Utrecht Interstitial Applicator Shifts and DVH Parameter Changes in 3D CT-based HDR Brachytherapy of Cervical Cancer

  • Shi, Dan (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • He, Ming-Yuan (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • Zhao, Zhi-Peng (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • Wu, Ning (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • Zhao, Hong-Fu (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • Xu, Zhi-Jian (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University) ;
  • Cheng, Guang-Hui (Department of Radiation Oncology, China-Japan Union Hospital of Jilin University)
  • Published : 2015.05.18


Background: For brachytherapy of cervical cancer, applicator shifts can not be avoided. The present investigation concerned Utrecht interstitial applicator shifts and their effects on organ movement and DVH parameters during 3D CT-based HDR brachytherapy of cervical cancer. Materials and Methods: After the applicator being implanted, CT imaging was achieved for oncologist contouring CTVhr, CTVir, and OAR, including bladder, rectum, sigmoid colon and small intestines. After the treatment, CT imaging was repeated to determine applicator shifts and OARs movements. Two CT images were matched by pelvic structures. In both imaging results, we defined the tandem by the tip and the base as the marker point, and evaluated applicator shift, including X, Y and Z. Based on the repeated CT imaging, oncologist contoured the target volume and OARs again. We combined the treatment plan with the repeated CT imaging and evaluated the change range for the doses of CTVhr D90, D2cc of OARs. Results: The average applicator shift was -0.16 mm to 0.10 mm for X, 1.49 mm to 2.14 mm for Y, and 1.9 mm to 2.3 mm for Z. The change of average physical doses and EQD2 values in Gy${\alpha}/{\beta}$ range for CTVhr D90 decreased by 2.55 % and 3.5 %, bladder D2cc decreased by 5.94 % and 8.77 %, rectum D2cc decreased by 2.94 % and 4 %, sigmoid colon D2cc decreased by 3.38 % and 3.72 %, and small intestines D2cc increased by 3.72 % and 10.94 %. Conclusions: Applicator shifts and DVH parameter changes induced the total dose inaccurately and could not be ignored. The doses of target volume and OARs varied inevitably.


  1. Ahamad A, D'Souza W, Salehpour M, et al (2005). Intensity-modulated radiation therapy after hysterectomy: comparison with conventional treatment and sensitivity of the normaltissue-sparing effect to margin size. Int J Radiat Oncol Biol Phys, 62, 1117-24.
  2. Coia L, Won M, Lanciano R, et al (1990). The Patterns of Care Outcome Study for cancer of the uterine cervix. Results of the Second National Practice Survey. Cancer, 66, 2451-6.<2451::AID-CNCR2820661202>3.0.CO;2-5
  3. Datta NR, Basu R, Das KJM, et al (2003). Problems in reporting doses and volumes during multiple high-dose-rate intracavitary brachytherapy for carcinoma cervix as per ICRU Report 38: a comparative study using flexible and rigid applicators. Gynecologic Oncology, 91, 285-92.
  4. De Leeuw AA, Moerland MA, Nomden C, et al (2009). Applicator reconstruction and applicator shifts in 3D MR-based PDR brachytherapy of cervical cancer. Radiother Oncol, 93, 341-6.
  5. Eskander RN, Scanderbeg D, Saenz CC, et al (2010). Comparison of computed tomography and magnetic resonance imaging in cervical cancer brachytherapy target and normal tissue contouring, Int J Gynecol Cancer, 20, 47-53.
  6. Green JA, Kirwan JM, Tierney JF, et al (2001). Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet, 358, 781-6.
  7. Hanks GE, Herring DF, Kramer S (1983). Patterns of care outcome studies. Results of the national practice in cancer of the cervix. Cancer, 51, 959-67.<959::AID-CNCR2820510533>3.0.CO;2-K
  8. Kirisits C, Potter R, Lang S, et al (2005). Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer. Int J Radiat Oncol Biol Phys, 62, 901-11.
  9. Krishnatry R, Patel FD, Singh P, et al (2012). CT or MRI for image-based brachytherapy in cervical cancer. Jpn J Clin Oncol, 42, 309-13.
  10. Kvale G, Heuch I, Ursin G (1988). Reproductive factors and risk of cancer of the uterine corpus: a prospective study. Cancer Res, 48, 6217-21.
  11. Lang S, Kirisits C, Dimopoulos J, et al (2007). Treatment planning for MRI assisted brachytherapy of gynecologic malignancies based on total dose constraints. Int J Radiat Oncol Biol Phys, 69, 619-27.
  12. Lang S, Nesvacil N, Kirisits C, et al (2013). Uncertainty analysis for 3D image-based cervix cancer brachytherapy by repetitive MR imaging: assessment of DVH-variations between two HDR fractions within one applicator insertion and their clinical relevance. Radiother Oncol, 107, 26-31.
  13. Logsdon MD, Eifel PJ (1999). Figo IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy. Int J Radiat Oncol Biol Phys, 43, 763-75.
  14. Mahantshetty U, Khanna N, Swamidas J, et al (2012). Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol, 102, 130-4.
  15. Morgia M, Cuartero J, Walsh L, et al (2013). Tumor and normal tissue dosimetry changes during MR-guided pulsed-dose-rate (PDR) brachytherapy for cervical cancer. Radiother Oncol, 107, 46-51.
  16. Nesvacil N, Tanderup K, Hellebust TP, et al (2013). A multicentre comparison of the dosimetric impact of inter- and intrafractional anatomical variations in fractionated cervix cancer brachytherapy. Radiother Oncol, 107, 20-5.
  17. Palvolgyi J (2010). Influence of different Fletcher-Suit applicator geometries on sagittal dose distribution. Phys Med, 26, 49-54.
  18. Patidar AK, Kumar HS, Walke RV, et al (2012). Evaluation of the response of concurrent high dose rate intracavitary brachytherapy with external beam radiotherapy in management of early stage carcinoma cervix. J Obstet Gynaecol India, 62, 562-5.
  19. Potter R, Georg P, Dimopoulos JC, et al (2011). Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol, 100, 116-23.
  20. Potter R, Kirisits C, Fidarova EF, et al (2008). Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma. Acta Oncol, 47, 1325-36.
  21. Ren YF, Gao YH, Cao XP, et al (2010). 3D-CT implanted interstitial brachytherapy for T2b nasopharyngeal carcinoma. Radiat Oncol, 5, 113.
  22. Shen XR, Feng R, Chai J, et al (2014). Modeling age-specific cancer incidences using logistic growth equations: implications for data collection. Asian Pac J Cancer Prev, 15, 9731-7.
  23. Viswanathan AN, Dimopoulos J, Kirisits C, et al (2007). Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys, 68, 491-8.