PurposeWell-known defect of TG-43 based algorithms used in brachytherapy is a lack of information about interaction cross-sections, which are determined not only by electron density but also by atomic number. TG-186 recommendations with using of MBDCA (model-based dose calculation algorithm), accurate tissues segmentation, and the structure's elemental composition continue to create difficulties in brachytherapy dosimetry. For the clinical use of new algorithms, it is necessary to introduce reliable and repeatable methods of treatment planning systems (TPS) verification. The aim of this study is the verification of calculation algorithm used in TPS for shielded vaginal applicators as well as developing verification procedures for current and further use, based on the film dosimetry method.Material and methodsCalibration data was collected by separately irradiating 14 sheets of Gafchromic® EBT films with the doses from 0.25 Gy to 8.0 Gy using HDR 192Ir source. Standard vaginal cylinders of three diameters were used in the water phantom. Measurements were performed without any shields and with three shields combination. Gamma analyses were performed using the VeriSoft® package.ResultsCalibration curve was determined as third-degree polynomial type. For all used diameters of unshielded cylinder and for all shields combinations, Gamma analysis were performed and showed that over 90% of analyzed points meets Gamma criteria (3%, 3 mm).ConclusionsGamma analysis showed good agreement between dose distributions calculated using TPS and measured by Gafchromic films, thus showing the viability of using film dosimetry in brachytherapy.

Purpose The purpose of this study was to report clinical outcomes of patients treated with pulse-dose-rate brachytherapy (PDR-BT) for lip cancer after insufficient surgery. Material and methods Twenty lip cancer patients were treated from January 2012 to September 2016. Primary treatment included surgery with or without reconstruction. All patients were diagnosed with squamous cell carcinoma, most of the tumors were pT1. Brachytherapy procedures were done after post-operative wound healing. Median of three plastic tubes were implanted using a free-hand technique. Two PDR-BT treatments were scheduled for every patient, with the gap of median 13 days. The planned dose was 0.8-1 Gy per pulse to the total dose of 50 Gy from two PDR-BT treatments. Patients were evaluated every 3-6 months. Follow-up time was counted from the last day of treatment to any event or last visit. Early and late toxicities were scored with RTOG scale. Results Average follow-up was 34.7 months (range, 12.7-67.6). Three- and five-year estimated disease-free survival was 95% and local control was 100%. One patient suffered from regional relapse in the submental region (IA lymph node group). Skin erythema or dry desquamation (grade 1) or wet desquamation (grade 2) was observed in 13 patients (65%) and one patient (5%), respectively. Six patients presented no acute toxicity. Moreover, there were no complications involving lip mucosa. All patients had grade 1 soft tissue fibrosis in the irradiated area, besides that, late toxicity included only skin complications. There were no significant factors associated with late toxicity ≥ grade 2. Conclusions PDR-BT in the adjuvant treatment of the lip cancer yields high local control with low toxicity. Even patients with close margins after surgery (< 5 mm) should be considered as candidates for PDR-BT.

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PurposeTreatment planning system commissioning is one of the most important parts of the quality assurance system in a working brachytherapy department. Migration to a more sophisticated system is always a step forward for the planning team but careful verification of the workflow and obtained results is mandatory. The question is not only whether the quality and safety of the previous standards can be preserved, but also about the possibility of reaching a higher level. The general objective of this study was to compare and verify calculation algorithms implemented in the treatment planning systems Plato Brachytherapy v.14.3.7 and Oncentra Masterplan (Brachy) V.3.1 SP 3.Material and methodsIn order to revise the optimization algorithms implemented in the compared treatment systems, a series of 20 interstitial breast cancer applications were used. Treatment plans were optimized using geometric optimization with distance option. The parameters V, D90, D100, V100, V150, V200 and DNR were gained for target volume. On the basis of the value of Student’s t-test parameters (α = 0.05) plans prepared using optimization algorithms implemented in the two treatment planning systems were compared.ResultsFor the treatment plans prepared using Oncentra Masterplan a lower value of DNR (p = 0.018) was obtained. Uniformity of the dose distribution does not collide with comparable D90 values for both treatment planning systems (p = 0.109). Dose throughout the target volume (D100) was also proved to be higher in plans prepared using Oncentra Masterplan (p = 0.012).ConclusionsFor interstitial applications Oncentra Masterplan planning system enables one to prepare a more homogeneous dose distribution but also a higher dose in the whole treated volume, while the volume covered with the therapeutic dose does not statistically differ.