DOI QR코드

DOI QR Code

Dose comparison between prescription methods according to anatomical variations in intracavitary brachytherapy for cervical cancer

  • Choi, Euncheol (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Jae Ho (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Ok Bae (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Byun, Sang Jun (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Jin Hee (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Oh, Young Kee (Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2018.07.31
  • Accepted : 2018.09.11
  • Published : 2018.09.30

Abstract

Purpose: We compared how doses delivered via two-dimensional (2D) intracavitary brachytherapy (ICBT) and three-dimensional (3D) ICBT varied anatomically. Materials and Methods: A total of 50 patients who received 30 Gy of 3D ICBT after external radiotherapy (RT) were enrolled. We compared the doses of the actual 3D and 2D ICBT plans among patients grouped according to six anatomical variations: differences in a small-bowel V2Gy, small bowel circumference, the direction of bladder distension, bladder volume, sigmoid V3.5Gy, and sigmoid circumference. Seven dose parameters were measured in line with the EMBRACE recommendations. Results: In terms of bladder volume, the bladder and small-bowel D2cc values were lower in the 150-250 mL bladder volume subgroup; and the rectum, sigmoid, and bladder D2mL values were all lower in the >250 mL subgroup, for 3D vs. 2D ICBT. In the sigmoid V3.5Gy >2 mL subgroup, the sigmoid and bladder D2mL values were significantly lower for 3D than 2D ICBT. The bladder D2mL value was also significantly lower for 3D ICBT, as reflected by the sigmoid circumference. In patients with a small bowel V2.0Gy >10 mL or small bowel circumference >15%, most dose parameters were significantly lower for 3D than 2D ICBT. The bladder distension direction did not significantly affect the doses. Conclusion: Compared to 2D ICBT, a greater bladder volume can reduce the internal 3D ICBT organ dose without affecting the target dose.

References

  1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: cervical cancer [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; 2018 [cited 2018 Sep 10]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf.
  2. International Commission on Radiological Units and Measurements. Dose and volume specification for reporting intracavitary therapy in gynecology (ICRU Report 38). Bethesda, MD: International Commission on Radiological Units and Measurements; 1985.
  3. Haie-Meder C, Potter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005;74:235-45.
  4. Potter R, Haie-Meder C, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006;78:67-77.
  5. Hellebust TP, Kirisits C, Berger D, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radiother Oncol 2010;96:153-60.
  6. Dimopoulos JC, Petrow P, Tanderup K, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol 2012;103:113-22.
  7. Fellner C, Potter R, Knocke TH, Wambersie A. Comparison of radiography- and computed tomography-based treatment planning in cervix cancer in brachytherapy with specific attention to some quality assurance aspects. Radiother Oncol 2001;58:53-62.
  8. Montana GS, Fowler WC. Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complications. Int J Radiat Oncol Biol Phys 1989;16:95-100.
  9. Ogino I, Kitamura T, Okamoto N, et al. Late rectal complication following high dose rate intracavitary brachytherapy in cancer of the cervix. Int J Radiat Oncol Biol Phys 1995;31:725-34.
  10. Kobayashi K, Murakami N, Wakita A, et al. Dosimetric variations due to interfraction organ deformation in cervical cancer brachytherapy. Radiother Oncol 2015;117:555-8.
  11. Potter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018;9:48-60.
  12. Derks K, Steenhuijsen JLG, van den Berg HA, et al. Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer. J Contemp Brachytherapy 2018;10:17-25.
  13. Dimopoulos JC, Potter R, Lang S, et al. Dose-effect relationship for local control of cervical cancer by magnetic resonance image-guided brachytherapy. Radiother Oncol 2009;93:311-5.
  14. Simha V, Rai B, Patel FD, et al. Clinical outcomes with MRIguided image-based brachytherapy in cervical cancer: an institutional experience. Brachytherapy 2018;17:345-51.
  15. Kang HC, Shin KH, Park SY, Kim JY. 3D CT-based high-doserate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control. Radiother Oncol 2010;97:507-13.
  16. Pelloski CE, Palmer M, Chronowski GM, Jhingran A, Horton J, Eifel PJ. Comparison between CT-based volumetric calculations and ICRU reference-point estimates of radiation doses delivered to bladder and rectum during intracavitary radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2005;62:131-7.
  17. Tan YI, Choo BA, Lee KM. 2D to 3D evaluation of organs at risk doses in intracavitary brachytherapy for cervical cancer. J Contemp Brachytherapy 2010;2:37-43.
  18. Mazeron R, Champoudry J, Gilmore J, et al. Intrafractional organs movement in three-dimensional image-guided adaptive pulsed-dose-rate cervical cancer brachytherapy: assessment and dosimetric impact. Brachytherapy 2015;14:260-6.
  19. Siavashpour Z, Aghamiri MR, Jaberi R, et al. A comparison of organs at risk doses in GYN intracavitary brachytherapy for different tandem lengths and bladder volumes. J Appl Clin Med Phys 2016;17:5-13.
  20. Siavashpour Z, Aghamiri MR, Jaberi R, Manshadi HR, Ghaderi R, Kirisits C. Optimum organ volume ranges for organs at risk dose in cervical cancer intracavitary brachytherapy. J Contemp Brachytherapy 2016;8:135-42.
  21. Sharma AD, Poddar J, Suryanarayan KU, et al. Dosimetric analysis of the effects of the bladder volume on organs at risk (OAR) in high-dose-rate intracavitary brachytherapy in carcinoma cervix: an institutional study. J Contemp Brachytherapy 2018;10:26-31.