Intermediate-term results of trans-abdominal ultrasound (TAUS)-guided brachytherapy in cervical cancer Ekkasit Tharavichitkul a,b, ⁎, Somvilai Chakrabandhu a,b , Pitchayaponne Klunklin a,b , Wimrak Onchan a,b , Bongkot Jia-Mahasap a,b , Somsak Wanwilairat a , Damrongsak Tippanya a , Rungtip Jayasvasti a , Patumrat Sripan b , Razvan M. Galalae c , Imjai Chitapanarux a,b a The division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand b Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand c Faculty of Medicine, Christian-Albrechts-University, Kiel, Germany HIGHLIGHTS • Ultrasound normally use in brachytherapy to prevent uterine perforation. • This study reported the results of TAUS-guided brachytherapy for cervical cancer. • TAUS-guided brachytherapy is feasible with excellent tumor control/toxicity rates. • TAUS-guided brachytherapy improves dose to Organs at risk. abstract article info Article history: Received 13 November 2017 Received in revised form 11 January 2018 Accepted 14 January 2018 Available online 3 February 2018 Objectives. To report the intermediate-term results of trans-abdominal ultrasound (TAUS)-guided brachy- therapy in cervical cancer. Materials and methods. Ninety-two patients with cervical cancer (stage IB-IVA, according to FIGO staging), were treated by curative radiotherapy from February 2012 to June 2015. All patients were treated with whole pelvic radiotherapy to 50 Gy in 25 fractions and central shielding after 44 Gy, in combination with TAUS-guided brachytherapy, in order to escalate the total dose (EQD2) to the minimal dose at cervical points (in EQD2 con- cepts) defined by TAUS, while maintaining low doses to ICRU bladder and rectal points. The treatment results and toxicity profiles were reported. Results. At median follow-up time of 41.2 months (range 8 to 61 months) the pelvic control, disease-free sur- vival, and overall survival rates were 84.8%, 75%, and 88%, respectively. The mean applied doses to cervix, bladder, and rectal points were 83.5, 72.3, and 76.5 Gy, respectively. Eight patients developed grade 2 Gastrointestinal toxicity. Conclusion. The 3-year results demonstrated that TAUS-guided brachytherapy is feasible and associated with excellent tumor control/toxicity rates in cervical cancer. © 2018 Elsevier Inc. All rights reserved. Keywords: Cervical cancer Brachytherapy Trans-abdominal ultrasound (TAUS) 1. Introduction Cervical cancer is one of the most common gynecological cancers in Asia. In Northern Thailand, the incidence rate of cervical cancer was 22.7 per 100.000 in 2005 [1]. In patients who are categorized inoperable, a combination of whole pelvic irradiation (WPRT) and brachytherapy is commonly used. Intra- cavitary brachytherapy (ICBT) is employed to escalate the dose to the tumor/cervix. A point-based approach based on the Manchester system is extensively applied, using orthogonal X-rays to calculate and pre- scribe ICBT [2–3]. This system rigidly calculates Point A, ignoring the specific tumor geography of each individual patient. This may under- dose the target area and/or overdose organs at risk (OARs) [4–6]. Instead of conventional planning, image-guided brachytherapy (IGBT) with magnetic resonance imaging (MRI) and/or computed Gynecologic Oncology 148 (2018) 468–473 ⁎ Corresponding author at: The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. E-mail address: ekkasit.t@cmu.ac.th (E. Tharavichitkul). https://doi.org/10.1016/j.ygyno.2018.01.015 0090-8258/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno