Direction Modulated Brachytherapy for Treatment of Cervical Cancer. II: Comparative Planning Study With Intracavitary and Intracavitary–Interstitial Techniques

Dae Yup Han, Habib Safigholi, Abraam Soliman, Ananth Ravi, Eric Leung, Daniel J. Scanderbeg, Zhaowei Liu, Amir Owrangi, William Y. Song

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer. Methods and Materials A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm3, capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Européen de Curiethérapie–European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house–developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans. Results In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm3 reductions achieved were −2.48% ± 11.03%, −4.45% ± 5.24%, and −5.66% ± 6.43% for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used. Conclusions Integrating the novel DMBT tandem onto both intracavitary and intracavitary–interstitial applicator assembly enabled consistent improvement in the sparing of the OARs, over a standard “single-channel” tandem, though individual variations in benefit were considerable. Although at an early stage of development, the DMBT concept design is demonstrated to be useful and pragmatic for potential clinical translation.

Original languageEnglish (US)
Pages (from-to)440-448
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume96
Issue number2
DOIs
StatePublished - Oct 1 2016

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Brachytherapy
Uterine Cervical Neoplasms
planning
needles
cancer
Needles
rings
Therapeutics
tungsten alloys
rectum
bladder
Tungsten
recommendations
grooves
Sigmoid Colon
Direction compound
radiation therapy
Rectum
rods
assembly

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Direction Modulated Brachytherapy for Treatment of Cervical Cancer. II : Comparative Planning Study With Intracavitary and Intracavitary–Interstitial Techniques. / Han, Dae Yup; Safigholi, Habib; Soliman, Abraam; Ravi, Ananth; Leung, Eric; Scanderbeg, Daniel J.; Liu, Zhaowei; Owrangi, Amir; Song, William Y.

In: International Journal of Radiation Oncology Biology Physics, Vol. 96, No. 2, 01.10.2016, p. 440-448.

Research output: Contribution to journalArticle

Han, Dae Yup ; Safigholi, Habib ; Soliman, Abraam ; Ravi, Ananth ; Leung, Eric ; Scanderbeg, Daniel J. ; Liu, Zhaowei ; Owrangi, Amir ; Song, William Y. / Direction Modulated Brachytherapy for Treatment of Cervical Cancer. II : Comparative Planning Study With Intracavitary and Intracavitary–Interstitial Techniques. In: International Journal of Radiation Oncology Biology Physics. 2016 ; Vol. 96, No. 2. pp. 440-448.
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abstract = "Purpose To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer. Methods and Materials A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm3, capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Europ{\'e}en de Curieth{\'e}rapie–European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house–developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans. Results In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm3 reductions achieved were −2.48{\%} ± 11.03{\%}, −4.45{\%} ± 5.24{\%}, and −5.66{\%} ± 6.43{\%} for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used. Conclusions Integrating the novel DMBT tandem onto both intracavitary and intracavitary–interstitial applicator assembly enabled consistent improvement in the sparing of the OARs, over a standard “single-channel” tandem, though individual variations in benefit were considerable. Although at an early stage of development, the DMBT concept design is demonstrated to be useful and pragmatic for potential clinical translation.",
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AU - Han, Dae Yup

AU - Safigholi, Habib

AU - Soliman, Abraam

AU - Ravi, Ananth

AU - Leung, Eric

AU - Scanderbeg, Daniel J.

AU - Liu, Zhaowei

AU - Owrangi, Amir

AU - Song, William Y.

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N2 - Purpose To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer. Methods and Materials A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm3, capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Européen de Curiethérapie–European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house–developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans. Results In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm3 reductions achieved were −2.48% ± 11.03%, −4.45% ± 5.24%, and −5.66% ± 6.43% for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used. Conclusions Integrating the novel DMBT tandem onto both intracavitary and intracavitary–interstitial applicator assembly enabled consistent improvement in the sparing of the OARs, over a standard “single-channel” tandem, though individual variations in benefit were considerable. Although at an early stage of development, the DMBT concept design is demonstrated to be useful and pragmatic for potential clinical translation.

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