Imagerie 3D en curiethérapie gynécologique : applications des recommandations du GEC-ESTRO et résultats

Even if the prognosis of patients with cervical cancer has been dramatically improved with concomitant chemoradiation, brachytherapy still plays fundamental role in the therapeutic approach of patients with Figo stage I-IV cervical carcinoma. The development of imaging with three-dimensional dosimetry has contributed to the improvement in target and organs at risk knowledge. In 2005 and 2006, GEC-ESTRO recommendations on 3-D based image brachytherapy have defined the different volumes of interest. These recommendations have been validated with intercomparison delineation studies. Data on dose to normal tissues are better known with dose volume-histograms analysis. Dose limits to the bladder are high in the range of 90 Gy to the 2 cm³ while 2 cm³ limits to the rectum do not differ from ICRU point. The sigmoid is currently under study as this organ was not extensively studied before the era of imaging. Doses to the tumour (HR-CTV or IR-CTV) are not clearly stated and will likely depend on tumour extension.