Single Versus Customized Treatment Planning for Image-guided High-Dose-Rate Brachytherapy for Cervical Cancer: Dosimetric Comparison and Predicting Factor for Organs at Risk Overdose With Single Plan Approach

Alexander Chi, Mingcheng Gao, James Sinacore, Nam P. Nguyen, Faisal Vali, Kevin Albuquerque

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Purpose: To compare the dose distribution between customized planning (CP) and adopting a single plan (SP) in multifractionated high-dose-rate brachytherapy and to establish predictors for the necessity of CP in a given patient. Methods and Materials: A total of 50 computed tomography-based plans for 10 patients were evaluated. Each patient had received 6 Gy for five fractions. The clinical target volume and organs at risk (i.e., rectum, bladder, sigmoid, and small bowel) were delineated on each computed tomography scan. For the SP approach, the same dwell position and time was used for all fractions. For the CP approach, the dwell position and time were reoptimized for each fraction. Applicator position variation was determined by measuring the distance between the posterior bladder wall and the tandem at the level of the vaginal fornices. Results: The organs at risk D2cc (dose to 2 cc volume) was increased with the SP approach. The dose variation was statistically similar between the tandem and ring and tandem and ovoid groups. The bladder D2cc dose was 81.95-105.42 Gy2 for CP and 82.11-122.49 Gy2 for SP. In 5 of the 10 patients, the bladder would have been significantly overdosed with the SP approach. The variation of the posterior bladder wall distance from that in the first fraction was correlated with the increase in the bladder D2cc (SP/CP), with a correlation coefficient of -0.59. Conclusion: Our results support the use of CP instead of the SP approach to help avoid a significant overdose to the bladder. This is especially true for a decrease in the posterior wall distance of ≥0.5 cm compared with that in the first fraction.

Original languageEnglish (US)
Pages (from-to)309-314
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume75
Issue number1
DOIs
StatePublished - Sep 1 2009

Keywords

  • Customized planning
  • brachytherapy
  • cervical cancer
  • image guidance
  • reoptimization

ASJC Scopus subject areas

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

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