Skip to main content
Top
Published in: Strahlentherapie und Onkologie 2/2013

01-02-2013 | Original article

Feasibility of transrectal ultrasonography for assessment of cervical cancer

Authors: M.P. Schmid, MD, R. Pötter, MD, P. Brader, MD, A. Kratochwil, MD, G. Goldner, MD, K. Kirchheiner, MSc, A. Sturdza, MD, C. Kirisits, DSc

Published in: Strahlentherapie und Onkologie | Issue 2/2013

Login to get access

Abstract

Purpose

To retrospectively compare the maximum target width and target thickness in patients with locally advanced cervical cancer between magnetic resonance imaging (MRI) and transrectal ultrasonography (TRUS) in the course of primary radiochemotherapy.

Patients and methods

T2-weighted MRI and TRUS were performed on patients with locally advanced cervical cancer at the same timepoint—either at the time of diagnosis, or at the time of brachytherapy before or after insertion of the applicator. Patients treated from 2009 to 2011 were selected for this study based on the availability of MRI and TRUS at the defined time points. The target was defined as the complete macroscopic tumor mass and the remaining cervix and was measured on transversal planes. Descriptive statistics and a linear regression analysis were performed for the groups.

Results

Images from 17 patients were available for analysis. Mean maximum target width was 4.2 ± 0.83 cm and 4.2 ± 0.79 cm for MRI and TRUS, respectively. Mean maximum target thickness was 3.3 ± 1.03 cm and 3.1 ± 1.15 cm for MRI and TRUS, respectively. Linear regression analysis for target width and thickness between TRUS and MRI demonstrated a correlation with R2 = 0.842 and R2 = 0.943, respectively.

