**Image‐Guided Adaptive Brachytherapy for Cervical Cancer Using Magnetic Resonance Imaging: Overview and Experience**

Kenji Yoshida, Ryo Nishikawa, Daisuke Miyawaki,

Yasuhiko Ebina and Ryohei Sasaki

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/67382

#### **Abstract**

dosimetric and clinical outcomes with conventional radiotherapy. Gynecol Oncol.

[18] ACR–ASTRO practice guideline for image‐guided radiation therapy (IGRT). American College of Radiology. http://www.acr.org/SecondaryMainMenuCategories/quality\_

[19] Potter R, Georg P, Dimopoulos JC, Grimm M, Berger D, Nesvacil N, et al. Clinical out‐ come 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 2011;100(1):116–123.

2012;125(1):151–157.

88 Radiotherapy

safety/guidelines/ro/IGRT.aspx.

Image-guided adaptive brachytherapy (IGABT) using magnetic resonance imaging (MRI) has been accepted as a novel treatment technique for cervical cancer. During the development of MRI-based IGABT, a very important concept called "High-risk clinical target volume (HR-CTV)" was introduced. However, computed tomography (CT)-based IGABT is the most common modality in Japan.

MRI-based IGABT was initiated in September 2014 at Kobe University Hospital and 50 patients were treated through March 2016. Although a total HR-CTV D90 ranging from 80 to 85 Gy equivalent dose in 2 Gy fractions in combination with 45 Gy of external beam radiotherapy (EBRT) and 7 Gy×4 fractions of IGABT is the most standard treatment aim in European institutions, our aim for a total HR-CTV D90 was a 70–80 Gy because of the use of the central shielding technique for the protection of organs at risk in the late phase of EBRT.

The mean total HR-CTV D90 for our 50 patients was 77 Gy. Although our aim was achieved, it was relatively low because Japanese radiotherapy protocols for cervical cancer still differ from those in European institutions. Therefore, a new treatment protocol, which is closer to the global standard, should be established.

**Keywords:** image-guided adaptive brachytherapy, high-risk clinical target volume, D90, D2cc, magnetic resonance imaging

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
