Inter-application variation of dose and spatial location of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" altimg="si1.gif" overflow="scroll"><mml:mrow><mml:msub><mml:mrow><mml:mi>D</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn><mml:msup><mml:mrow><mml:mtext>cm</mml:mtext></mml:mrow><mml:mrow><mml:mn>3</mml:mn></mml:mrow></mml:msup></mml:mrow></mml:msub></mml:mrow></mml:math> volumes of OARs during MR image based cervix brachytherapy

Swamidas, Jamema; Mahantshetty, Umesh; Tanderup, Kari; Malvankar, Deepti; Sharma, Shilpa; Chopra, Supriya; Shrivastava, Shyam K.; Deshpande, Deepak D.

doi:10.1016/j.radonc.2013.01.011

Cited by 51 publications

(12 citation statements)

References 17 publications

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“…Various parameters such as bladder filling, rectal filling, movements of sigmoid colon, and variation in vaginal packing have an impact on dosimetry and intra/inter fraction variations [6]. In this study, we investigated the dosimetric impact of bladder filling status during HDR intracavitary cervical brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

Optimal bladder filling during high-dose-rate intracavitary brachytherapy for cervical cancer: a dosimetric study

Mahantshetty

Shetty

Majumder

et al. 2017

jcb

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PurposeThe aim of this study is to compare 3D dose volume histogram (DVH) parameters of bladder and other organs at risk with different bladder filling protocol during high-dose-rate intracavitary brachytherapy (HDR-ICBT) in cervical cancer, and to find optimized bladder volume.Material and methodsThis dosimetric study was completed with 21 patients who underwent HDR-ICBT with computed tomography/magnetic resonance compatible applicator as a routine treatment. Computed tomography planning was done for each patient with bladder emptied (series 1), after 50 ml (series 2), and 100 ml (series 3) bladder filling with a saline infusion through the bladder catheter. Contouring was done on the Eclipse Planning System. 7 Gy to point A was prescribed with the standard loading patterns. Various 3D DVH parameters including 0.1 cc, 1 cc, 2 cc doses and mean doses to the OAR’s were noted. Paired t-test was performed.ResultsThe mean (± SD) bladder volume was 64.5 (± 25) cc, 116.2 (± 28) cc, and 172.9 (± 29) cc, for series 1, 2, and 3, respectively. The 0.1 cm3,1 cm3, 2 cm3 mean bladder doses for series 1, series 2, and series 3 were 9.28 ± 2.27 Gy, 7.38 ± 1.72 Gy, 6.58 ± 1.58 Gy; 9.39 ± 2.28 Gy, 7.85 ± 1.85 Gy, 7.05 ± 1.59 Gy, and 10.09 ± 2.46 Gy, 8.33 ± 1.75 Gy, 7.6 ± 1.55 Gy, respectively. However, there was a trend towards higher bladder doses in series 3. Similarly, for small bowel dose 0.1 cm3, 1 cm3, and 2 cm3 in series 1, 2, and 3 were 5.44 ± 2.2 Gy, 4.41 ± 1.84 Gy, 4 ± 1.69 Gy; 4.57 ± 2.89 Gy, 3.78 ± 2.21 Gy, 3.35 ± 2.02 Gy, and 4.09 ± 2.38 Gy, 3.26 ± 1.8 Gy, 3.05 ± 1.58 Gy. Significant increase in small bowel dose in empty bladder (series 1) compared to full bladder (series 3) (p = 0.03) was noted. However, the rectal and sigmoid doses were not significantly affected with either series.ConclusionsBladder filling protocol with 50 ml and 100 ml was well tolerated and achieved a reasonably reproducible bladder volume during cervical brachytherapy. In our analysis so far, there is no significant impact of bladder filling on DVH parameters, although larger bladders tend to have higher doses. Small bowel doses are lesser with higher bladder volumes. Further evaluation and validation are necessary.