Conclusion

The feasibility of TRUS for the assessment of local target extension could be demonstrated. Comparison of the target width and thickness showed a high correlation between TRUS and MRI, indicating the potential of TRUS for target definition in image-guided adaptive brachytherapy.
Literature
1.
go back to reference Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRef
2.
go back to reference Pötter R, Dimopoulos J, Georg P et al (2007) Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 83:148–155PubMedCrossRef Pötter R, Dimopoulos J, Georg P et al (2007) Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 83:148–155PubMedCrossRef
3.
go back to reference Pötter R, Georg P, Dimopoulos J et al (2011) Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 100:116–123PubMedCrossRef Pötter R, Georg P, Dimopoulos J et al (2011) Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 100:116–123PubMedCrossRef
4.
go back to reference Van Dyk S, Narayan K, Franzcr et al (2009) Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound. Int J Rad Oncol Biol Phys 75:64–70CrossRef Van Dyk S, Narayan K, Franzcr et al (2009) Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound. Int J Rad Oncol Biol Phys 75:64–70CrossRef
5.
go back to reference Malyapa RS, Mutic S, Low DA et al (2002) Physiologic FDG-PET three-dimensional treatment planning for cervical cancer. Int J Rad Oncol Biol Phys 54:1140–1146CrossRef Malyapa RS, Mutic S, Low DA et al (2002) Physiologic FDG-PET three-dimensional treatment planning for cervical cancer. Int J Rad Oncol Biol Phys 54:1140–1146CrossRef
6.
go back to reference Schmid MP, Mansmann B, Federico M et al (n d) Residual tumour volumes and grey zones after external beam radiotherapy (± chemotherapy) in cervix cancer patients: a low-field MRI study. Submitted to Strahlenther Onkol Schmid MP, Mansmann B, Federico M et al (n d) Residual tumour volumes and grey zones after external beam radiotherapy (± chemotherapy) in cervix cancer patients: a low-field MRI study. Submitted to Strahlenther Onkol
7.
go back to reference Brocker KA, Alt CD, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 1. Strahlenther Onkol 187:611–618PubMedCrossRef Brocker KA, Alt CD, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: part 1. Strahlenther Onkol 187:611–618PubMedCrossRef
8.
go back to reference Alt CD, Brocker KA, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: Part 2. Strahlenther Onkol 187:705–714PubMedCrossRef Alt CD, Brocker KA, Eichbaum M et al (2011) Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: Part 2. Strahlenther Onkol 187:705–714PubMedCrossRef
9.
go back to reference Dimopoulos JCA, Schirl G, Baldinger A et al (2009) MRI assessment of cervical cancer for adaptive radiotherapy. Strahlenther Onkol 185:282–287PubMedCrossRef Dimopoulos JCA, Schirl G, Baldinger A et al (2009) MRI assessment of cervical cancer for adaptive radiotherapy. Strahlenther Onkol 185:282–287PubMedCrossRef
10.
go back to reference Mitchell DG, Snyder B, Coakley F et al (2006) Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography and clinical examination, verfied by pathologic results in the ACRIN 6651/GOG 183 intergroup study. J Clin Oncol 24:5687–5694PubMedCrossRef Mitchell DG, Snyder B, Coakley F et al (2006) Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography and clinical examination, verfied by pathologic results in the ACRIN 6651/GOG 183 intergroup study. J Clin Oncol 24:5687–5694PubMedCrossRef
11.
go back to reference Dimopoulos JCA, Schard G, Berger D et al (2006) Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Rad Oncol Biol Phys 64:1380–1388CrossRef Dimopoulos JCA, Schard G, Berger D et al (2006) Systematic evaluation of MRI findings in different stages of treatment of cervical cancer: potential of MRI on delineation of target, pathoanatomic structures, and organs at risk. Int J Rad Oncol Biol Phys 64:1380–1388CrossRef
12.
go back to reference Mahanshetty U, Khanna N, Swamidas J et al (2012) Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol 102:130–134CrossRef Mahanshetty U, Khanna N, Swamidas J et al (2012) Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol 102:130–134CrossRef
13.
go back to reference Small W Jr, Strauss JB, Hwang CS et al (2011) Should uterine tandem applicators ever be placed without ultrasound guidance? No: a brief report and review of the literature. Int J Gynecol Cancer 21:941–944PubMedCrossRef Small W Jr, Strauss JB, Hwang CS et al (2011) Should uterine tandem applicators ever be placed without ultrasound guidance? No: a brief report and review of the literature. Int J Gynecol Cancer 21:941–944PubMedCrossRef
14.
go back to reference Davidson MT, Yuean J, D’Souza DP et al (2008) Optimization of high-dose rate cervix brachytherapy applicator placement: the benefits of intraoperative ultrasound guidance. Brachytherapy 7:248–253PubMedCrossRef Davidson MT, Yuean J, D’Souza DP et al (2008) Optimization of high-dose rate cervix brachytherapy applicator placement: the benefits of intraoperative ultrasound guidance. Brachytherapy 7:248–253PubMedCrossRef
15.
go back to reference Haie-Meder C, Pötter R, van Limbergen E et al (2004) Recommendations from the Gynaecological (GYN) GEC ESTRO Working Group: concepts and terms in 3D-image based 3D-treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 74:235–245CrossRef Haie-Meder C, Pötter R, van Limbergen E et al (2004) Recommendations from the Gynaecological (GYN) GEC ESTRO Working Group: concepts and terms in 3D-image based 3D-treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 74:235–245CrossRef
16.
go back to reference Pötter R, Haie-Meder C, van Limbergen E et al (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose-volume parameters and aspects of 3D-image-based anatomy, radiation physics, radiobiology. Radiother Oncol 78:67–77PubMedCrossRef Pötter R, Haie-Meder C, van Limbergen E et al (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose-volume parameters and aspects of 3D-image-based anatomy, radiation physics, radiobiology. Radiother Oncol 78:67–77PubMedCrossRef
