Dosimetric impact of applicator displacement on three-dimensional image-guided high-dose-rate brachytherapy treatments for cervical cancer.

IF 1.1 4区 医学 Q4 ONCOLOGY
Journal of Contemporary Brachytherapy Pub Date : 2023-10-01 Epub Date: 2023-10-31 DOI:10.5114/jcb.2023.132697
Sandun Jayarathna, Matthew Hoang, Rajeev Badkul, Andrew Hoover
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Abstract

Purpose: To determine the dosimetric impact of brachytherapy applicator displacement during intracavitary (IC) and combined intracavitary/interstitial (IC/IS) high-dose-rate brachytherapy in the treatment of cervical cancer.

Material and methods: Data from 27 consecutively treated patients undergoing IC or IC/IS high-dose-rate brachytherapy with tandem and ovoid-based applicators at a single academic medical center were analyzed. Virtual applicator displacements (a single shift of whole applicator with tandem/ovoid/associated needles) of 0 (clinical position), 2, 5, 7, and 10 mm in the inferior direction were modeled on treatment planning CT or MRI scans, with maintaining the same dwell times. Radiation dose to target volumes (D90 of high-risk clinical target volume) and organs at risk (OARs) (D0.1cc, D1cc, and D2cc of bladder, rectum, and sigmoid) were calculated for each virtual applicator shift, and significance of displacements was assessed using general linear model and Kruskal-Wallis test.

Results: Mean dose to high-risk clinical target volume (HR-CTV) D90 was 95.7%, 88.9%, 84.6%, and 77.1% of the prescribed dose in clinical position with displacements of 2, 5, 7, and 10 mm, respectively. Rectal D2cc significantly increased by 28% and 44% at displacement of 7 mm and 10 mm, respectively. IC/IS cases showed relatively greater dosimetric differences than IC cases, with HR-CTV D90 doses of 94.4%, 85.8%, 80.4%, and 72.4% at virtual displacements of 2, 5, 7, and 10 mm, respectively.

Conclusions: Applicator displacements of 5 mm or greater result in statistically significant and clinically meaningful decreases in radiation dose to HR-CTV during 3-dimensional high-dose-rate brachytherapy treatment planning, with corresponding increase in radiation dose to the rectum. IC/IS applicator displacements lead to relatively greater differences than those of IC applicators.

涂抹器位移对三维图像引导下宫颈癌高剂量率近距离放射治疗的剂量学影响。
目的:探讨腔内(IC)和腔内/间质联合(IC/IS)高剂量率近距离放疗对宫颈癌治疗的剂量学影响。材料和方法:分析来自单一学术医疗中心27例连续接受IC或IC/IS高剂量近距离治疗的患者的数据,这些患者使用串联和卵泡为基础的涂抹器。在治疗计划CT或MRI扫描中,在保持相同停留时间的情况下,虚拟施药器位移(整个施药器与串联/卵形/关联针头的单次移动)在下方向为0(临床位置)、2、5、7和10 mm。计算每次虚拟施药器移位对靶体积(临床高危靶体积的D90)和危险器官(OARs)(膀胱、直肠和乙状结肠的D0.1cc、D1cc和D2cc)的辐射剂量,并使用一般线性模型和Kruskal-Wallis检验评估移位的意义。结果:高危临床靶体积(HR-CTV) D90的平均剂量在临床位移2、5、7、10 mm位置分别为处方剂量的95.7%、88.9%、84.6%、77.1%。直肠D2cc在移位7 mm和10 mm时分别显著增加28%和44%。与IC病例相比,IC/IS病例显示出相对更大的剂量学差异,HR-CTV D90在虚拟位移为2、5、7和10 mm时的剂量分别为94.4%、85.8%、80.4%和72.4%。结论:在三维高剂量率近距离放射治疗方案中,放置器位移5mm或更大可导致HR-CTV放射剂量的降低,具有统计学意义和临床意义,同时直肠放射剂量相应增加。IC/IS涂敷器位移导致的差异相对于IC涂敷器的差异更大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Contemporary Brachytherapy
Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
2.40
自引率
14.30%
发文量
54
审稿时长
16 weeks
期刊介绍: The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
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