Evaluation of interfractional variation of organs and displacement of catheters during high-dose-rate interstitial brachytherapy for gynecologic malignancies

Lee, Soyoung; Rodney, Ellis; Traughber, Bryan; Biswas, Tithi; Colussi, Valdir C.; Podder, Tarun

doi:10.1016/j.brachy.2017.09.001

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…These results suggest that for any three-fraction prescription regimen, a Day 2 verification image adds value to assessing inter-fraction changes. The results of this study also reinforce the findings of previous adaptive planning studies indicating that re-planning may provide value in particular cases [7,8,9,10]. That is, adaptive planning is capable of improving plan quality, but is not strictly required to adhere to the ABS normal tissue guidelines or the EMBRACE II limits for prescribed dose.…”

Section: Discussionsupporting

confidence: 85%

“…Previous gynecologic brachytherapy studies have investigated the dosimetric impact of inter-fraction changes [5,6] and the added value of adaptive planning [7,8,9,10]. Most of these studies have assessed the value of adaptive planning for treatment regimens where the prescription dose is delivered over five or six fractions [7,8,9]. These studies showed mixed results on the benefit of adaptive planning but demonstrate improvement in selected cases with large anatomical changes.…”

Section: Purposementioning

confidence: 99%

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The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

Belliveau¹,

Thind²,

Banerjee³

et al. 2019

jcb

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Purpose Perineal template-based interstitial gynecologic brachytherapy (ISBT) treatments are evaluated to determine whether adaptive inter-fraction re-planning is beneficial and necessary to meet the treatment aims of the American Brachytherapy Society (ABS) consensus guidelines for interstitial brachytherapy. Adherence to the EMBRACE II protocol is also assessed. Material and methods Ten patients receiving radical intent treatment for locally advanced or recurrent gynecologic malignancies underwent a three-fraction ISBT treatment with an ABS-recommended prescription regimen of 21 to 24 Gy. Clinical treatment plans were created according to a computed tomography (CT) acquired immediately post-implant. The first fraction was delivered on the same day as the implant (Day 1). The remaining two fractions were delivered on the next day (Day 2), at least six hours apart. Prior to treating on Day 2, a verification CT was acquired, permitting assessment of over-night changes. The Day 2 CT was used to evaluate deviations in 2-Gy-per-fraction equivalent dose (EQD 2 ) from the clinically intended dosimetry for clinical target volume (CTV), bladder, rectum, and sigmoid. Results For all patients, the median (range) difference between the intended and the delivered dosimetry for the CTV D90% was 1.4 Gy 10 (0.3-4.4 Gy 10 ). For all normal tissues, the median (range) difference from the intended normal tissue dose was 2.6 Gy 3 (0.1-15.5 Gy 3 ). In all cases, the deviation from clinically intended dosimetry did not lead to a violation of recommended normal tissue dose guidelines. For two of 10 patients with large normal tissue differences (> 10 Gy 3 from the intended dose), inter-fraction adaptive planning did improve the plan quality, but was not strictly required to meet the normal tissue dose planning aims. Conclusions The implementation of perineal template-based ISBT treatment without inter-fraction adaptive planning can be delivered to comply with the ABS normal tissue dose guidelines and EMBRACE II limits for prescribed dose.

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Section: Discussionsupporting

confidence: 85%

Section: Purposementioning

confidence: 99%

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

Belliveau¹,

Thind²,

Banerjee³

et al. 2019

jcb

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“…BT utilizes various devices to position strongly ionizing radioactive seeds in the immediate vicinity of the primary tumour, which allows for the considerable sparing of OARs [224]. Anchorage of these devices to the patient also greatly reduces concerns of organ displacement which is a major concern for EBRT [225][226][227]. The radiation of BT seeds possesses an intrinsic sharp dose falloff and so optimization of seeds' dwell positions and times leads to highly conformal dose distributions in treatment plans [228].…”

Section: Brachytherapymentioning

confidence: 99%

An Evaluation of the Impact of MR Image Slice Thickness on the Accuracy of High-Dose-Rate Brachytherapy for Gynaecological Cancers

