Clinical Outcomes of Computed Tomography–Based Volumetric Brachytherapy Planning for Cervical Cancer

Simpson, Daniel R.; Scanderbeg, Daniel J.; Carmona, Ruben; McMurtrie, R.; Einck, John; Mell, Loren K.; McHale, Michael; Saenz, Cheryl C.; Plaxe, Steven C.; Harrison, Terry A.; Mundt, Arno J.; Yashar, Catheryn M.

doi:10.1016/j.ijrobp.2015.04.043

Cited by 38 publications

(15 citation statements)

References 30 publications

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“…In previous reports, Nomden et al reported that the mean HR-CTV D90 in EQD2 was 84 Gy [9]. Simpson et al reported that the mean HR-CTV D90 was 86.3 Gy [12]. Although our HR-CTV D90 per implant was equivalent to that in other institutions [8,9], Radiotherapythe goal of total D90 was set lower because the use of the CS technique might hinder delivery of higher D90.…”

Section: Hr-ctvmentioning

confidence: 57%

“…There are an increasing number of published reports regarding treatment results of IGABT for cervical cancer as shown in Table 4 [8][9][10][11][12][14][15][16][17]. In 2011, Pötter et al retrospectively analyzed 156 patients with FIGO stage IB to IVA cervical cancer treated by IGABT at Medical University of Vienna [8].…”

Section: Reported Treatment Resultsmentioning

confidence: 99%

“…Increasing numbers of treatment results have been reported, and the impressive role of IGABT, especially in LC, has been demonstrated when delivering more than 80 Gy as a mean total HR-CTV D90s. Therefore, many representative institutions aimed at least more than 80 Gy [9][10][11][12][13]. Although MRI-based IGABT has been performed since September 2014 at Kobe University, CT-based IGABT still has been performed at most Japanese institutions because of various circumstances, and interstitial needles are less frequently used.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment schedules at representative institutions are also shown in Table 2b for direct comparison with the Japanese protocol. CS technique is not used by all institutions [8][9][10][11][12].…”

Section: Treatment Schedule and Details Of Ebrtmentioning

confidence: 99%

“…Doses from PI with the CS technique are not included. As for these OARs, many previous studies used similar criteria [8][9][10]12]. …”

Section: Oarmentioning

confidence: 99%

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Image‐Guided Adaptive Brachytherapy for Cervical Cancer Using Magnetic Resonance Imaging: Overview and Experience

Yoshida¹,

Nishikawa²,

Miyawaki³

et al. 2017

Radiotherapy

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Image-guided adaptive brachytherapy (IGABT) using magnetic resonance imaging (MRI) has been accepted as a novel treatment technique for cervical cancer. During the development of MRI-based IGABT, a very important concept called "High-risk clinical target volume (HR-CTV)" was introduced. However, computed tomography (CT)-based IGABT is the most common modality in Japan.MRI-based IGABT was initiated in September 2014 at Kobe University Hospital and 50 patients were treated through March 2016. Although a total HR-CTV D90 ranging from 80 to 85 Gy equivalent dose in 2 Gy fractions in combination with 45 Gy of external beam radiotherapy (EBRT) and 7 Gy×4 fractions of IGABT is the most standard treatment aim in European institutions, our aim for a total HR-CTV D90 was a 70-80 Gy because of the use of the central shielding technique for the protection of organs at risk in the late phase of EBRT.The mean total HR-CTV D90 for our 50 patients was 77 Gy. Although our aim was achieved, it was relatively low because Japanese radiotherapy protocols for cervical cancer still differ from those in European institutions. Therefore, a new treatment protocol, which is closer to the global standard, should be established.

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Section: Hr-ctvmentioning

confidence: 57%

Section: Reported Treatment Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Schedule and Details Of Ebrtmentioning

confidence: 99%

“…Doses from PI with the CS technique are not included. As for these OARs, many previous studies used similar criteria [8][9][10]12]. …”

Section: Oarmentioning

confidence: 99%

See 3 more Smart Citations

Image‐Guided Adaptive Brachytherapy for Cervical Cancer Using Magnetic Resonance Imaging: Overview and Experience

Yoshida¹,

Nishikawa²,

Miyawaki³

et al. 2017

Radiotherapy

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Automatic segmentation and applicator reconstruction for CT‐based brachytherapy of cervical cancer using 3D convolutional neural networks

