Adaptable

Top Line: Image-guided brachytherapy has become standard in the treatment of intact cervical cancer.

The Study: How should brachytherapy target volumes be delineated for vaginal recurrences of cervical and endometrial cancer? Here are consensus recommendations for MRI-based target volume delineation from GEC-ESTRO, the American Brachytherapy Society (ABS), and the Canadian Brachytherapy Group (CBG). After developing recommendations, the group found substantial agreement among expert contours of the high-risk and intermediate risk CTV and moderate agreement for GTV contours. The latter points to the challenges in accurately identifying and delineating residual vaginal disease on MRI. The HR-CTV consists of the residual GTV at the time of brachytherapy as well as adjacent tissue that is clinically or radiographically suspicious for harboring disease. After a response to initial external beam RT, the HR-CTV would include thickened or fibrotic tissue involved by the pre-treatment GTV. The IR-CTV consists of at least 5mm around the original extent of disease, and it could be even larger when there are high-risk histopathologic features such as serous histology or extensive LVSI. When there has been a complete response to external beam RT, the entire target volume would consist of the IR-CTV.

TBL: Adaptive, image-guidance techniques can be applied to brachytherapy for vaginal recurrences of cervical or endometrial cancer.