Dosimetric and cost comparison of first fraction imaging versus fractional re-imaging on critical organ dose in vaginal cuff brachytherapy

Corso, Christopher D.; Jarrio, Christie S.; Nunnery, Edwin W.; Ali, Arif; Ghavidel, S.; Rossi, Peter J.; Díaz, Roberto

doi:10.1016/j.prro.2012.10.002

Cited by 15 publications

(7 citation statements)

References 14 publications

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“…ABS guidelines do not demand that each fraction of VCB is planned because there is an assumed fixed geometry of the implant. Image at each fraction of three increments costs 35% compared with a single simulation but did not produce any dosimetric advantage 95. Similar results with single-channel or multichannel cylinders were observed; imaging at each fraction was 19% and 22% more expensive, respectively 96.…”

Section: Custom or Standard Radiotherapy Planningsupporting

confidence: 61%

Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

Sabater¹,

Andrés²,

Lopez-Honrubia³

et al. 2017

CMAR

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Endometrial cancer (EC) is one of the most common gynecological cancers among women in the developed countries. Vaginal cuff is the main location of relapses after a curative surgical procedure and postoperative radiation therapy have proven to diminish it. Nevertheless, these results have not translated into better survival results. The preeminent place of vaginal cuff brachytherapy (VCB) in the postoperative treatment of high- to intermediate-risk EC was given by the PORTEC-2 trial, which demonstrated a similar reduction in relapses with VCB than with external beam radiotherapy (EBRT), but VCB induced less late toxicity. As a result of this trial, the use of VCB has increased in clinical practice at the expense of EBRT. A majority of the clinical reviews of VCB usually address the risk categories and patient selection but pay little attention to technical aspects of the VCB procedure. Our review aimed to address both aspects. First of all, we described the risk groups, which guide patient selection for VCB in clinical practice. Then, we depicted several technical aspects that might influence dose deposition and toxicity. Bladder distension and rectal distension as well as applicator position or patient position are some of those variables that we reviewed.

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Section: Custom or Standard Radiotherapy Planningsupporting

confidence: 61%

Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

Sabater¹,

Andrés²,

Lopez-Honrubia³

et al. 2017

CMAR

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“…Multiple studies evaluated 3D treatment planning at the first fraction only or for each fraction. They show that 3D planning for each fraction does not decrease dose to the normal tissues but incurs greater expense than performing 3D planning for the first fraction only [102–104]. CT-based treatment planning effectively allows assessment of air gaps between the applicator and the vaginal cuff prior to treatment delivery [105].…”

Section: Vaginal Brachytherapy Treatment Deliverymentioning

confidence: 99%

American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review

et al. 2017

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This article aims to review the risk stratification of endometrial cancer, treatment rationale, outcomes, treatment planning, and treatment recommendations of vaginal brachytherapy (VBT) in the post-operative management of endometrial cancer patients. The authors performed a thorough review of the literature and reference pertinent articles pertaining to the aims of this review. Adjuvant VBT for early stage endometrial cancer patients results in very low rates of vaginal recurrence (0–3.1%) with low rates of late toxicity which are primarily vaginal in nature. PORTEC-2 supports that VBT results in non-inferior rates of vaginal recurrence compared to external beam radiotherapy (EBRT) for the treatment of high-intermediate risk patients. VBT as a boost following EBRT, in combination with chemotherapy, and for high-risk histologies have shown excellent results as well though randomized data do not exist supporting VBT boost. There are many different applicators, dose-fractionation schedules, and treatment planning techniques which all result in favorable clinical outcomes and low rates of toxicity. Recommendations have been published by the American Brachytherapy Society and the American Society of Radiation Oncology to help guide practitioners in the use of VBT. Data support that patients and physicians both prefer joint decision-making regarding the use of VBT, and patients often desire additional treatment for a marginal benefit in risk of recurrence. Discussions regarding adjuvant therapy for endometrial cancer are best performed in a multi-disciplinary setting and patients should be counseled properly regarding the risks and benefits of adjuvant therapy.

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“…It’s reasonable to hypothesize that the extra-tension could act as another source of displacement of vaginal vault, which was not controlled in our analysis, but should be tested in future studies. However, other studies suggest that the evaluation of the first insertion is sufficient in terms of dose reporting 9 18 ; this is the current approach at our institution. Another limitation is the absence of a documented manometer reading, which can measure various levels of tension and help reproduce the findings of our study.…”

Section: Discussionmentioning

confidence: 97%

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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Dosimetric and cost comparison of first fraction imaging versus fractional re-imaging on critical organ dose in vaginal cuff brachytherapy

Cited by 15 publications

References 14 publications

Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review

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

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Dosimetric and cost comparison of first fraction imaging versus fractional re-imaging on critical organ dose in vaginal cuff brachytherapy

Cited by 15 publications

References 14 publications

Vaginal cuff brachytherapy in endometrial cancer &ndash; a technically easy treatment?

Vaginal cuff brachytherapy in endometrial cancer &ndash; a technically easy treatment?

American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review

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

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Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?