Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Comparisons between the KKU-Model and Conventional Rectal Tubes as Markers for Checking Rectal Doses during Intracavitary Brachytherapy of Cervical Cancer

  • Published : 2014.08.15
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Abstract

Background: To compare the KKU-model rectal tube (KKU-tube) and the conventional rectal tube (CRT) for checking rectal doses during high-dose-rate intracavitary brachytherapy (HDR-ICBT) of cervical cancer. Materials and Methods: Between February 2010 and January 2011, thirty -two patients with cervical cancer were enrolled and treated with external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). The KKU-tube and CRT were applied intrarectally in the same patients at alternate sessions as references for calculation of rectal doses during ICBT. The gold standard references of rectum anatomical markers which are most proximal to radiation sources were anterior rectal walls (ARW) adjacent to the uterine cervix demonstrated by barium sulfate suspension enema. The calculated rectal doses derived from actual anterior rectal walls, CRT and the anterior surfaces of the KKU-tubes were compared by using the paired t-test. The pain caused by insertion of each type of rectal tube was assessed by the visual analogue scale (VAS). Results: The mean dose of CRT was lower than the mean dose of ARW ($Dmean_0-Dmean_1$) by $80.55{\pm}47.33cGy$ (p-value <0.05). The mean dose of the KKU-tube was lower than the mean dose of ARW ($Dmean_0-Dmean_2$) by $30.82{\pm}24.20cGy$ (p-value <0.05). The mean dose difference [($Dmean_0-Dmean_1$)-($Dmean_0-Dmean_2$)] was $49.72{\pm}51.60cGy$, which was statistically significant between 42.32 cGy -57.13 cGy with the t-value of 13.24 (p-value <0.05). The maximum rectal dose by using CRT was higher than the KKU-tube as much as 75.26 cGy and statistically significant with the t-score of 7.55 (p-value <0.05). The mean doses at the anterior rectal wall while using the CRTs and the KKU-tubes were not significantly different (p-value=0.09). The mean pain score during insertion of the CRT was significantly higher than the KKU-tube by a t-score of 6.15 (p-value <0.05) Conclusions: The KKU-model rectal tube was found to be an easily producible, applicable and reliable instrument as a reference for evaluating the rectal dose during ICBT of cervical cancer without negative effects on the patients.

