Study of dosimetric variation due to interfraction organ movement in High Dose Rate Interstital (MUPIT) brachytherapy for gynecologic malignancies

Velmurugan, Thanigaimalai; Sukumar, Prabakar; Krishnappan, Chokkalingam; Boopathy, Raghavendiran

doi:10.2478/v10013-010-0008-6

Cited by 6 publications

(6 citation statements)

References 12 publications

(11 reference statements)

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“…Velumurugan et al observed that the CTV mean dose varies from +9.8% to −13.3%. Out of 10 patients the mean dose was more than the prescribed dose in seven patients and less in three patients [10]. The maximum variation to CTV dose was estimated to be around 13%.…”

Section: Discussionmentioning

confidence: 88%

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Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Kandasamy¹,

Reddy²,

Nagarajan³

et al. 2013

IJMPCERO

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Background: Patient setup errors in External Beam Radiotherapy (EBRT) are minimized to a great extent, due to recent technological developments, but in contrary brachytherapy received less attention in inter-fraction catheter movement and its impact in dose delivery. This article deals with inter-fraction interstitial catheter movement and its impact in dose delivery to the target. An attempt is made to study the dosimetric impact of this variation. Objectives: The objective of the study is to evaluate the inter-fraction variation in the position of implanted interstitial applicators and to assess the dosimetric impact in interstitial High Dose Rate (HDR) brachytherapy. Materials and Methods: 55 patients treated for carcinoma tongue, breast, buccal mucosa, cervix, floor of the mouth and soft tissue sarcoma over a period of 2 years (December 2011-May 2013) were considered. All the patients underwent CT scan the next day of the implanting and 3D planning was done either by Eclipse or Oncentra Master Plan Treatment Planning System (TPS). Patients were treated by HDR brachytherapy remote after-loading units, either by Gamma Med iX plus or Microselectron. At the end of the last fraction, CT scan was repeated and re-planning done. The variation in the position of the implanted applicators/catheters and its impact on dosimetric parameters was evaluated and analyzed. Results: The range of positional displacement of the interstitial catheters ranges from 4.5 mm to 6.8 mm. The maximum variation in prescribed dose to D90 of Clinical Target Volume was 10.88%. Conclusions: If the total duration of the interstitial implant of HDR brachytherapy extends for more than a week from the day of imaging, it is recommended to do CT imaging and re-plan again. It is mandatory to suture the buttons of the implanting to the skin. Edema and movement of organs (e.g., tongue) are the main cause for the positional variation of the catheters.

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Section: Discussionmentioning

confidence: 88%

“…Velumurugan et al evaluated MUPIT implantation in patients with carcinoma cervix. In their study they recommended to repeat CT and re-plan before each fraction [10]. In our study imaging and planning was done before the first fraction.…”

Section: Discussionmentioning

confidence: 98%

Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Kandasamy¹,

Reddy²,

Nagarajan³

et al. 2013

IJMPCERO

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“…Velmurugan et al 11 studied the dosimetric variation due to inter-fraction organ movement in HDR interstitial (MUPIT) brachytherapy for gynaecological malignancies in ten patients. They estimated the variation in the volume of the clinical target.…”

Section: Discussionmentioning

confidence: 99%

Inter-fraction variation in interstitial high-dose-rate brachytherapy

et al. 2015

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AimTo evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.BackgroundAlthough brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.Materials and methodsA total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.ResultsFor all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.ConclusionInter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

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“…Velmurugan et al [18] suggested that the variation is significant and CT imaging for each fraction should be done to minimize the error in gynecological patients. CT/MRI imaging before each fraction can be an effective way to find the tumor shrinkage, edema and applicator displacement.…”

Section: Discussionmentioning

confidence: 99%

Inter-Fraction and Intra-Fraction Variation in the Absorbed-Dose Delivery during Interstitial High Dose Rate Brachytherapy—A Study Using MicroMOSFET <i>In-Vivo</i> Dosimeter

