American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy

Small, William; Beriwal, Sushil; Demanes, D. Jeffrey; Dusenbery, Kathryn E.; Eifel, Patricia J.; Erickson, Beth; Jones, Ellen L.; Rownd, Jason; Santos, Jennifer F. De Los; Viswanathan, Akila N.; Gaffney, David K.

doi:10.1016/j.brachy.2011.08.005

Cited by 235 publications

(222 citation statements)

References 48 publications

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“…Figure 2 compares the calculated doses with plan doses using examples of a vaginal cylinder HDR plan (37) . For 30 dose points in the VC plan, the dose difference was

< 3 %

.…”

Section: Resultsmentioning

confidence: 99%

Commissioning of a 3D image‐based treatment planning system for high‐dose‐rate brachytherapy of cervical cancer

Kim

Modrick

Pennington

et al. 2016

J Applied Clin Med Phys

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The objective of this work is to present commissioning procedures to clinically implement a three‐dimensional (3D), image‐based, treatment‐planning system (TPS) for high‐dose‐rate (HDR) brachytherapy (BT) for gynecological (GYN) cancer. The physical dimensions of the GYN applicators and their values in the virtual applicator library were varied by 0.4 mm of their nominal values. Reconstruction uncertainties of the titanium tandem and ovoids (T&O) were less than 0.4 mm on CT phantom studies and on average between 0.8‐1.0 mm on MRI when compared with X‐rays. In‐house software, HDRCalculator, was developed to check HDR plan parameters such as independently verifying active tandem or cylinder probe length and ovoid or cylinder size, source calibration and treatment date, and differences between average Point A dose and prescription dose. Dose‐volume histograms were validated using another independent TPS. Comprehensive procedures to commission volume optimization algorithms and process in 3D image‐based planning were presented. For the difference between line and volume optimizations, the average absolute differences as a percentage were 1.4% for total reference air KERMA (TRAK) and 1.1% for Point A dose. Volume optimization consistency tests between versions resulted in average absolute differences in 0.2% for TRAK and 0.9 s (0.2%) for total treatment time. The data revealed that the optimizer should run for at least 1 min in order to avoid more than 0.6% dwell time changes. For clinical GYN T&O cases, three different volume optimization techniques (graphical optimization, pure inverse planning, and hybrid inverse optimization) were investigated by comparing them against a conventional Point A technique. End‐to‐end testing was performed using a T&O phantom to ensure no errors or inconsistencies occurred from imaging through to planning and delivery. The proposed commissioning procedures provide a clinically safe implementation technique for 3D image‐based TPS for HDR BT for GYN cancer.PACS number(s): 87.55.D‐

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“…Figure 2 compares the calculated doses with plan doses using examples of a vaginal cylinder HDR plan (37) . For 30 dose points in the VC plan, the dose difference was

< 3 %

.…”

Section: Resultsmentioning

confidence: 99%

Commissioning of a 3D image‐based treatment planning system for high‐dose‐rate brachytherapy of cervical cancer

Kim

Modrick

Pennington

et al. 2016

J Applied Clin Med Phys

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“…Intracavitary brachytherapy is suitable for vaginal carcinomas invading a depth up to 0.5 cm whereas bulkier disease should be treated with interstitial brachytherapy 2. To avoid under‐dosing tumour, it is imperative that the applicator conforms to the vaginal mucosa without air gaps 1. Cylinders and ovoids, with standardised lengths and diameters, are commonly used.…”

Section: Introductionmentioning

confidence: 99%

“…Cylinders and ovoids, with standardised lengths and diameters, are commonly used. Cylinders are able to treat a greater length; however ovoids may achieve better mucosal contact in the presence of a widened vaginal apex 1. Multi‐channel cylinders offer a greater level of dosimetric control 1.…”

Section: Introductionmentioning

confidence: 99%

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Intracavitary vaginal brachytherapy using a custom balloon applicator

Paterson

Pearson

Wilson

2017

J of Medical Radiation Sci

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A custom balloon applicator was created to deliver intracavitary high‐dose‐rate brachytherapy to a patient with a superficial vaginal cancer. The patient was unable to be treated conventionally due to an extremely narrow introitus that prevented the introduction of a conventional cylinder applicator. The custom applicator was constructed by inserting a straight titanium tandem applicator through the drainage lumen of a Foley catheter. The applicator was inserted and the catheter balloon was inflated when positioned at the vaginal apex. Three brachytherapy treatments were performed using this technique. Individual balloon eccentricities resulted in small radial tandem offsets within the balloon. This phenomenon was exploited by orientating the tandem offset in the direction of the target volume. Acceptable dosimetry was achieved for all fractions and the procedure was very well tolerated. The custom applicator was a viable solution that was safely developed in a short time frame using equipment readily available in our department.

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“…The primary reason is that it is simple, convenient, and almost foolproof. Clinical data indicated that the HDR VCBT not only provides a large dose boost to an endometrial lesion, but also reduces the risk of recurrence in the vagina and causes significantly less toxicity than pelvic external‐beam radiation therapy 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Dosimetric impact of cylinder size in high‐dose rate vaginal cuff brachytherapy (VCBT) for primary endometrial cancer

Zhang

Gopalakrishnan

Lee

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to evaluate the dosimetric impact of cylinder size in high‐dose‐rate (HDR) vaginal cuff brachytherapy (VCBT). Sample plans of HDR VCBT in a list of cylinders ranging from 2.5 to 4 cm in diameter at 0.5 cm increment were created and analyzed. The doses were prescribed either at the 0.5 cm depth with 5.5 Gy for 4 fractions or at the cylinder surface with 8.8 Gy for 4 fractions, in various treatment lengths. A 0.5 cm shell volume called PTV_Eval was contoured for each plan and served as the target volume for dosimetric evaluation. The cumulative and differential dose volume histograms (c‐DVH and d‐DVH), mean doses (D‐mean) and the doses covering 90% (D90), 10% (D10), and 5% (D5) of PTV_Eval were calculated. In the 0.5 cm depth regimen, the DVH curves were found to have shifted toward the lower dose zone when a larger cylinder was used, but in the surface regimen the DVH curves shifted toward the higher dose zone as the cylinder size increased. The D‐means of the both regimens were between 6.9 and 7.8 Gy and dependent on the cylinder size but independent of the treatment length. A 0.5 cm variation of diameter could result in a 4% change of D‐mean. Average D90s were 5.7 (ranging from 5.6 to 5.8 Gy) and 6.1 Gy (from 5.7 to 6.4 Gy), respectively, for the 0.5 cm and surface regimens. Average D10 and D5 were 9.2 and 11 Gy, respectively, for the 0.5 cm depth regimen, and 8.9 and 9.7 Gy, respectively, for the surface regimen. D‐mean, D90, D10, and D5 for other prescription doses could be calculated from the lookup tables of this study. Results indicated that the cylinder size has moderate dosimetric impact, and that both regimens are comparable in dosimetric quality.PACS number(s): 87.61.‐c, 87.53.Jw, 87.19.xj

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American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy

Cited by 235 publications

References 48 publications

Commissioning of a 3D image‐based treatment planning system for high‐dose‐rate brachytherapy of cervical cancer

Commissioning of a 3D image‐based treatment planning system for high‐dose‐rate brachytherapy of cervical cancer

Intracavitary vaginal brachytherapy using a custom balloon applicator

Dosimetric impact of cylinder size in high‐dose rate vaginal cuff brachytherapy (VCBT) for primary endometrial cancer

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