Comparison of dose volume parameters evaluated using three forward planning – optimization techniques in cervical cancer brachytherapy involving two applicators

Chakrabarti, Bikramjit; Basu-Roy, Somapriya; Kar, Sanjay Kumar; Das, Shambaditya; Lahiri, Annesha

doi:10.5114/jcb.2017.70677

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…The evolution of 3D planning from 2D planning resulted in the advent of volume-based HDR-BT planning, where the dose can be prescribed to the HR-CTV delineated by CT and/or MRI scans with close monitoring of OAR doses [ 7 , 8 ]. Accurate target and OAR delineation led to T&R and T&O based dose optimization techniques to create conformal plans by altering dwell times and dwell positions [ 34 , 35 , 36 ]. Several studies have shown the benefits of image-guided volume-based brachytherapy planning in gynecological malignancies compared to Point A-based plans [ 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer

Paul

Nalichowski

Abrams

et al. 2018

jcb

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PurposeExternal beam radiation therapy (EBRT) and brachytherapy (BT) with concurrent cisplatin is the standard of care for locally advanced cervical cancer. The applicability of image-guided adaptive volume-based high-dose-rate (HDR) intracavitary brachytherapy planning is an active area of investigation. In this study, we examined whether volume-based HDR-BT (HDRVOL) plans leads to more conformal plans compared to Point A (HDRPointA)-based plans.Material and methodsTwo hundred and forty HDRPointA plans from 48 cervical cancer patients treated with chemoradiotherapy were retrospectively collected. Point A plans were renormalized with respect to the high-risk clinical target volume (HR-CTV) for the HDRVOL plans. The doses to organs at risk (OAR; rectum, sigmoid, and bladder), and HR-CTV and the conformal index were compared between HDRPointA and HDRVOL plans.ResultsHDRVOL plans resulted in a 6-12% reduction in the total dose (EBRT + HDR-BT) to 0.1 cc, 1.0 cc, and 2.0 cc of the OAR as well as an 8-37% reduction in the dose to 2 cc of OAR per HDR-BT fraction compared to HDRPointA plans. Differences in the conformal indexes between the two groups of plans showed an 18-31% relative increase per HDR-BT fraction for HDRVOL plans. The D90 of the HR-CTV was reduced by 11% by HDRVOL planning and had a median dose of 86 Gy.ConclusionsOur study reports the relative improvement in OAR doses per HDR-BT fraction by HDRVOL planning compared to HDRPointA planning and demonstrates the dosimetric advantages of volume-based HDR-BT planning in creating more conformal plans.

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Section: Discussionmentioning

confidence: 99%

Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer

Paul

Nalichowski

Abrams

et al. 2018

jcb

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“…Chakrabarti et al . in their study included tandem in CTV contour on plan comparisons of different applicators [ 3 ]. Vivekanandan et al .…”

Section: Purposementioning

confidence: 99%

Effect of applicator removal from target volume for cervical cancer patients treated with Venezia high-dose-rate brachytherapy applicator

