ArticleRadiation oncology journal2025
Magnetic resonance linear accelerator boost for para-urethral cancer: a new treatment paradigm replacement for brachytherapy.
Article in Radiation oncology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This study evaluates the use of magnetic resonance-guided radiation therapy (MRgRT) as an alternative to brachytherapy in treating para-urethral gynecological cancers, particularly for patients who are not candidates for brachytherapy. Five female patients with advanced para-urethral gynecological cancers underwent MRgRT using a custom 3-dimensional-printed intravaginal cylinder for image registration and treatment alignment. MRgRT was administered as a five-fraction adaptive boost following standard chemoradiation, with each fraction utilizing the cylinder to achieve precise positioning and improve organ sparing. A 1.5T magnetic resonance linear accelerator was used to deliver adapt-to-shape treatment, allowing real-time adjustments to compensate for anatomical variations. The cylinder served not only as a surrogate for accurate image registration but also as a spacer to displace the rectum from high-dose regions. The median follow-up period was 14.4 months, during which all patients completed treatment with no grade >3 genitourinary toxicities. Acute toxicities included dysuria and vaginal pain, while chronic toxicities, such as urinary incontinence and mild cystitis, were recorded in a subset of patients. Treatment achieved an overall survival rate of 100% and a recurrence-free survival rate of 80%. Dosimetric analysis demonstrated effective target coverage with minimal exposure to surrounding organs, particularly sparing the urethra from hotspots, unlike traditional brachytherapy. These results suggest that MRgRT with a vaginal cylinder offers a promising approach for managing para-urethral gynecological cancers in patients ineligible for brachytherapy. Further studies are warranted to validate these findings and refine treatment protocols.
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