17.
go back to reference Haie-Meder C, Chargari C, Rey A et al (2010) MRI-based low dose-rate brachytherapy experience in locally advanced cervical cancer patients initially treated by concomitant chemoradiotherapy. Radiother Oncol 96:161–165PubMedCrossRef Haie-Meder C, Chargari C, Rey A et al (2010) MRI-based low dose-rate brachytherapy experience in locally advanced cervical cancer patients initially treated by concomitant chemoradiotherapy. Radiother Oncol 96:161–165PubMedCrossRef
18.
go back to reference Chargari C, Magné N, Dumas I et al (2009) Physics contributions and clinical outcome with 3D-MRI-based pulsed-dose-rate intracavitary brachytherapy in cervical cancer patients. Int J Rad Oncol Biol Phys 74:133–139CrossRef Chargari C, Magné N, Dumas I et al (2009) Physics contributions and clinical outcome with 3D-MRI-based pulsed-dose-rate intracavitary brachytherapy in cervical cancer patients. Int J Rad Oncol Biol Phys 74:133–139CrossRef
19.
go back to reference Pötter R, Kirisits C, Fidarova EF et al (2008) Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma. Acta Oncol 47(7):1325–1336PubMedCrossRef Pötter R, Kirisits C, Fidarova EF et al (2008) Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma. Acta Oncol 47(7):1325–1336PubMedCrossRef
20.
go back to reference Schmid AP, Salomonowitz E, Schratter-Sehn AU, Zechner O (1986) New ultrasonically-guided 192-Iridium afterloading technique for radiotherapy of prostatic cancer. Semin Intervent Radiol 4:295–298CrossRef Schmid AP, Salomonowitz E, Schratter-Sehn AU, Zechner O (1986) New ultrasonically-guided 192-Iridium afterloading technique for radiotherapy of prostatic cancer. Semin Intervent Radiol 4:295–298CrossRef
21.
go back to reference Goldner G, Pötter R, Battermann JJ et al (2012) Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients. Strahlenther Onkol 103:223–227 Goldner G, Pötter R, Battermann JJ et al (2012) Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients. Strahlenther Onkol 103:223–227
22.
go back to reference Kovacs G, Pötter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74:137–148PubMedCrossRef Kovacs G, Pötter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74:137–148PubMedCrossRef
23.
go back to reference Ash D, Flynn A, Battermann J et al (2000) ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 57:315–321PubMedCrossRef Ash D, Flynn A, Battermann J et al (2000) ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 57:315–321PubMedCrossRef
24.
go back to reference Rosenthal SA, Bittner NH, Beyer DC et al (2011) American society for radiation oncology (ASTRO) and American college of radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 79:335–341PubMedCrossRef Rosenthal SA, Bittner NH, Beyer DC et al (2011) American society for radiation oncology (ASTRO) and American college of radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 79:335–341PubMedCrossRef
25.
go back to reference Magee BJ, Loque JP, Swindell R et al (1991) Tumor size as a prognostic factor in carcinoma of the cervix: assessment by transrectal ultrasound. Br J Radiol 64:812–815PubMedCrossRef Magee BJ, Loque JP, Swindell R et al (1991) Tumor size as a prognostic factor in carcinoma of the cervix: assessment by transrectal ultrasound. Br J Radiol 64:812–815PubMedCrossRef
26.
go back to reference Innocenti P, Pulli F, Savino L et al (1992) Staging of cervical cancer: reliability of transrectal US. Radiology 185:201–205PubMed Innocenti P, Pulli F, Savino L et al (1992) Staging of cervical cancer: reliability of transrectal US. Radiology 185:201–205PubMed
27.
go back to reference Hawenaur JM, Johnson RJ, Carrington BM et al (1998) Predictive value of clinical examination, transrectal ultrasound and magnetic resonance imaging prior to radiotherapy in carcinoma of the cervix. Br J Radiol 71:819–827 Hawenaur JM, Johnson RJ, Carrington BM et al (1998) Predictive value of clinical examination, transrectal ultrasound and magnetic resonance imaging prior to radiotherapy in carcinoma of the cervix. Br J Radiol 71:819–827
28.
go back to reference Fischerova D, Cibula D, Stenhova H et al (2008) Transrectal ultrasound and magnetic resonance imaging in staging early cervical cancer. Int J Gynecol Cancer 18:766–772PubMedCrossRef Fischerova D, Cibula D, Stenhova H et al (2008) Transrectal ultrasound and magnetic resonance imaging in staging early cervical cancer. Int J Gynecol Cancer 18:766–772PubMedCrossRef
29.
go back to reference Sharma DN, Rath GK, Thulkar S et al (2010) Use of transrecal ultrasound for high dose rate interstitial brachytherapy for patients of carcinoma of uterine cervix. J Gynecol Oncol 21:12–17PubMedCrossRef Sharma DN, Rath GK, Thulkar S et al (2010) Use of transrecal ultrasound for high dose rate interstitial brachytherapy for patients of carcinoma of uterine cervix. J Gynecol Oncol 21:12–17PubMedCrossRef
30.
go back to reference Stock RG, Chan K, Terk M et al (1997) A new technique for performing syed-neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance. Int J Radiat Oncol Biol Phys 37:819–825PubMedCrossRef Stock RG, Chan K, Terk M et al (1997) A new technique for performing syed-neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance. Int J Radiat Oncol Biol Phys 37:819–825PubMedCrossRef
31.
go back to reference Weitmann HD, Knocke TH, Waldhäusl C et al (2006) Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma. Strahlenther Onkol 182:86–95PubMedCrossRef Weitmann HD, Knocke TH, Waldhäusl C et al (2006) Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma. Strahlenther Onkol 182:86–95PubMedCrossRef
Metadata
Title
Feasibility of transrectal ultrasonography for assessment of cervical cancer
Authors
M.P. Schmid, MD
R. Pötter, MD
P. Brader, MD
A. Kratochwil, MD
G. Goldner, MD
K. Kirchheiner, MSc
A. Sturdza, MD
C. Kirisits, DSc
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Strahlentherapie und Onkologie / Issue 2/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-012-0258-1

Other articles of this Issue 2/2013

Strahlentherapie und Onkologie 2/2013 Go to the issue