An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Barney, Bradley J.; Macdonald, O. Kenneth; Lee, Christopher M.; Rankin, James A.; Gaffney, David K.

doi:10.1016/j.brachy.2007.03.005

Cited by 13 publications

(8 citation statements)

References 34 publications

(16 reference statements)

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“…One representative study by Barney et al . (21) reported no greater than Grade 1 acute toxicities and only 1 of 24 patients developing a late toxicity greater than Grade 1 (one Grade 3 gastrointestinal toxicity).…”

Section: Discussionmentioning

confidence: 95%

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning

et al. 2014

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PURPOSE To assess the effect of body mass index (BMI) on dose to organs at risk (OARs) during high-dose-rate vaginal brachytherapy and evaluate the role of three-dimensional dose evaluation during treatment planning. METHODS AND MATERIALS Three-dimensional dosimetric data for rectum, bladder, sigmoid colon, and small bowel for 125 high-dose-rate vaginal brachytherapy fractions were analyzed. Dose–volume histograms were generated for D0.1 cc and D2 cc of each OAR. Contributing factors including the use of urinary catheter and cylinder size were also recorded. As different dose fractionations were used, the OAR doses were tabulated as a percent dose prescribed to 0.5 cm. All patients were treated to 4 cm of the vaginal length. RESULTS Median BMI in this cohort was 31.7 kg/m2. The BMI values had a weak inverse correlation with D0.1 cc to sigmoid colon (rs = −0.18, p = 0.047) and D0.1 cc to bladder (rs = −0.19, p = 0.038). There was a strong inverse correlation of D2 cc and increasing BMI (rs = −0.64, p = 0.003). The median D2 cc was 25.1% for BMI higher than 31 and 61.9% for BMI of 31 or lower. For D0.1 cc, there was also a strong inverse correlation with increasing BMI (rs = −0.57, p < 0.001). Median D1 cc was 33.5% for BMI >31 and 84.4% for BMI ≤31. On multivariate analysis higher BMI remained a significant predictor of lower small bowel D2 cc (p < 0.001) and D0.1 cc (p < 0.001). CONCLUSIONS Women with a lower BMI receive higher doses to the bladder and small bowel compared with those with a higher BMI. Three-dimensional dose evaluation should be considered in patients with low BMI, particularly when combined with external beam radiation.

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Section: Discussionmentioning

confidence: 95%

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning

et al. 2014

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“…The need for full treatment planning and routine dose calculation of OARs for use with single‐channel VC HDR BT without EBRT has been criticized for two main reasons: 1) the isodose lines of a single‐channel VC depends solely on the VC size; the isodose lines are not customized according to a patient's anatomy; and 2) the relatively low dose delivered to the OARs (9) by single‐channel VC HDR BT when compared to EBRT and the overall low toxicity observed in single‐channel VC HDR BT (3) . Evidence of favorable clinical outcomes persists, especially an improved survival rate and a quicker treatment recovery time when using single‐channel VC HDR BT 2 , 4 , 5 , 6 , 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Evidence of favorable clinical outcomes persists, especially an improved survival rate and a quicker treatment recovery time when using single‐channel VC HDR BT 2 , 4 , 5 , 6 , 7 . In particular, a simulation study by Barney et al (3) evaluating rectal and bladder toxicity using a single‐channel VC HDR BT reported that less than 5% of the patients (1 out of 24) developed a Grade 3 or higher toxicity level. In this study, we proposed using a dose‐distance modeling technique to estimate the OARs doses by measuring the distances between single‐channel VC and the ICRU rectum or the bladder point on orthogonal radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation therapy after hysterectomy is the standard treatment for stage I–IV endometrial cancer. In particular, high‐dose‐rate (HDR) vaginal cuff brachytherapy (BT) without external beam radiation therapy (EBRT) has been widely used due to its efficacy, especially low local recurrence with minimal toxicity, low morbidity, and favorable quality of life after treatment 2 , 3 , 4 , 5 , 6 , 7 . The most common applicator used for HDR BT is a vaginal cylinder (VC) with a single, central channel (8) .…”