Zhang

Yang

Jiang

et al. 2020

J Applied Clin Med Phys

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In this study, we present deep learning‐based approaches to automatic segmentation and applicator reconstruction with high accuracy and efficiency in the planning computed tomography (CT) for cervical cancer brachytherapy (BT). A novel three‐dimensional (3D) convolutional neural network (CNN) architecture was proposed and referred to as DSD‐UNET. The dataset of 91 patients received CT‐based BT of cervical cancer was used to train and test DSD‐UNET model for auto‐segmentation of high‐risk clinical target volume (HR‐CTV) and organs at risk (OARs). Automatic applicator reconstruction was achieved with DSD‐UNET‐based segmentation of applicator components followed by 3D skeletonization and polynomial curve fitting. Digitization of the channel paths for tandem and ovoid applicator in the planning CT was evaluated utilizing the data from 32 patients. Dice similarity coefficient (DSC), Jaccard Index (JI), and Hausdorff distance (HD) were used to quantitatively evaluate the accuracy. The segmentation performance of DSD‐UNET was compared with that of 3D U‐Net. Results showed that DSD‐UNET method outperformed 3D U‐Net on segmentations of all the structures. The mean DSC values of DSD‐UNET method were 86.9%, 82.9%, and 82.1% for bladder, HR‐CTV, and rectum, respectively. For the performance of automatic applicator reconstruction, outstanding segmentation accuracy was first achieved for the intrauterine and ovoid tubes (average DSC value of 92.1%, average HD value of 2.3 mm). Finally, HDs between the channel paths determined automatically and manually were 0.88 ± 0.12 mm, 0.95 ± 0.16 mm, and 0.96 ± 0.15 mm for the intrauterine, left ovoid, and right ovoid tubes, respectively. The proposed DSD‐UNET method outperformed the 3D U‐Net and could segment HR‐CTV, bladder, and rectum with relatively good accuracy. Accurate digitization of the channel paths could be achieved with the DSD‐UNET‐based method. The proposed approaches could be useful to improve the efficiency and consistency of treatment planning for cervical cancer BT.

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A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy

et al. 2021

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Purpose We aimed to develop a disposable rectum dosimeter and to demonstrate its ability to measure exposure dose to the rectum during brachytherapy for cervical cancer treatment using high‐dose rate 192Ir. Our rectum dosimeter measures the dose with an optically stimulated luminescence (OSL) sheet which was furled to a catheter. The catheter we used is 6 mm in diameter; therefore, it is much less invasive than other rectum dosimeters. The rectum dosimeter developed in this study has the characteristics of being inexpensive and disposable. It is also an easy‐to‐use detector that can be individually sterilized, making it suitable for clinical use. Methods To obtain a dose calibration curve, phantom experiments were performed. Irradiation was performed using a cubical acrylic phantom, and the response of the OSL dosimeter was calibrated with the calculation value predicted by the treatment planning system (TPS). Additionally, the dependence of catheter angle on the dosimeter position and repeatability were evaluated. We also measured the absorbed dose to the rectum of patients who were undergoing brachytherapy for cervical cancer (n = 64). The doses measured with our dosimeters were compared with the doses calculated by the TPS. In order to examine the causes of large differences between measured and planned doses, we classified the data into common and specific cases when performing this clinical study. For specific cases, the following three categories were considered: (a) patient movement, (b) gas in the vagina and/or rectum, and (c) artifacts in the X‐ray image caused by applicators. Results A dose calibration curve was obtained in the range of 0.1 Gy–10.0 Gy. From the evaluation of the dependence of catheter angle on the dosimeter position and repeatability, we determined that our dosimeter can measure rectum dose with an accuracy of 3.1% (k = 1). In this clinical study, we succeeded in measuring actual doses using our rectum dosimeter. We found that the deviation of the measured dose from the planned dose was derived to be 12.7% (k = 1); this result shows that the clinical study included large elements of uncertainty. The discrepancies were found to be due to patient motion during treatment, applicator movement after planning images were taken, and artifacts in the planning images. Conclusions We present the idea that a minimally invasive rectum dosimeter can be fabricated using an OSL sheet. Our clinical study demonstrates that a rectum dosimeter made from an OSL sheet has sufficient ability to evaluate rectum dose. Using this dosimeter, valuable information concerning organs at risk can be obtained during brachytherapy.

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Clinical Outcomes of Computed Tomography–Based Volumetric Brachytherapy Planning for Cervical Cancer

Cited by 38 publications

References 30 publications

Image‐Guided Adaptive Brachytherapy for Cervical Cancer Using Magnetic Resonance Imaging: Overview and Experience

Image‐Guided Adaptive Brachytherapy for Cervical Cancer Using Magnetic Resonance Imaging: Overview and Experience

Automatic segmentation and applicator reconstruction for CT‐based brachytherapy of cervical cancer using 3D convolutional neural networks

A disposable OSL dosimeter for in vivo measurement of rectum dose during brachytherapy

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