Dubnitzky¹,

Kumaradas²

2022

Preprint

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High-dose-rate (HDR) Magnetic Resonance (MR) guided brachytherapy (BT) is rapidly becoming the standard for treatment of locally advanced cervical cancer, globally. MR is an integral aspect of this treatment, enabling the level of soft tissue visualization required for precise delineation of organ and target contours with respect to the BT applicator or needles during treatment planning. The optimal slice thickness for MR datasets, and the role of super-resolved datasets are questions yet to be investigated. A digital phantom-based study assessed the impact of slice thickness on volumetric and geometric uncertainties in traditional MR datasets and estimated the resultant dosimetric uncertainty. Datasets with traditional slice thicknesses produced uncertainties up to 27% of the imaged structure volume, and contour uncertainty up to one third of the slice thickness This resulted in the exceeding of the American Association of Physicists in Medicine’s (AAPM) recommended dosimetric uncertainty in HDR BT. Trilinearly interpolated datasets reduced these uncertainties substantially, allowing imaging with 2.7 mm coarser slices while conferring an imaging time reduction of 6 minutes. The results of this thesis demonstrate that the recommended range of slice thicknesses introduces uncertainties on a level known to impact dosimetry more than 9%. Trilinearly interpolated datasets may thus confer benefit in this clinical setting.

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“…There is a scarcity of definitive comparative studies in the literature involving the use of real-time guidance for the catheter placement in P-ISBT. The lack of adequate and accessible real-time guidance for catheter placement is a significant issue that contributes to the difficulty associated with the P-ISBT technique for gynecological cancers [28,87,90]. In addition to minimizing the difficulty associated with the technically challenging nature of P-ISBT, real-time guidance during the implant procedure has demonstrated improvements in implant geometry [87].…”

Section: Research Problem 161 Definition Of Research Problemmentioning

confidence: 99%

“…The lack of adequate and accessible real-time guidance for catheter placement is a significant issue that contributes to the difficulty associated with the P-ISBT technique for gynecological cancers [28,87,90]. In addition to minimizing the difficulty associated with the technically challenging nature of P-ISBT, real-time guidance during the implant procedure has demonstrated improvements in implant geometry [87]. Optimal implant geometry is associated with uniform dose across the target volume and minimized dose to OARs while poor quality implants are linked to less desirable patient outcomes [34,91].…”

Section: Research Problem 161 Definition Of Research Problemmentioning

confidence: 99%

Electromagnetic-Guided Interstitial Catheter Navigation for Gynecological Brachytherapy: a Phase I Trial (E-MINT)

Khan¹

2021

Preprint

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<div>Catheter insertion for gynecological interstitial brachytherapy is a challenging surgical procedure due to the lack of real-time guidance available to Radiation Oncologists. To mitigate the limitations associated with catheter placement, electromagnetic navigation (EMN) was proposed as a solution to the current interstitial brachytherapy workflow. The sequence of events leading up to the completion of this project were as follows, the validation of the system and then the application of the EMN system in a clinical trial. Using a phantom-based validation method, submillimetric accuracy and jitter was characterized for the operational performance of an EMN system in a brachytherapy operating room environment.</div><div>Following validation, the EMN system was used for catheter placement in 5 patients, in an ongoing prospective clinical study. The mean catheter deflection documented was 3.52 +/- 2.53 mm when adopting EMN as a form of real-time guidance compared to 5.48 +/- 3.63 mm when the standard clinical workflow (SCW) was employed. The mean catheter spacing when using EMN was 9.31 +/- 4.81 mm compared to 7.09 +/- 6.06 mm when the SCW was followed. Also, the mean intraoperative time was 50.00 +/- 18.80 minutes for EMN and 38.20 +/- 15.29 minutes for the SCW.</div><div>The results of this project demonstrate that electromagnetic navigated interstitial catheter placement is promising as a real-time guidance option for the interstitial gynecological brachytherapy workflow. <br></div>

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Evaluation of interfractional variation of organs and displacement of catheters during high-dose-rate interstitial brachytherapy for gynecologic malignancies

Cited by 11 publications

References 29 publications

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

An Evaluation of the Impact of MR Image Slice Thickness on the Accuracy of High-Dose-Rate Brachytherapy for Gynaecological Cancers

Electromagnetic-Guided Interstitial Catheter Navigation for Gynecological Brachytherapy: a Phase I Trial (E-MINT)

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