Correlation of dose–volume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy

Georg, Petra; Kirisits, Christian; Goldner, Gregor; Dörr, Wolfgang; Hammer, Johann; Pötzi, R; Berger, Daniel; Dimopoulos, Johannes; Georg, Dietmar; Pötter, Richard

doi:10.1016/j.radonc.2009.01.006

Cited by 109 publications

(65 citation statements)

References 42 publications

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“…The Vienna group has also shown that the D 2cc rectum correlates well with rectal toxicity, as measured on the Vienna rectoscopy score (VRS) and late effects in normal tissue subjective, objective, management and analytic (LENT SOMA) scales [28]. Similar studies with respect to the correlation of bladder dose and toxicity are lacking; this paucity could result from the short follow-up available in most studies reported to date, together with the higher tolerance of the bladder to radiation [28].…”

Section: Discussionmentioning

confidence: 99%

Can point doses predict volumetric dose to rectum and bladder: a CT-based planning study in high dose rate intracavitary brachytherapy of cervical carcinoma?

Patil

Patel²,

Chakraborty³

et al. 2011

BJR

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Objective: Point doses, as defined by the International Commission on Radiation Units and Measurements (ICRU), are classically used to evaluate doses to the rectum and bladder in high dose rate intracavitary brachytherapy (HDR-ICBT) in cervical cancer. Several studies have shown good correlation between the ICRU point doses and the volumetric doses to these organs. In the present study we attempted to evaluate whether this correlation could be used to predict the volumetric doses to these organs. Methods: A total of 150 HDR-ICBT insertions performed between December 2006 and June 2008 were randomly divided into two groups. Group A (n550) was used to derive the correlation between the point and volumetric doses using regression analysis. This was tested in Group B (n5100) insertions using studentised residuals and Bland-Altman plots. Results: Significant correlations were obtained for all volumetric doses and ICRU point doses for rectum and bladder in Group A insertions. The strongest correlation was found for the dose to 2 cc volumes (D 2cc ). The correlation coefficients for bladder and rectal D 2cc versus the respective ICRU point doses were 0.82 and 0.77, respectively (p,0.001). Statistical validation of equations generated in Group B showed mean studentised residual values of 0.001 and 0.000 for the bladder and rectum. However, Bland-Altman analysis showed that the error range for these equations for bladder and rectum were ¡64% and ¡41% of the point A dose, respectively, which makes these equations unreliable for clinical use. Conclusion: Volumetric imaging is essential to obtain proper information about volumetric doses.

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Section: Discussionmentioning

confidence: 99%

Can point doses predict volumetric dose to rectum and bladder: a CT-based planning study in high dose rate intracavitary brachytherapy of cervical carcinoma?

Patil

Patel²,

Chakraborty³

et al. 2011

BJR

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“…For patients who received 28 fractions of 1.8 Gy/fr (total 50.4 Gy), tolerances of 4.8 Gy/fr to 2 cc of rectum and sigmoid and 7.0 Gy/fr to 2 cc of bladder, were adopted. ( 20 , 21 ) These values were obtained transforming the tolerances given in the work of Pötter and colleagues, as equivalent dose delivered at 2 Gy/fr (EQD2), ( 22 ) after subtracting 45 Gy or 50.4 Gy EQD2. Then, using the linear quadratic model, the remaining doses in 4 and 3 fractions (using

α / β = 3 Gy

), were obtained.…”

Section: Methodsmentioning

confidence: 99%

Local tumor control probability to evaluate an applicator‐guided volumetric‐modulated arc therapy solution as alternative of 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecological cancer

Pedicini¹,

Strigari

Caivano³

et al. 2013

J Applied Clin Med Phys

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The purpose of this study was to evaluate the applicator‐guided volumetric‐modulated arc therapy (AGVMAT) solution as an alternative to high‐dose‐rate brachytherapy (HDR‐BRT) treatment of the vaginal vault in patients with gynecological cancer (GC). AGVMAT plans for 51 women were developed. The volumetric scans used for plans were obtained with an implanted CT‐compatible vaginal cylinder which provides spatial registration and immobilization of the gynecologic organs. Dosimetric and radiobiological comparisons for planning target volume (PTV) and organs at risk (OARs) were performed by means of a dose‐volume histogram (DVH), equivalent uniform dose (EUD), and local tumor control probability (LTCP). In addition, the integral dose and the overall delivery time, were evaluated. The HDR‐BRT averages of EUD and minimum LTCP were significantly higher than those of AGVMAT. Doses for the OARs were comparable for the bladder and sigmoid, while, although HDR‐BRT was able to better spare the bowel, AGVMAT provided a significant reduction of normald2cc, normald1cc, and dmax (p<0.01) for the rectum. AGVMAT integral doses were higher than HDR‐BRT with low values in both cases. Delivery times were about two or three times higher for HDR‐BRT with respect to the single arc technique (AGVMAT1) and dual arc technique (AGVMAT2), respectively. The applicator‐guided volumetric‐modulated arc therapy seems to have the potential of improving rectum avoidance. However, brachytherapy improves performance in terms of PTV coverage, as demonstrated by a greater EUD and better LTCP curves.PACS number: 87

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“…A similar trend has been demonstrated by the Vienna group for 141 patients: the incidence of G1-G4 late toxicity for rectum was significantly higher when the D 2cc for the rectum was !75 Gy (a/b 03) (20% versus 4%) [44]. These findings were even more significant for the Vienna rectoscopy study in 35 patients [45]. Nowadays a dose limit of 70Á75 Gy EQD2 is applied in most centres.…”

Section: Dose Response Relationship For Local Controlmentioning

confidence: 99%

“…In the Vienna series with 141 patients some dose effect relation could be shown for an overall number of 3 sigmoid events with 9% (2/22) compared to 1% (1/119) applying a cut off level of 75 Gy [44]. However, in the Vienna rectosigmoidoscopy study the frequency of teleangiectasia was for a similar mean dose of 6597 and 6698 Gy to the 2 cc volume of sigmoid and rectum, respectively only 3 of 29 (10%) in the sigmoid compared to 26 of 35 (74%) in the rectum [45]. In a recent small study by Sturzda et al major interfraction variation was found for the sigmoid in 15 of 22 patients [46].…”

Section: Dose Response Relationship For Local Controlmentioning

confidence: 99%

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

et al. 2008

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Correlation of dose–volume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy

Cited by 109 publications

References 42 publications

Can point doses predict volumetric dose to rectum and bladder: a CT-based planning study in high dose rate intracavitary brachytherapy of cervical carcinoma?

Can point doses predict volumetric dose to rectum and bladder: a CT-based planning study in high dose rate intracavitary brachytherapy of cervical carcinoma?

Local tumor control probability to evaluate an applicator‐guided volumetric‐modulated arc therapy solution as alternative of 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecological cancer

Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

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