resonance image guided brachytherapy. Semin Radiat Oncol 24:181-91

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