{"title":"HDR影像引导下近距离放疗对盆腔淋巴结区的剂量贡献——一项重新思考现代容积规划的研究。","authors":"Akkineni Naga Prasanthi, Anil Kumar Talluri, Lakshmi Venkataramana Puriparthi, Nvn Madhusudhan Sresty, Deleep Kumar Gudipudi","doi":"10.5603/rpor.109093","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Previous studies have evaluated nodal dose using Point-A prescriptions or variable dose rates. However, the impact of volume-based high-dose-rate (HDR) brachytherapy approaches remains less explored. In this study, we aimed to assess the dose contribution to the pelvic lymph nodes with volume-based (HR-CTV) prescription in comparison to point-A-based prescription during HDR brachytherapy in carcinoma cervix. This comparison has not been comprehensively evaluated in earlier literature, especially in the context of elective nodal contouring and HDR brachytherapy.</p><p><strong>Materials and methods: </strong>Thirty patients with carcinoma of the cervix [International Federation of Gynecology and Obstetrics (FIGO) stage IB2 or higher] were included for this retrospective study. Two plans were generated on each brachytherapy scan. The first plan (point-A-based) prescribed a dose of 7 Gy to point-A, while the second plan (HR-CTV-based) prescribed the dose to the HR-CTV. Dose volume histograms (DVH) parameters were compared between both the plans.</p><p><strong>Results: </strong>HR-CTV-based plans registered safer doses to OARs. Both the plans showed noticeable dose contributions to the pelvic lymph node stations, particularly the obturator, internal iliac, and presacral stations, with the highest contribution observed in the obturator group. However, HR-CTV-based plans contributed lower doses to these nodal regions, approximately 1 Gy less to the internal iliac and obturator stations and 2 Gy less to the presacral station compared to point-A-based plans when D50 was considered.</p><p><strong>Conclusions: </strong>HR-CTV-based plans demonstrated recognizable dose contribution to lymph nodes, although lower than the contribution by point-A-based plans. However, this modest difference can be effectively compensated by optimizing the external beam radiotherapy (EBRT) dose while simultaneously maintaining safe organ at risk (OAR) doses.</p>","PeriodicalId":47283,"journal":{"name":"Reports of Practical Oncology and Radiotherapy","volume":"31 1","pages":"133-141"},"PeriodicalIF":2.0000,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046417/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dose contribution from brachytherapy to the pelvic lymph nodal region during HDR image-guided brachytherapy - a study for rethinking modern volume-based planning.\",\"authors\":\"Akkineni Naga Prasanthi, Anil Kumar Talluri, Lakshmi Venkataramana Puriparthi, Nvn Madhusudhan Sresty, Deleep Kumar Gudipudi\",\"doi\":\"10.5603/rpor.109093\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Previous studies have evaluated nodal dose using Point-A prescriptions or variable dose rates. However, the impact of volume-based high-dose-rate (HDR) brachytherapy approaches remains less explored. In this study, we aimed to assess the dose contribution to the pelvic lymph nodes with volume-based (HR-CTV) prescription in comparison to point-A-based prescription during HDR brachytherapy in carcinoma cervix. This comparison has not been comprehensively evaluated in earlier literature, especially in the context of elective nodal contouring and HDR brachytherapy.</p><p><strong>Materials and methods: </strong>Thirty patients with carcinoma of the cervix [International Federation of Gynecology and Obstetrics (FIGO) stage IB2 or higher] were included for this retrospective study. Two plans were generated on each brachytherapy scan. The first plan (point-A-based) prescribed a dose of 7 Gy to point-A, while the second plan (HR-CTV-based) prescribed the dose to the HR-CTV. Dose volume histograms (DVH) parameters were compared between both the plans.</p><p><strong>Results: </strong>HR-CTV-based plans registered safer doses to OARs. Both the plans showed noticeable dose contributions to the pelvic lymph node stations, particularly the obturator, internal iliac, and presacral stations, with the highest contribution observed in the obturator group. However, HR-CTV-based plans contributed lower doses to these nodal regions, approximately 1 Gy less to the internal iliac and obturator stations and 2 Gy less to the presacral station compared to point-A-based plans when D50 was considered.</p><p><strong>Conclusions: </strong>HR-CTV-based plans demonstrated recognizable dose contribution to lymph nodes, although lower than the contribution by point-A-based plans. However, this modest difference can be effectively compensated by optimizing the external beam radiotherapy (EBRT) dose while simultaneously maintaining safe organ at risk (OAR) doses.</p>\",\"PeriodicalId\":47283,\"journal\":{\"name\":\"Reports of Practical Oncology and Radiotherapy\",\"volume\":\"31 1\",\"pages\":\"133-141\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2026-02-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046417/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reports of Practical Oncology and Radiotherapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5603/rpor.109093\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2026/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reports of Practical Oncology and Radiotherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5603/rpor.109093","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Dose contribution from brachytherapy to the pelvic lymph nodal region during HDR image-guided brachytherapy - a study for rethinking modern volume-based planning.
Background: Previous studies have evaluated nodal dose using Point-A prescriptions or variable dose rates. However, the impact of volume-based high-dose-rate (HDR) brachytherapy approaches remains less explored. In this study, we aimed to assess the dose contribution to the pelvic lymph nodes with volume-based (HR-CTV) prescription in comparison to point-A-based prescription during HDR brachytherapy in carcinoma cervix. This comparison has not been comprehensively evaluated in earlier literature, especially in the context of elective nodal contouring and HDR brachytherapy.
Materials and methods: Thirty patients with carcinoma of the cervix [International Federation of Gynecology and Obstetrics (FIGO) stage IB2 or higher] were included for this retrospective study. Two plans were generated on each brachytherapy scan. The first plan (point-A-based) prescribed a dose of 7 Gy to point-A, while the second plan (HR-CTV-based) prescribed the dose to the HR-CTV. Dose volume histograms (DVH) parameters were compared between both the plans.
Results: HR-CTV-based plans registered safer doses to OARs. Both the plans showed noticeable dose contributions to the pelvic lymph node stations, particularly the obturator, internal iliac, and presacral stations, with the highest contribution observed in the obturator group. However, HR-CTV-based plans contributed lower doses to these nodal regions, approximately 1 Gy less to the internal iliac and obturator stations and 2 Gy less to the presacral station compared to point-A-based plans when D50 was considered.
Conclusions: HR-CTV-based plans demonstrated recognizable dose contribution to lymph nodes, although lower than the contribution by point-A-based plans. However, this modest difference can be effectively compensated by optimizing the external beam radiotherapy (EBRT) dose while simultaneously maintaining safe organ at risk (OAR) doses.
期刊介绍：
Reports of Practical Oncology and Radiotherapy is an interdisciplinary bimonthly journal, publishing original contributions in clinical oncology and radiotherapy, as well as in radiotherapy physics, techniques and radiotherapy equipment. Reports of Practical Oncology and Radiotherapy is a journal of the Polish Society of Radiation Oncology, the Czech Society of Radiation Oncology, the Hungarian Society for Radiation Oncology, the Slovenian Society for Radiotherapy and Oncology, the Polish Study Group of Head and Neck Cancer, the Guild of Bulgarian Radiotherapists and the Greater Poland Cancer Centre, affiliated with the Spanish Society of Radiotherapy and Oncology, the Italian Association of Radiotherapy and the Portuguese Society of Radiotherapy - Oncology.
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