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ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1562670
This article is part of the Research Topic Optimizing Radiotherapy for Cervical Cancer Efficacy Toxicity and Brachytherapy Integration View all 3 articles
Establishing an intraoperative, mobile-CBCT based workflow for gynecologic brachytherapy: Primary experience and benefit assessment
Provisionally accepted- Uniklinikum Erlangen Department of Radiation Oncology, Erlangen, Bavaria, Germany
In brachytherapy of cervical cancer, creating a suitable implant based on ultrasound-guidance might be impacted by imaging limitations. To validate the implant also if ultrasound is not sufficient, we implemented a new workflow utilizing additional intraoperative cone-beam computed tomography (CBCT). The aim of this work was to describe the newly established workflow, to reflect associated (dis)advantages, and to assess geometric and dosimetric benefits compared to the previous solely ultrasound-guided workflow.We reported the establishment of our new workflow utilizing mobile CBCT during interventions and corresponding experiences for 26 consecutive patients. Image quality was assessed by considering the applicator visualization and contrast-noise-ratio (CNR) between tissues. Implant changes based on CBCT scans were analyzed with respect to the enhanced insertion depths (EID) of needles and their tip distances to target volume borders. Dosimetric effects were evaluated by calculating common dosevolume parameters for target volume and organs at risk (OARs) and comparison to both a previous patient cohort and scenarios simulating sole ultrasound-guidance. Implant uncertainties between intraand postoperative imaging were analyzed by a corresponding registration as well.Implementing intraoperative CBCT was associated with clinical challenges but increased the safety feeling during interventions and resulted in geometric as well as dosimetric benefits. Needles could be shifted deeper into the pelvis by an EID of 14±11 mm based on CBCT, associated with corresponding significant dose improvements for target volume and OARs with mean tradeoff increase up to 4.8Gy. With a reasonable CNR between tissues up to 8.5±3.6 and clear detectability of applicators, image quality was sufficient to fulfill intraoperative intentions. Furthermore, the CBCT scans were suitable for treatment planning purposes from a geometric uncertainty perspective.The implementation of intraoperative CBCT can substantially improve the quality and safety of image-guided gynecologic brachytherapy.
Keywords: Interventional radiotherapy, Intraoperative imaging, Image-guidance, Adaptive brachytherapy, Mobile CT
Received: 17 Jan 2025; Accepted: 26 Mar 2025.
Copyright: © 2025 Karius, Strnad, Bert, Fietkau, Merten and Schweizer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Andre Karius, Uniklinikum Erlangen Department of Radiation Oncology, Erlangen, Bavaria, Germany
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