Computed Tomography-Based High-Dose-Rate Intracavitary Brachytherapy for Uterine Cervical Cancer: Preliminary Demonstration of Correlation Between Dose–Volume Parameters and Rectal Mucosal Changes Observed by Flexible Sigmoidoscopy

Koom, Woong Sub; Sohn, Dae Kyung; Kim, Joo Young; Kim, Jong Won; Shin, Kyung Hwan; Yoon, Sang Min; Kim, Dae Yong; Yoon, Myonggeun; Shin, Dongho; Park, Sung Yong; Cho, Kwan Ho

doi:10.1016/j.ijrobp.2007.02.009

Cited by 111 publications

(69 citation statements)

References 39 publications

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“…As Koom et al. described, reporting organ doses in terms of a single point, or a maximal small volume dose assessment is not appropriate considering an inhomogeneous dose distribution, even in the event of a steep gradient over the high‐risk clinical target volume (HR‐CTV) and OARs near the source 15. In this study, all physical HDR plan doses (D2cc and D0.1 cc) were calculated based upon the AAPM TG 43 formula49, 50, 51 without heterogeneity‐corrections.…”

Section: Resultsmentioning

confidence: 99%

“…These adaptive, conformal BT approaches have resulted in significantly improved clinical outcomes 12. Volumetric OAR dose constraints, such as the minimal dose of the 2 cc of normal tissue with the highest dose (D2cc) or D0.1 cc, have been investigated13, 14, 15 as an alternative to conventional rectum and bladder point doses. These alternatives originated from the ICRU Report #38,16 and are mainly applicable to Point A‐based BT planning techniques.…”

Section: Introductionmentioning

confidence: 99%

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Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD 2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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“…For the vagina no dose volume parameters and constraints have been recommended so far. [43] . A similar trend has been demonstrated by the Vienna group for 141 patients: the incidence of G1-G4 late toxicity for rectum was significantly higher when the D 2cc for the rectum was !75 Gy (a/b 03) (20% versus 4%) [44].…”

Section: Dose Response Relationship For Local Controlmentioning

confidence: 99%

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

et al. 2008

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“…Point dosing can also lead to excessive normal tissue toxicity, as with smaller tumors and smaller uteri in which predefined points may deliver dose into the bladder or rectum. Conventional International Commission on Radiation Units and Measurements (ICRU) points have been shown in several studies to underestimate maximum doses to the bladder and rectum (3,(5)(6)(7)(8)(9)(10)(11), and doses to these points have often failed to correlate with late toxicity (12). This may in part explain the relatively high rates of severe late gastrointestinal (GI) and genitourinary (GU) toxicity in the range of 5% to 10% reported in previous studies of conventional treatment techniques (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

“…For many radiation departments, the routine use of MRI at each brachytherapy fraction is not feasible because of its cost and inaccessibility. To address this issue, a few groups, including our own, have adopted a hybrid computed tomography (CT)-based IGBT technique (6,(22)(23)(24). When our department initially adopted this technique in 2007, MRI was routinely done for 1 brachytherapy fraction in all patients.…”

Section: Introductionmentioning

confidence: 99%

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

Simpson¹,

Scanderbeg²,

Carmona³

et al. 2015

Brachytherapy

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SummaryImage guided brachytherapy (IGBT) has been adopted by multiple centers in recent years for the treatment of cervical cancer. The clinical outcomes are promising, with favorable results compared with those of conventional techniques. Previously reported studies have used primarily magnetic resonance imagingdbased treatment planning. We report the clinical outcomes of a novel hybrid computed tomographyebased IGBT technique. At 2 years, local control was excellent, with low rates of treatment toxicity. Further Purpose/Objectives: A report of clinical outcomes of a computed tomography (CT)-based image guided brachytherapy (IGBT) technique for treatment of cervical cancer. Methods and Materials: Seventy-six women with International Federation of Gynecology and Obstetrics stage IB to IVA cervical carcinoma diagnosed between 2007 and 2014 were treated with definitive external beam radiation therapy (EBRT) with or without concurrent chemotherapy followed by high-dose-rate (HDR) IGBT. All patients underwent planning CT simulation at each implantation. A high-risk clinical target volume (HRCTV) encompassing any visible tumor and the entire cervix was contoured on the simulation CT. When available, magnetic resonance imaging (MRI) was performed at implantation to assist with tumor delineation. The prescription dose was prescribed to the HRCTV. Results: The median follow-up time was 17 months. Thirteen patients (17%) had an MRI done before brachytherapy, and 16 patients (21%) were treated without MRI guidance. The mean EBRT/IGBT sum 2-Gy equivalent dose (EQD2) delivered to the 90% volume of the HRCTV was 86.3 Gy. The mean maximum EQD2s delivered to 2 cm 3 of the rectum, sigmoid, and bladder were 67.5 Gy, 66.2 Gy, and 75.3 Gy, respectively. The 2-year cumulative incidences of local, locoregional, and distant failure were 5.8% (95% confidence interval [CI]: 1.4%-14.8%), 15.1% (95% CI: 5.4%-29.4%), and 24.3% (95% CI: 12.1%-38.9%), respectively. The 2-year overall and disease-free survival rates were 75% (95% CI, 61%-91%) and 73% (95% CI, 60%-90%), respectively. Twenty-nine patients (38%) experienced grade !2 acute toxicity, with 5 cases of acute grade 3 toxicity and no grade !4 toxicities. One

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Computed Tomography-Based High-Dose-Rate Intracavitary Brachytherapy for Uterine Cervical Cancer: Preliminary Demonstration of Correlation Between Dose–Volume Parameters and Rectal Mucosal Changes Observed by Flexible Sigmoidoscopy

Cited by 111 publications

References 39 publications

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

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

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