Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer

Pasha, Tanvir; Hassann, Hanan Naniparuthayil; Radhakrishna, Nikhila; N, Muhammed Shafeeque; Varghese, Ajin Shaji; Viswanath, Lokesh; Valuvil, Nithin Bhaskar; Sathiyan, S; Govardhan, H.B.; Khaleel, Ibrahim; Palled, Siddanna R.; Thimmaiah, Naveen

doi:10.5114/jcb.2021.112113

Cited by 1 publication

(1 citation statement)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…OARs (e.g., sigma) typically change position and need re-delineation. Previous studies have suggested that execution of a dose-optimized previous day plan of brachytherapy in subsequent fraction, resulted in an increase of D 2cc doses to OARs [ 28 , 29 ]. Therefore, the work of a medical physicist is required for image fusion, verifying the position of the applicator, and correcting the dose optimization.…”

Section: Discussionmentioning

confidence: 99%

The impact of different treatment protocols on achieved radiation doses of high-dose-rate brachytherapy for locally advanced cervical cancer: a comparison between 2 fractions in 1 application and separate applications for each fraction

Jääskeläinen¹,

Anttila²,

Palmgren³

et al. 2022

jcb

View full text Add to dashboard Cite

Purpose: To compare radiation doses achieved by image-guided brachytherapy for locally advanced cervical carcinoma implemented with two different protocols.Material and methods: Medical records of 117 patients with locally advanced cervical carcinoma treated with brachytherapy from 2009 to 2018 at our institution were retrospectively reviewed. All patients had received previous external beam radio/chemotherapy. We performed magnetic resonance image-guided adaptive high-dose-rate brachytherapy delivered by intra-cavitary/interstitial applicators. Dose prescription was 7 Gy for four fractions within two weeks. Original schedule of brachytherapy was two fractions delivered on consecutive days with one applicator insertion; this process was repeated one week later (group 1, 54 patients). From 2015 onwards, another protocol of brachytherapy was mainly used, separately performing applicator insertions for each of the four administered fractions (group 2, 63 patients).Results: The high-risk clinical target volume (HR-CTV) D 90 planning aim (PA) of ≥ 85 Gy (hard constraint) was not achieved in 9 cases out of 54 (17%) in group 1 compared with only 2 out of 63 cases (3%) in group 2 (p = 0.022). A difference between the two groups was also found in the fulfillment of PA 90 Gy (soft constraint) (p = 0.027). We conducted a sub-group analysis of target volume groups and observed that the differences were most pronounced with very large tumors (> 50 cm 3 ). In these patients, PA 85 Gy was only fulfilled in 67% cases when treatment involved two applications, but in all cases with four separate applicator insertions (p = 0.010).Conclusions: In our experience, by performing an applicator insertion for each of the fractions, it is possible to correct the non-optimal position of the applicator immediately, and to deliver better doses for consecutive fractions. As a result, the planning aim is more often achieved, especially for large tumors.

show abstract

Section: Discussionmentioning

confidence: 99%