Xu¹,

Traughber²,

Harris³

et al. 2022

jcb

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Purpose The volume of Venezia applicator with vaginal caps can be relatively large compared to target volumes. This study investigated the dosimetric and radiobiological effects of applicator volume removal for cervical cancer patients treated with Venezia (VZ) and tandem and split-ring (TSR) applicators used in the clinic. Material and methods A total of 40 patients (101 plans) with stage IIA-IIIC cervical cancer were retrospectively reviewed. Thirty patients were treated with VZ and ten patients were treated with TSR. Applicators were contoured on planning CTs where target contours were involved. Applicator contours were subtracted from the target contours. External beam radiation therapy (EBRT) and brachytherapy doses were calculated in biologically equivalent doses in 2 Gy fractions (EQD 2 ) and combined using full parameter addition for dose-volume histogram (DVH) parameters of composited dose. D 90% , D 50% , V 100% , V 150% , V 200% , and tumor control probability (TCP) were evaluated and compared for targets after applicator exclusion. Results The average volume changes in gross tumor volume (GTV), high-risk clinical target volume (HR-CTV), and intermediate-risk clinical target volume (IR-CTV) after VZ applicator exclusion were 1.4 ±1.5 cm 3 , 15.7 ±6.6 cm 3 , and 33.8 ±15.1 cm 3 , respectively. VZ exclusion resulted in significant changes ( p < 0.05) in small volume parameters (D 50% ) and high-dose parameters (V 150% and V 200% ) for HR-CTV and IR-CTV. Dosimetric impact of TSR exclusion on targets was not significant. There was no significant change in TCP after applicator exclusion. Conclusions Venezia applicator with vaginal caps has significant impact on small volume and high-dose DVH parameters of the target. Applicator contour exclusion is recommended for dosimetric evaluation when Venezia applicator is used.

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“…Recent studies have shown that the outer margins of tumors may be missed with HDR brachytherapy if the dose prescription is optimized to point A without three-dimensional (3D) image guidance, especially if the tumor has not regressed significantly at the time of brachytherapy. [28][29][30] Image-guided planning allows for better tumor localization and delineation with more accurate optimized planning Original research to improve dose inhomogeneity, especially in patients with bulky disease.…”

Section: Strengths and Weaknesses Of The Studymentioning

confidence: 99%

Outcomes of patients with cervical cancer treated with low- or high-dose rate brachytherapy after concurrent chemoradiation

Scott

Yarney

Vanderpuye

et al. 2021

Int J Gynecol Cancer

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ObjectiveThe majority of patients with cervical cancer in Ghana present with locally advanced disease. In October 2014, high-dose rate (HDR) brachytherapy was introduced at the National Center for Radiotherapy, Accra after years of using low-dose rate (LDR) brachytherapy. The aim of this study was to compare the treatment outcomes of patients treated with LDR versus HDR brachytherapy.MethodsPatients with cervical cancer treated from January 2008 to December 2017 were reviewed. Those with stage IB–IIIB who received chemoradiation plus brachytherapy were included in the study. Post-operative patients and those with stage IV were excluded. The study end points were local control, disease-free survival, and overall survival at 2 years. Endpoints were estimated using the Kaplan–Meier method. Comparisons between treatment groups were performed using the log-rank test and Cox proportional hazards model.ResultsWe included 284 LDR and 136 HDR brachytherapy patients. For stages IB, IIA, IIB, IIIA and IIIB disease, the 2-year local control for LDR versus HDR brachytherapy was 63% and 61% (p=0.35), 86% and 90% (p=0.68), 86% and 88% (p=0.83), 66% and 60% (p=0.56), and 77% and 40% (p=0.005), respectively. The 2-year disease-free survival for LDR versus HDR brachytherapy was 64% and 61% (p=0.50), 81% and 69% (p=0.18), 81% and 80% (p=0.54), 62% and 33% (p=0.82), and 71% and 30% (p=0.001) for stages IB, IIA, IIB, IIIA, and IIIB, respectively. The 2-year overall survival for LDR versus HDR brachytherapy was 94% and 93% (p=0.92), 98% and 68% (p=0.21), 89% and 88% (p=0.60), and 88% and 82% (p=0.34) for stages IB, IIA, IIB, and IIIB disease, respectively.ConclusionThere was no difference between LDR and HDR brachytherapy in local control and disease-free survival for all stages of disease, except in stage IIIB. These findings highlight the need to refine this brachytherapy technique for this group of patients.

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Comparison of dose volume parameters evaluated using three forward planning – optimization techniques in cervical cancer brachytherapy involving two applicators

Cited by 8 publications

References 24 publications

Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer

Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer

Effect of applicator removal from target volume for cervical cancer patients treated with Venezia high-dose-rate brachytherapy applicator

Outcomes of patients with cervical cancer treated with low- or high-dose rate brachytherapy after concurrent chemoradiation

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