MRI-Only Guided Adaptive Radiation Therapy for Cervical Cancer Patients

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for women with proven cervical cancer who will have radiation therapy together with chemotherapy. It tests a radiation workflow that uses MRI scans only.

Age

Over 18 years

Sex

Women only

Disease stage

Proven cervical cancer (squamous cell, adenocarcinoma or mixed) of FIGO/TNM stage IB2, IIA, IIB, IIIA or IIIB, with or without lymph node involvement. WHO performance status below 2.

Earlier treatment

Must not have had earlier radiation to the belly or pelvis. Must not have had a partial or total hysterectomy.

Main reasons for not taking part

• Cancer that has spread to other organs (metastatic disease)
• Cannot have an MRI scan (for example claustrophobia or metal in the body)
• Signs of active infection or serious health problems
• Earlier radiation to the belly or pelvis
• Partial or total hysterectomy in the past

The registry criteria, word for word

What the trial wants to find out

Current management of patients treated with External Beam Radiation Therapy (EBRT) for cervical cancer with a classical Image-guided Radiation Therapy (IGRT) strategy involves a complex, not entirely satisfactory, treatment workflow. Indeed, in our institution, two workflows have been designed to take into account the inter-fraction motion of cervix and uterus : an Internal Target Volume (ITV)-based approach and a plan of the day strategy requiring both several planning-CT (Computed Tomography) acquisitions with variable bladder filling.The upcoming installation of a Varian Ethos therapy system in our institution will allow us to implement a less cumbersome online adaptive radiotherapy strategy (oART), which, by conforming to the daily anatomy, will enable a reduction in the Clinical Target Volume (CTV) to Planning Target Volume (PTV) margins leading to an expected reduction in dose delivered to organs at risk (OAR) .On the other hand, MR (Magnetic Resonance)-only treatment planning is playing an increasing role in radiotherapy, notably in the treatment of prostate cancer. MR-only workflows are known (a) to provide the most reliable delineation in soft tissues and (b) to decrease spatial uncertainties by suppressing the Magnetic Resonance Imaging (MRI)-CT co-registration. Regarding the management of cervical cancer, the importance of MRI is well established and its use becomes essential. Combining a MR-only workflow with an adaptative one on the Varian Ethos system, could lead to an improved management of patients treated for cervical cancer with an expected reduction in margins and volumes treated (thanks to MRI delineation and online adaptation) and therefore a reduction of OAR toxicity. Including regular multi-parametric MR imaging during and after the course of the treatment could also provide in the future an assessment of the treatment response. One of the important challenges in developing this specific workflow is to have a reliable synthetic CT (derived from MRI) to (a) provide electron or mass density for treatment planning calculations and (b) allow accurate online repositioning/deformation with Ethos Cone Beam Computed Tomography (CBCT). The other fundamental challenge is to provide a formal assessment of the clinical benefit of introducing MR-only simulation and planning in an oART workflow.

The group in the trial

• MRI assessment during radiation therapy courseTreatment being tested

  Patients perform on MRI every week during the 5-weeks treatment

  Treatment: Magnetic resonance imaging