Intrafractional organs movement in three-dimensional image-guided adaptive pulsed-dose-rate cervical cancer brachytherapy: Assessment and dosimetric impact

Pulsed-dose rate image-guided adaptive brachytherapy in cervical cancer: Dose–volume effect relationships for the rectum and bladder

“…Three recent PDR series monitoring the rectal D2 cm 3 during the treatment delivery by transposing the dwell positions and times from the initial plan to CT or MRI acquired at day 2 and 3 of the treatment, reported increased delivered D2 cm 3 in regard to prescribed D2 cm 3 [24][25][26]. In our experience the mean difference between the prescribed D2 cm 3 and the estimated delivered D2 cm 3 was 3.7 Gy (EqD2) [24]. This source of uncertainty can potentially impact the dose-volume relationships for the rectum.…”

Dose–volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: Results from the prospective multicenter EMBRACE study

“…It has been demonstrated, however, that in PDR brachytherapy the prescribed rectal D 2cm 3 may underestimate the delivered dose due to OAR movements and deformations during treatment delivery, whereas no significant difference has been reported in HDR series [31][32][33]. Three recent series monitoring the rectal D 2cm 3 during treatment at day 2 and 3 reported increased delivered D 2cm 3 compared to the prescribed D 2cm 3 [33][34][35]. Two of these studies reported mean increases of 3.7 Gy and 2.5 Gy respectively [33,34].…”

“…Three recent series monitoring the rectal D 2cm 3 during treatment at day 2 and 3 reported increased delivered D 2cm 3 compared to the prescribed D 2cm 3 [33][34][35]. Two of these studies reported mean increases of 3.7 Gy and 2.5 Gy respectively [33,34]. In EMBRACE, nearly half of the patients were treated with PDR.…”

Dose comparison between prescription methods according to anatomical variations in intracavitary brachytherapy for cervical cancer

“…Some studies evaluated the movements of internal organs dosimetrically rather than clinically when measuring dose changes associated with intra- and inter-fractional movements [ 10 , 18 ]. Kobayashi et al [ 10 ] measured dose variations between fractions.…”

“…The differences in the cumulative doses for each index were: bladder D 2mL , 0.3±0.8 Gy; bladder D 0.1mL , 2.2±0.6 Gy. Mazeron et al [ 18 ] subjected intra-fractional organ movements to dose analyses by performing MRI after procedures featuring ICBT simulation, and CT on days 1–3 of treatment, when pulsed-dose-rate brachytherapy was employed. They found no significant movement of the bladder or sigmoid colon during treatment [ 18 ].…”