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References

  1. Basu B, Basu S, Chakraborti B, et al (2012). A comparison of dose distribution from Manchester-style and Fletcher-style intracavitary brachytherapy applicator systems in cervical cancer. J Contemp Brachyther, 4, 213-8. https://doi.org/10.5114/jcb.2012.32555
  2. Baucal M, Babic J, Kuzmanovic Z (2002). Rectal dosimetry in intracavitary applications of cervix carcinoma: comparison of two methods. Arch Oncol, 10, 253-9. https://doi.org/10.2298/AOO0204253B
  3. Chen SW, Liang JA, Yang SN, Liu RT, Lin FJ (2000).The prediction of late rectal complications following the treatment of uterine cervical cancer by high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys, 47, 955-61. https://doi.org/10.1016/S0360-3016(00)00559-9
  4. Clark BG, Souhmani L, Roman TN, Evans MD, Pla C (1994). Rectum complication in patients with carcinoma of the cervix treated with concomitant cisplatin and external beam irradiation with high dose rate brachytherapy: a dosimetric analysis. Int J Radiat Oncol Bio Phys, 28, 243-50.
  5. Eng TY, Fuller CD, Cavanaugh SX, et al (2004). Significant rectal and bladder dose reduction via utilization of Foley balloon catheters in high dose-rate tandem and ovoid intracavitary brachytherapy of the uterine cervix. Int J Radiat Oncol Biol Phys, 59,174-8. https://doi.org/10.1016/j.ijrobp.2003.09.090
  6. Haie-Meder C, Kramar A, Lambin P, et al (1994). Analysis of complication in a prospective randomized trial comparing two brachytherapy low dose rates in cervical carcinoma. Int J Radiat Oncol Bio Phys, 29, 953-60. https://doi.org/10.1016/0360-3016(94)90388-3
  7. Hartrick T, Kovan P, Shapiro S (2003). The numeric rating scale for clinical pain measurement: a ratio measure. Pain Pract, 3, 310-6. https://doi.org/10.1111/j.1530-7085.2003.03034.x
  8. International Commission on Radiological Units and Measurements (ICRU report No. 38). Bethesda, 1985. Dose and volume specifications for reporting intracavitary therapy in gynecology.
  9. Karnofsky A, Burchenal H (1949). Commonly used for assessing terminally ill patients, often used to determine appropriateness of hospice referral. The clinical Evaluation of chemotherapeutic Agents in Cancer, 1, 196.
  10. Montanna GS, Fowler WC (1989). Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complication. Int J Oncol Bio Phys, 16, 95-100. https://doi.org/10.1016/0360-3016(89)90015-1
  11. Nesvacil N, Potter R, Sturdza A, et al (2013). Adaptive image guided brachytherapy for cervical cancer: a combined MRI-/CT-planning technique with MRI only at first fraction. Radiother Oncol, 8, 75-81. https://doi.org/10.1186/1748-717X-8-75
  12. Parkin DM, Bray F, Ferlay J, Pisani P (2005). Global cancer statistics, 2002. CA Cancer J clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  13. Pearce A, Craighead P, Kay I, Traptow L, Doll C (2009). Brachytherapy for carcinoma of the cervix: a Canadian survey of practice pattern in changing era. Radiother Oncol, 91, 194-6. https://doi.org/10.1016/j.radonc.2008.09.001
  14. Perez CA, Breaux S, Bedwinek JM, et al (1984). Radiation therapy alone in the treatment of carcinoma of the uterine cervix: analysis of complication. Cancer, 54, 235-46. https://doi.org/10.1002/1097-0142(19840715)54:2<235::AID-CNCR2820540210>3.0.CO;2-H
  15. Pesee M, Krusun S, Padoongcharoen P (2012). High dose rate Cobalt-60 afterloading intracavitary therapy of the uterine cervical carcinoma in Srinagarind Hospital, Analysis of residual disease. Asian Pac J Cancer Prev, 13, 4835-7. https://doi.org/10.7314/APJCP.2012.13.9.4835
  16. Pesee M, Krusun S, Padoongcharoen P (2010). High dose rate Cobalt-60 afterloading intracavitary therapy of the uterine cervical carcinoma in Srinagarind Hospital, Analysis of survival. Asian Pacific J Cancer Prev, 11, 1469-71.
  17. Pesee M, Kirdpon K, Puapairoj A, Kirdpon S, Prathanadi P (2013). Palliative treatment of advanced cervical cancer with radiotherapy and Thai herbal medicine as supportive remedy, analysis of survival. Asian Pac J Cancer Prev, 14, 1593-6. https://doi.org/10.7314/APJCP.2013.14.3.1593
  18. Pesee M, Krusun S, Padoongcharoen P (2010). High dose rate cobalt-60 afterloading intracavitary therapy of uterine cervical carcinomas in Srinagarind Hospital-analysis of complications. Asian Pac J Cancer Prev, 11, 491-4.
  19. Shrivastava R, Umbarkar RB, Sarje MB, Singh KK (2009). Rectal dosimetry in intracavitary by HDR at rural center of Maharashtra: comparison of two methods. J Med Phys, 34, 93-6. https://doi.org/10.4103/0971-6203.51936
  20. Stewart AJ, Cormack RA, Lee H, et al (2008). Prospective clinical trial of bladder filling and three-dimensional dosimetry in high-dose-rate vaginal cuff brachytherapy. Int J Radiat Oncol Biol Phys, 72, 843-8. https://doi.org/10.1016/j.ijrobp.2008.01.041
  21. Thai National Cancer Institute (2009). Cervical Uteri. Cancer in Thailand, 4, 51-3.
  22. Van Lancker M, Storme G (1991). Prediction of severe late complication in fractionated, high dose rate brachytherapy in gynecological application. Int J Oncol Biol Phys, 20, 1125-9. https://doi.org/10.1016/0360-3016(91)90214-O
  23. Viswanathan AN, Erickson BA (2010). Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys, 76, 104-9. https://doi.org/10.1016/j.ijrobp.2009.01.043
  24. Wiangnon S, Promthet S, Koonmee S, et al (2012). Hospital-Based Tumor Registry of Srinagarind Hospital, Khon Kaen University: Statistical Report, 15.