Dosimetric evaluation of tandem-based cervical high-dose-rate brachytherapy treatment planning using American Brachytherapy Society 2011 recommendations

Goyal, Manish; Kehwar, Than S.; Manjhi, Jayanand; Barker, Jerry L.; Heintz, B; Shide, Kathleen L.; Vijay, Durg

doi:10.1017/s1460396916000133

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Onal et al [ 20 ] concluded that CT-based planning in ICBT is superior to conventional planning in target volume coverage and appropriate evaluation of OARs because the conventional plan overestimates tumor doses and underestimates doses to OARs. Goyal et al [ 21 ] found that point A dose prescriptions do not provide consistent coverage of the HR-CTV, and the difference in coverage increases with increasing CTV for conventional and CT image-based dose prescription approaches. In our study, it was evident that the use of CT image-based treatment planning for ICBT provides the scope to delineate the volumes of the target and OARs, generate DVH data, and optimize doses to each of them, which can prove to be a better surrogate for disease response and toxicity.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome after high dose rate intracavitary brachytherapy with traditional point ‘A’ dose prescription in locally advanced carcinoma of uterine cervix: dosimetric analysis from the perspective of computed tomography imaging-based 3-dimensional treatment planning

Dhabal,

Basu,

et al. 2024

Obstet Gynecol Sci

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Objective To analyze tumour response and toxicity with respect to cumulative radiotherapy dose to target and organs at risk (OARs) with computed tomography (CT)-based image guided adaptive brachytherapy planning for locally advanced carcinoma cervix.Methods Patients were treated with two-dimensional concurrent chemoradiotherapy to whole pelvis followed by intracavitary brachytherapy (ICBT) with dose prescription to point ‘A’. CT image-based delineation of high-risk clinical target volume (HR-CTV), urinary bladder, rectum and sigmoid colon was done with generation of dose-volume histogram (DVH) data and optimization of doses to target and OARs. Follow up assessments were done for response of disease and toxicity with generation of data for statistical analysis.Results One hundred thirty-six patients were enrolled in the study. Delineated volume of HR-CTV ranged from 20.9 to 37.1 mL, with median value of 30.2 mL. The equivalent dose in 2 Gy per fraction (EQD2) for point ‘A’ ranged from 71.31 to 79.75 Gy with median value of 75.1 Gy and EQD2 HR-CTV D90 ranged from 71.9 to 89.7 Gy with median value of 85.1 Gy. 69.2% of patients showed complete response and after median follow-up of 25 months, 50 patients remained disease free, of whom, 74.0% had received ≥85 Gy to HR-CTV D90 versus 26.0% receiving <85 Gy to HR-CTV D90.Conclusions Amidst the unavailability of magnetic resonance imaging facilities in low middle income countries, incorporation of CT-image based treatment planning into routine practice for ICBT provides the scope to delineate volumes of target and OARs and to generate DVH data, which can prove to be a better surrogate for disease response and toxicity.

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Section: Discussionmentioning

confidence: 99%

Clinical outcome after high dose rate intracavitary brachytherapy with traditional point ‘A’ dose prescription in locally advanced carcinoma of uterine cervix: dosimetric analysis from the perspective of computed tomography imaging-based 3-dimensional treatment planning

Dhabal,

Basu,

et al. 2024

Obstet Gynecol Sci

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“…V100 describes how closely the intended treatment could be achieved in terms of target coverage, providing information indirectly on the proportion of the underdosed area. For fractionated treatment, however, D90 and V100 are only usable for evaluation after the last fraction, as it uses summed doses of all fractions [9,13]. It was reported that 2D BT planning achieved lower HR-CTV and dosages to organs at risk (OARs) in patients with big cervical tumors than in those with small tumors.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

