Prediction of severe late complications in fractionated, high dose-rate brachytherapy in gynecological applications

Image-based three-dimensional treatment planning of intracavitary brachytherapy for cancer of the cervix: Dose-volume histograms of the bladder, rectum, sigmoid colon, and small bowel

“…The clinical value of these reference points is still controversial. Some authors have found a significant correlation between the calculated dose to the ICRU reference point and complications (21, 25e27), whereas several other authors have not (28,29). Inaccurate estimates of doses to OAR may be contributing factors for the poor correlation between the dose and late complications.…”

Rectal bleeding and its management after irradiation for uterine cervical cancer

“…Both Clark et al (8) and Esche et al (31) indicated that the correlation between the doses calculated at the rectal point defined by the ICRU and the incidence of late rectal complications was significant. Van Lancker and Storme (32) reported a statistically significant correlation between complications and the reference volume defined with reference to the HDR brachytherapy applicators. Shin et al (18) evaluated the incidence of rectal bleeding and the relationship between the measured dose and the calculated dose.…”

Comparison between In Vivo Dosimetry and Barium Contrast Technique for Prediction of Rectal Complications in High-Dose-Rate Intracavitary Radiotherapy in Cervix Cancer Patients

“…For definition of the rectal reference point, some authors [5,7,9,19,21,30] used the ICRU Report 38 criteria, while others [8,16,25] applied the barium contrast criteria. In the group that defined the rectal reference point according to the ICRU Report 38 [12], the results of the correlation between the rectal dose and the rectal complications were controversial.…”

“…According to Clark et al [5], patients with a rectal reference point greater than the prescribed point A dose had a significantly higher probability of developing a toxicity. Yet, Van Lancker & Storme [30] insisted that neither the single rectal reference point nor combinations of multiple rectal reference points were good predictors of complications, and suggested that volume calculation was a highly reliable predictor. In addition, because there were other rectal points besides the ICRU reference point which were receiving a dose close to the maximum, Deshpande et al [9] proposed that doses to multiple rectal reference points with ICRU-defined rectal reference point should be recorded.…”

“…Therefore, assessment and modification of the rectal dose in each individual case would be helpful for decreasing the risk of rectal complications. The methods of calculating the rectal dose are not uniform; some centers [7,9,17,19,21,30] use the recommendations of the ICRU Report 38 [12] and the points of barium contrast criteria [8,16,25], while others use in vivo rectal dose measurement [4,5,14,18,22,26,29].Since 1995, we have prospectively calculated the rectal point dose with the method of barium contrast criteria and have concomitantly measured the rectal dose with thermoluminescent dosimeters (TLD) during the first fraction of highdose-rate (HDR) ICR. Previously, we have reported an 11% incidence of complications among 74 patients [24].…”