{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T19:15:41Z","timestamp":1759778141803,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To explore the dosimetric advantage of combining intracavitary\/interstitial applicator with distal parametrial free needle interstitial brachytherapy (IC\/IS+ISBT DP) based on MRI for locally advanced cervical cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Materials<\/jats:title><jats:p>77 IC\/IS+ISBT DP treatment plans were developed for 34 patients with locally advanced cervical cancer from June 2016 to January 2020 in this study. We removed the free needles and devised a new IC\/ISBT treatment plan based on the same principle. We then compared the dosimetric differences of D90, D98, V100, V150, V200 for HR-CTV (high-risk clinical target volume), D90 for IR-CTV (Intermediate risk-CTV) and D2cc for OARs (organs at risk) between the two groups of treatment plans for the same patient, and the paired T test was performed in parallel. Further, the dosage differences between the two group plans under different parametrial extension widths (the maximum distance of HR-CTV from the vertical direction of the uterine tandem at coronal position) were compared. The survival rate was calculated using the Kaplan-Meier method. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were determined by Cox regression method. RTOG\/EORTC criteria were used to grade toxicities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 297 free needles were used, with a weight ratio of 15.8% \u00b1 0.11, and a mean insertion depth of 6.52cm \u00b1 2.8cm. D90, D98, V100 for HR-CTV, and D90 for IR-CTV for IC\/IS+ISBT DP were significantly higher than IC\/ISBT for which free needles were removed (p&amp;lt;0.05). And the V200 for HR-CTV and D2cc for bladder, rectum and sigmoid were decreased (p&amp;lt;0.05). When the parametrial extension widths were greater than 3cm, the HR-CTV D90 and the D2CC for rectum, bladder and sigmoid colon for IC\/IS-ISBT DP were advantageous compared to IC\/ISBT (p&amp;lt;0.05). The 2-yr OS, PFS and local control rate (LC) were 82.3, 66.8, and 93.1%, respectively. Parametrial extension widths was the only statistically prognostic factors for PFS (p = 0.002) on univariate analysis. No grade 3 or 4 Treatment-related toxicities were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our institutional experiences showed that IC\/IS+ISBT DP is an effective treatment for cervical cancer patients with distal parametrial extension. IC\/IS-ISBT DP had dosage advantage and clinical feasibility in locally advanced cervical cancer with distal parametrial extension when the parametrial extension widths were greater than 3cm.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2020.621347","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T16:48:33Z","timestamp":1613839713000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Intracavitary\/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric 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