Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Uterine Cervical Neoplasms

Uterine Neoplasms

Genital Neoplasms, Female

Urogenital Neoplasms

Uterine Cervical Diseases

Uterine Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Patient treated with Linac MRI for their locally advanced cervical cancer

External radiotherapy will be performed at Linac MRI, 25 fractions of radiation will be delivered for each patient.The MR-linac offers the ability to individualise and adapt daily treatment plans based on the position or anatomy of the day, following either a simple 'virtual couch shift' adapt-to-position (ATP) approach, or a more complex full reoptimisation adapt-to-shape (ATS) method based on the recontouring of relevant structures. During each radiation therapy, T2-weighted images and diffusion images will be purchased.Treatment plans can be produced and checked by appropriately trained Radiation Oncologists. Each radiation oncologist will decide based on the anatomy of the day the type of workflow to be used (ADP or ATS) for treatment.Patients will undergo accurate image acquisition, registration and interpretation to make sound clinical judgements and proceed to safe and accurate treatment delivery.

MRI Linac

Angela BOROS, Dr

Julien Berthiller, Mr

The management of locally advanced cervical cancer (Figo \>IB) is based on radiochemotherapy (RCT) followed by brachytherapy. At present there is no personalized treatment, all patients undergoing radiochemotherapy will follow a conventional treatment by external radiotherapy (46 Gy in 23 sessions associated with cisplatin (CDDP) weekly) and brachytherapy to achieve a total equivalent biological dose around 80-90 Gy).The efficacy of this treatment has been proven for most patients, almost 80% being in complete response after RCT. Nevertheless, on an individual scale, there remains a significant variation in the tumor response, with patients who respond from the first week of treatment, "early responders" or, on the contrary, others who present significant tumor residues after external beam radiotherapy.Various macroscopic tumor volume (GTV) response patterns have been identified based on magnetic resonance imaging (MRI) at diagnosis and MRI before brachytherapy, implying very different clinical target volumes for brachytherapy technique. The difference in tumor volume response has been identified as having a major impact on treatment response.

This is the first study attempting to evaluate tumor response in real time during radiochemotherapy treatment. Knowing the tumor response during treatment will make it possible to modify the management of locally advanced cervical cancer, several therapeutic options might then be discussed depending on the early response to treatment: dose de-escalation for early responders, reduction of time total treatment, personalization of brachytherapy management (technique and dose).

This observational study will allow rapid identification of responder and non-responder patients and might be used as a basis for personalized treatment strategies

Estimation of Tumor Response With Linac MRI-guided Adaptive Radiotherapy for Locally Advanced Cervical Cancer

The local response will be defined by the Recist 1.1 criteria on MRI. The response will be binary, i.e. complete response versus the 3 other categories of the Recist 1.1 classification that is to say partial response, stabilization or progression.

Nevertheless will identified 3 favorable situation:

1. complete response on MRI and PET scan
2. partial response but surgery no performed
3. partial response, surgery performed and no disease identified on the anatomopathology results

Hospices Civils de Lyon

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Estimation of Tumor Response With Linac MRI-guided Adaptive Radiotherapy for Locally Advanced Cervical Cancer	NCT05942742	Locally Advance...	MRI Linac	18 Years - 70 Years	Hospices Civils de Lyon
Estimation of Tumor Response With Linac MRI-guided Adaptive Radiotherapy for Locally Advanced Cervical Cancer	NCT05942742	Locally Advance...	MRI Linac	18 Years - 70 Years	Hospices Civils de Lyon

Spots Global Cancer Trial Database for radiotherapie