Pobijakova¹,

Šćepanović²,

Paluga³

et al. 2018

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Cervical cancer is the third most common cancer in women worldwide. Standard of care for patients with node positive or locally advanced tumors >4 cm is definitive radiotherapy and concurrent chemotherapy. Brachytherapy is an integral part of definitive radiotherapy for cervical cancer. The aim of the study was to show a dynamics of High Risk Clinical Target Volume (HR-CTV) reduction during Brachytherapy (BT) as a part of definitive treatment (External Beam Radiotherapy /EBRT/ +/- Chemotherapy /ChT/) depending on the initial Gross Tumor Volume (GTV) and its impact on HR-CTV coverage in patients with inoperable cervical cancer. We analyzed the dosimetric data for BT of 54 patients who have had Three Dimensional Planning of BT (3D BT). The Gross Tumor Volume, HR-CTV and organs at risk (OARs) were contoured on the magnetic resonance imaging (MRI), subsequently on the co-registered MRI images with computed tomography (CT). Point A and ICRU 38 rectal and bladder points were defined on reconstructed CT images. Patients were categorized on the basis of whether the 100% isodose line of the point-A prescription dose encompassed the HR-CTV (1st group) or not (2nd group). The 30cc volume has been determined as a cut-off value, which represented the most acceptable value of intermediate size of volumes. The initial mean value of GTV was 42cc. After completion of EBRT/ChT, the mean GTV was 3.24cc what was 91% reduction rate in relation to the initial value. We followed the dynamics of HR-CTV reduction during BT and have noted its minimal reduction from 24.3cc (mean value) at the time of the first fraction to the 24.1cc before fourth fraction. The mean V100 was 98% and increased with decreasing of the volume size (p=0.0063, Fisher's exact test). D90 (mean value was 96.3 Gy10) has been correlated with V100 and also, it increased with decreasing of the volume size (p=0.0003). The mean D0.1cc and D2cc of rectum doses were 80 Gy3 and 65.6 Gy3, respectively. The mean ICRU rectal dose for all patients was 67.2 Gy3. The mean D0.1cc (99.5 Gy3), D2cc (79.5 Gy3) and ICRU (75.2 Gy3) of bladder doses were acceptable. Dynamics of HR-CTV reduction during BT was minimal, although, significant reduction of the GTV was achieved after EBRT/ChT. This study revealed that the dose prescription of 7 Gy × 4 fractions to point A was not sufficient indicator for dose coverage of the HR-CTV. However, dosimetric parameters as V100 and D90 were strong indicators for coverage of HR-CTV which was inversely related to the volume of the target and the extension of tumor. However, dosimetric parameters for rectum and bladder (D0.1cc, D2cc and ICRU) did not show dependence on the target volumes.

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A comparison between revised Manchester Point A and ICRU-89–recommended Point A definition absorbed-dose reporting using CT images in intracavitary brachytherapy for patients with cervical carcinoma

et al. 2021

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This study is a comparison between revised Manchester Point A and International Commission on Radiation Units and measurements (ICRU) 89 reporterecommended Point A absorbed-dose reporting in intracavitary brachytherapy for patients with cervical carcinoma. METHODS AND MATERIALS:The retrospective dosimetric study is based on the data of 32 patients with cervical carcinoma treated with high-dose-rate brachytherapy. Patients received 21 Gy in three fractions (7.0 Gy X three fractions) to Point A (A flange , revised Manchester definition). All the patients were replanned with a new Point A (A icru89 ) defined on CT images as per the American Brachytherapy Society/ICRU-89. The data collected were compared with the data obtained from Point A (A flange ). RESULTS: When using the A flange plan normalization method, the mean dose of 0.1 cc, 1 cc, and 2 cc bladder volumes was 820.79

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Dosimetric evaluation of tandem-based cervical high-dose-rate brachytherapy treatment planning using American Brachytherapy Society 2011 recommendations

Cited by 3 publications

References 17 publications

Clinical outcome after high dose rate intracavitary brachytherapy with traditional point ‘A’ dose prescription in locally advanced carcinoma of uterine cervix: dosimetric analysis from the perspective of computed tomography imaging-based 3-dimensional treatment planning

Clinical outcome after high dose rate intracavitary brachytherapy with traditional point ‘A’ dose prescription in locally advanced carcinoma of uterine cervix: dosimetric analysis from the perspective of computed tomography imaging-based 3-dimensional treatment planning

Dynamics of high risk clinical target volume reduction during brachytherapy and impact on its coverage in patients with inoperable cervical cancer

A comparison between revised Manchester Point A and ICRU-89–recommended Point A definition absorbed-dose reporting using CT images in intracavitary brachytherapy for patients with cervical carcinoma

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