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Outcomes analysis of pre-brachytherapy MRI in patients with locally advanced cervical cancer
  1. Keiko Murofushi1,2,
  2. Yasuo Yoshioka2,
  3. Minako Sumi2,
  4. Hitoshi Ishikawa1,
  5. Masahiko Oguchi2 and
  6. Hideyuki Sakurai1
  1. 1Department of Radiation Oncology & Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
  2. 2Radiation Oncology Department, The Japanese Foundation for Cancer Research, Tokyo, Japan
  1. Correspondence to Dr Keiko Murofushi, University of Tsukuba, Tsukuba 305-8577, Japan; murofushi{at}


Introduction Various brachytherapy options are available for treating cervical cancer. This study investigated whether pre-brachytherapy magnetic resonance imaging (MRI) findings could help identify the appropriate brachytherapy technique for cervical cancer.

Methods We retrospectively evaluated patients with cervical cancer who underwent pre-brachytherapy MRI within 7 days before their first high-dose rate brachytherapy treatment between December 2009 and September 2015. Patients who could not undergo MRI at pre-treatment and/or pre-brachytherapy and complete radical radiotherapy were excluded. Conventional intracavitary brachytherapy was the preferred treatment for ≤4 cm and symmetrical tumors. Non-conventional intracavitary brachytherapy, including interstitial brachytherapy, was the preferred treatment for bulky tumors, asymmetrical tumors, tumors with severe vaginal invasion, or bulky barrel-shaped tumors. The 3-year rates of overall survival, disease-free survival, and local control were compared using the Kaplan–Meier method and the log-rank test. Overall survival and local control rates were assessed using Cox regression analysis to identify risk factors for poor overall survival and local control outcomes.

Results A total of 146 patients were included in the study. The median tumor sizes were 52 mm (range 17–85) at the pre-treatment MRI and 30 mm (range 0–78) at the pre-brachytherapy MRI. Six patients had International Federation of Gynecology and Obstetrics (FIGO) stage IB2, 67 patients had stage II, 64 patients had stage III, and nine patients had stage IVA disease. A total of 124 (85%) patients had squamous cell carcinoma and 22 (15%) patients had adenosquamous cell carcinoma or adenocarcinoma. The MRI findings showed severe vaginal invasion (pre-treatment: 19 patients, pre-brachytherapy: 10 patients), asymmetrical bulky tumors (pre-treatment: 28 patients, pre-brachytherapy: 16 patients), and severe corpus invasion (pre-treatment: 39 patients, pre-brachytherapy: 18 patients). Based on the pre-brachytherapy MRI findings, non-conventional intracavitary brachytherapy was administered to 34 (23.3%) patients. Brachytherapy seemed to be appropriate for 133 (91.1%) patients and inappropriate for 13 (8.9%) patients. The 3-year rates were 84.2% for overall survival and 90.1% for local control. Grade 3 late rectal complications occurred in two (1%) patients. Multivariate analysis showed that tumor characteristics (size, shape, and extent of invasion) were not risk factors, although inappropriate brachytherapy was significantly related to poor local control (p<0.001).

Conclusion Pre-brachytherapy MRI may help to select appropriate brachytherapy for cervical cancer and reduce the likelihood of inappropriate brachytherapy leading to poor local control.

  • Cervical Cancer
  • Brachytherapy
  • Radiotherapy, Image-Guided

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  • Contributors KM, MO and HS conceived and designed the study. KM and Nozomi Kitamura analyzed and interpreted the data. KM, YY, MS and HI drafted the article. HS gave final approval of the article.

  • Funding This research was supported by Japan Agency for Medical Research and Development (grant number: 18xx0000000 h 0001).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified participant data are available from Keiko Murofushi ( Protocol is available as an aditional information.