Section: Introductionmentioning

confidence: 99%

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Bladder and rectum dose estimations on digitized radiographs for vaginal brachytherapy after hysterectomy

Zhang

Bhatia

Sun

et al. 2014

J Applied Clin Med Phys

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The purpose of this study was to evaluate the feasibility of assessing bladder and rectal point doses, using orthogonal radiographs without treatment planning, for vaginal cylinder applicator (VC), high‐dose‐rate (HDR) vaginal cuff brachytherapy (BT) after hysterectomy. Thirty‐three VC HDR BT treatment plans from 31 postoperative endometrial cancer patients were retrospectively analyzed. Single‐channel VC with four differing diameters — 2.0 cm, 2.3 cm, 2.6 cm, and 3.0 cm — were analyzed. Dose‐distance modeling was performed to estimate bladder and rectal point doses by measuring distances on each orthogonal radiograph without treatment planning. The estimated doses were then compared with doses calculated on treatment planning system (TPS). Their percent (%) dose differences were recorded. Analysis was performed for each VC size, ICRU bladder and rectal points, and the closest rectal point. The estimated doses obtained from dose‐distance modeling displayed on average less than 2.5% difference when compared with TPS doses at ICRU bladder and rectal points for each VC size. Dose percent differences between estimated values and TPS values were on average 1.9% and 2.5% for ICRU bladder and rectal point, respectively, regardless of VC sizes. Dose‐distance modeling for closest rectal point presented on average 5.4% dose difference when compared with TPS values of all VC sizes. It was feasible to estimate rectal and bladder point doses by measuring distances on orthogonal radiographs without treatment planning. Percent dose differences were 2.5% less for both ICRU bladder and rectal points, regardless of VC sizes. The use of closest rectal point is not recommended for estimating rectal dose.PACS number: 87.53.‐j, 87.53.Jw, 87.55.‐x, 87.55.D‐, 87.55dk

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“…Currently, the choice between point dose parameters, such as ICRU bladder point dose (D ICRU ) and maximum bladder dose (Dmax), and volumetric parameters relies solely on dosimetric evidence6789101112. Several studies have compared ICRU and volumetric dose, but the lack of a relation or difference between them prevents either from being recommended over the other.…”

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confidence: 99%

Volumetric (3D) bladder dose parameters are more reproducible than point (2D) dose parameters in vaginal vault high-dose-rate brachytherapy

Sapienza

Flosi

Aiza

et al. 2016

Sci Rep

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There is no consensus on the use of computed tomography in vaginal cuff brachytherapy (VCB) planning. The purpose of this study was to prospectively determine the reproducibility of point bladder dose parameters (DICRU and maximum dose), compared with volumetric-based parameters. Twenty-two patients who were treated with high-dose-rate (HDR) VCB underwent simulation by computed tomography (CT-scan) with a Foley catheter at standard tension (position A) and extra tension (position B). CT-scan determined the bladder ICRU dose point in both positions and compared the displacement and recorded dose. Volumetric parameters (D0.1cc, D1.0cc, D2.0cc, D4.0cc and D50%) and point dose parameters were compared. The average spatial shift in ICRU dose point in the vertical, longitudinal and lateral directions was 2.91 mm (range: 0.10–9.00), 12.04 mm (range: 4.50–24.50) and 2.65 mm (range: 0.60–8.80), respectively. The DICRU ratio for positions A and B was 1.64 (p < 0.001). Moreover, a decrease in Dmax was observed (p = 0.016). Tension level of the urinary catheter did not affect the volumetric parameters. Our data suggest that point parameters (DICRU and Dmax) are not reproducible and are not the ideal choice for dose reporting.

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An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Cited by 13 publications

References 34 publications

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning

Body mass index, dose to organs at risk during vaginal brachytherapy, and the role of three-dimensional CT-based treatment planning

Bladder and rectum dose estimations on digitized radiographs for vaginal brachytherapy after hysterectomy

Volumetric (3D) bladder dose parameters are more reproducible than point (2D) dose parameters in vaginal vault high-dose-rate brachytherapy

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