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Section: Discussionmentioning

confidence: 99%

Optimal bladder filling during high-dose-rate intracavitary brachytherapy for cervical cancer: a dosimetric study

Mahantshetty

Shetty

Majumder

et al. 2017

jcb

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“…[20] and Jamema et al . [21] reported that D 2cc of bladder and rectum in MRI-based image guided brachytherapy of cervical cancer is a stable spatial location for direct dose summation for each fraction. Our total D 2cc for OARs from the contribution of each brachytherapy fraction is based on the same observation as their study.…”

Section: Discussionmentioning

confidence: 99%

Mapping of dose distribution from IMRT onto MRI-guided high dose rate brachytherapy using deformable image registration for cervical cancer treatments: preliminary study with commercially available software

Kim¹,

Huq²,

Houser³

et al. 2014

jcb

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PurposeFor patients undergoing external beam radiation therapy (EBRT) and brachytherapy, recommendations for target doses and constraints are based on calculation of the equivalent dose in 2 Gy fractions (EQD2) from each phase. At present, the EBRT dose distribution is assumed to be uniform throughout the pelvis. We performed a preliminary study to determine whether deformable dose distribution mapping from the EBRT onto magnetic resonance (MR) images for the brachytherapy would yield differences in doses for organs at risk (OARs) and high-risk clinical target volume (HR-CTV).Material and methodsNine cervical cancer patients were treated to a total dose of 45 Gy in 25 fractions using intensity-modulated radiation therapy (IMRT), followed by MRI-based 3D high dose rate (HDR) brachytherapy. Retrospectively, the IMRT planning CT images were fused with the MR image for each fraction of brachytherapy using deformable image registration. The deformed IMRT dose onto MR images were converted to EQD2 and compared to the uniform dose assumption.ResultsFor all patients, the EQD2 from the EBRT phase was significantly higher with deformable registration than with the conventional uniform dose distribution assumption. The mean EQD2 ± SD for HR-CTV D90 was 45.7 ± 0.7 Gy vs. 44.3 Gy for deformable vs. uniform dose distribution, respectively (p < 0.001). The dose to 2 cc of the bladder, rectum, and sigmoid was 46.4 ± 1.2 Gy, 46.2 ± 1.0 Gy, and 48.0 ± 2.5 Gy, respectively with deformable dose distribution, and was significantly higher than with uniform dose distribution (43.2 Gy for all OAR, p < 0.001).ConclusionsThis study reveals that deformed EBRT dose distribution to HR-CTV and OARs in MR images for brachytherapy is technically feasible, and achieves differences compared to a uniform dose distribution. Therefore, the assumption that EBRT contributes the same dose value may need to be carefully investigated further based on deformable image registration.

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“…Deformable registration in bladder and likely also rectum seems to have little advantage for dose accumulation (62), and may even introduce uncertainties due to unreliable deformations. For sigmoid and bowel, dose accumulation based on rigid registration has significant limitations (64), but there exists currently no convincing deformable registration tool for these organs.…”

Section: Mri-guided Treatment Planningmentioning

confidence: 99%

Magnetic Resonance Image Guided Brachytherapy

Tanderup

Viswanathan

Kirisits

et al. 2014

Seminars in Radiation Oncology

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108

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The application of MRI-guided brachytherapy has demonstrated significant growth during the last two decades. Clinical improvements in cervix cancer outcomes have been linked to the application of repeated MRI for identification of residual tumor volumes during radiotherapy. This has changed clinical practice in the direction of individualized dose administration, and mounting evidence of improved clinical outcome with regard to local control, overall survival as well as morbidity. MRI-guided prostate HDR and LDR brachytherapy has improved the accuracy of target and organs-at-risk (OAR) delineation, and the potential exists for improved dose prescription and reporting for the prostate gland and organs at risk. Furthermore, MRI-guided prostate brachytherapy has significant potential to identify prostate subvolumes and dominant lesions to allow for dose administration reflecting the differential risk of recurrence. MRI-guided brachytherapy involves advanced imaging, target concepts, and dose planning. The key issue for safe dissemination and implementation of high quality MRI-guided brachytherapy is establishment of qualified multidisciplinary teams and strategies for training and education.

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Inter-application variation of dose and spatial location of D2cm3 volumes of OARs during MR image based cervix brachytherapy

Cited by 51 publications

References 17 publications

Optimal bladder filling during high-dose-rate intracavitary brachytherapy for cervical cancer: a dosimetric study

Optimal bladder filling during high-dose-rate intracavitary brachytherapy for cervical cancer: a dosimetric study

Mapping of dose distribution from IMRT onto MRI-guided high dose rate brachytherapy using deformable image registration for cervical cancer treatments: preliminary study with commercially available software

Magnetic Resonance Image Guided Brachytherapy

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