Ramapandian¹,

Nagarajan²,

Mukherji³

et al. 2017

IJMPCERO

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Background: The delivered dose has to be checked and verified with planned dose since precise and accurate dose delivery is essential in Brachytherapy. Sources of uncertainty during Brachytherapy are intra-fraction, inter-fraction and inter-application variations. In-vivo dosimetry is the direct method to monitor the radiation dose delivered to a patient during radiotherapy. In this study, assessment of the inter-fraction and intra-fraction variations in the interstitial Brachytherapy was done with microMOSFET. Aim: To analyze the inter-fraction variations in dose delivery during interstitial HDR Brachytherapy and to compare the measured point dose with the TPS-calculated point dose, intra-fraction variation, using the microMOSFET in-vivo dosimeter. Materials and Methods: From May 2014 to February 2016, 22 patients with Head and Neck cancers and 8 patients with Soft-Tissue Sarcomas (STS) were selected for this study. All these patients underwent CT imaging more than 24 hours after the application. Brachyvision 3DTPS and GammaMed Plus iX HDR unit were used for treatments. MicroMOSFET in-vivo dosimeter after calibration was used for the measurements of dose inside the treated volume. Intra & Inter-fraction variations were analyzed and reported. Results: The SD of inter-fraction variation among 22 Head & Neck patients ranges from 2.14% to 14.26%. Minimum & maximum dose variation with first fraction dose of patients ranged from −22.33% to +26.71% and the mean doses were −6.42% to +19.76%. Differences of TPS dose and microMOSFET measured first fraction dose, intra-fraction variation, ranged from −12.36% to +5.05%. The SD of inter-fraction variation How to cite this paper: Ramapandian, S., Nagarajan, V., Mukherji, A., Vedasoundaram, P., Reddy, K.S., Singhavajala, V. for 8 STS patients was from 2.81% to 14.43%. Minimum and maximum doses vary from −38.72% to +25.74% and mean dose varies from −21.5% to +12.53%. Differences of point doses of TPS and measured, intra-fraction variation, were from −5.86% to 4.88%. Conclusions: MicroMOSFET has the potential to minimize the gross errors during multi-fractionated Interstitial Brachytherapy. Edema, applicator displacements and placement of microMOSFET are the main influencing factors for inter-fraction uncertainty in dose delivery. Re-planning with re-simulated images should be considered whenever the microMOSFET readings vary more than ±10% of the planned dose inside the CTV measured in two successive fractions. KeywordsMicroMOSFET, Interstitial Brachytherapy, MicroMOSFET in Brachytherapy,In-Vivo Dosimetry in Brachytherapy, Dose Verification in Brachytherapy

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Study of dosimetric variation due to interfraction organ movement in High Dose Rate Interstital (MUPIT) brachytherapy for gynecologic malignancies

Cited by 6 publications

References 12 publications

Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Inter-fraction variation in interstitial high-dose-rate brachytherapy

Inter-Fraction and Intra-Fraction Variation in the Absorbed-Dose Delivery during Interstitial High Dose Rate Brachytherapy—A Study Using MicroMOSFET <i>In-Vivo</i> Dosimeter

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Study of dosimetric variation due to interfraction organ movement in High Dose Rate Interstital (MUPIT) brachytherapy for gynecologic malignancies

Cited by 6 publications

References 12 publications

Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Dosimetric Impact of Inter-Fraction Variation in Interstitial HDR Brachytherapy

Inter-fraction variation in interstitial high-dose-rate brachytherapy

Inter-Fraction and Intra-Fraction Variation in the Absorbed-Dose Delivery during Interstitial High Dose Rate Brachytherapy—A Study Using MicroMOSFET &lt;i&gt;In-Vivo&lt;/i&gt; Dosimeter

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Inter-Fraction and Intra-Fraction Variation in the Absorbed-Dose Delivery during Interstitial High Dose Rate Brachytherapy—A Study Using MicroMOSFET <i>In-Vivo</i> Dosimeter