Inter-fractional variation of markers and applicators in single-implant high-dose-rate interstitial brachytherapy for gynecologic malignancies

Ostyn, Mark; Burke, Aidan M.; Fields, Emma C.; Todor, Dorin

doi:10.1016/j.brachy.2021.03.011

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Dosimetric effects of interfractional displacement of source or needle positions is often ignored in iHDR treatment. Tambas et al [24] reported that 68% of needles shifted 2 6 2.3 mm, and other researchers have reported shifts up to 5 mm [25][26][27]. Such shifts alter dose distribution and are comparable to the typical robustness range of a proton plan of 3 mm/3.5%.…”

Section: Discussionmentioning

confidence: 90%

Proton Arc Therapy vs Interstitial HDR Brachytherapy in Gynecologic Cancer with Parametrial/pelvic Side Wall Extension

Mossahebi

Modiri

et al. 2022

International Journal of Particle Therapy

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Purpose To investigate whether volumetric-modulated proton arc therapy (VPAT) plans generate comparable doses to organs at risk (OARs) compared with interstitial high–dose-rate (iHDR) brachytherapy for patients with gynecologic cancer with disease extension to parametrial/pelvic side wall, who are not eligible for the aggressive procedure. Materials and Methods VPAT delivers proton arc beams by modulated energies at the beam nozzle while maintaining the same incident energy to the gantry during the arc rotation. Plans of 10 patients previously treated with iHDR brachytherapy for high-risk clinical treatment volumes (HRCTV; 31.8–110.6 cm3; lateral dimensions, 4.2–5.6 cm) were selected and compared with VPAT plans. VPAT plans for each patient were designed using a 152- to 245-MeV range of energy-modulated proton beams. Results HRCTV coverage of the VPAT plans was comparable to that of the iHDR plans, with V150% showing no statistical differences. On average, the V100% and V90% of VPAT plans were higher than those of the iHDR plans, 95.0% vs 91.9% (P = .02) and 98.6% vs 97.5% (P = .02), respectively. D100 was also 17% higher for the VPAT plans (P = .03). On average, the D2cm3 of bladder, rectum, and small bowels in the VPAT plans were considerably lower than those in iHDR plans (by 17.4%, 35.2%, and 65.6%, respectively; P < .05 for all OARs). Conclusion VPAT–generated plans were dosimetrically superior to those with HDR brachytherapy with interstitial needles for locally advanced gynecologic cancer with parametrial/pelvic side wall disease extension. Dosimetrically, VPAT provides a noninvasive alternative to iHDR brachytherapy with a superior dosimetric profile.

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Section: Discussionmentioning

confidence: 90%

Proton Arc Therapy vs Interstitial HDR Brachytherapy in Gynecologic Cancer with Parametrial/pelvic Side Wall Extension

Mossahebi

Modiri

et al. 2022

International Journal of Particle Therapy

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“…Second, we increased time interval to 8 h between the BID sessions on day 2 (7 Gy + 2x7Gy + 7 Gy). Third, we systematically checked implant position on day 2 by means of an additional CT-scan done before the 3rd fraction (fusion facilitated by gold seed markers implanted during BT procedure on first day) [52] . Finally, we lowered our dose constraints to OARs as proposed in the EMBRACE-2 protocol while paying more attention to vaginal delineation and constraints.…”

Section: Discussionmentioning

confidence: 99%

High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes

Guyader

Kee

Thamphya

et al. 2022

Clinical and Translational Radiation Oncology

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“…To evaluate the influence of applicator displacement on the dose to the CTV and OARs, the applicators in the 2D-BT and 3D-BT plans were virtually moved in 3 directions: left (+ X ) or right (−X ), cranial (+ Y ) or caudal (− Y ), and anterior (+ Z), or posterior (−Z). Since most of the current studies reported displacement measurements of less than 1 cm in clinical practice, [9][10][11][16][17][18] we set the simulated shift distances as ± 0.15, ± 0.2, ± 0.4, ± 0.6, ± 0.8, and ± 1 cm in this study. After changing the spatial position of T&O, the dwell times and relative positions of the radiation sources in the applicators remained the same as those in the original plans for both 2D-BT and 3D-BT.…”

Section: Simulation Of Applicator Displacementmentioning

confidence: 99%

Comparison of the Dosimetric Influence of Applicator Displacement on 2D and 3D Brachytherapy for Cervical Cancer Treatment

Tang

et al. 2021

Technol Cancer Res Treat

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To compare the dosimetric influence of applicator displacement on two-dimensional brachytherapy (2D-BT) and three-dimensional brachytherapy (3D-BT) for cervical cancer. Nineteen patients who received computed tomography-guided tandem-and-ovoid (T&O) brachytherapy were retrospectively selected. Both 2D (point-based) and 3D (volume-based) plans with and without virtual applicator displacement in the 3 axes were created for each patient. Dose changes at point A, D90 of the high-risk clinical target volume (HR-CTV) and intermediate-risk CTV (IR-CTV), and the D0.1cc, D1cc, D2cc, and D5cc of organs-at-risk (OARs) caused by applicator displacement were evaluated. Both 2D-BT and 3D-BT plans were sensitive to T&O applicator displacement. The D90 of the CTV and the dose at point A were very sensitive to applicator displacement in the right–left direction ( X-axis). An applicator shift of >2 mm in the X-axis resulted in a change of >5% in the dose at point A and D90 of HR-CTV and IR-CTV. In addition, the doses to the OARs were mostly affected by applicator displacement in the anterior–posterior direction ( Z-axis). A displacement of <1.5 mm in the Z-axis was required to avoid a dose change of >10% for OARs. For both 2D-BT and 3D-BT plans, T&O displacement greater than ± 2 mm in the X-axis or T&O applicator displacement ± 1.5 mm in the Z-axis resulted in significant dose changes to the tumor and OARs. In comparison with 3D-BT plans, 2D-BT plans delivered a higher dose to the tumor, and the OARs received more undesirable doses when applicator displacement occurred. The influence of applicator displacement on the doses to the tumor and OARs differed between 2D-BT and 3D-BT. Physicians should take individual patient differences into account when selecting a brachytherapy plan to mitigate the influence of applicator displacement.

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Inter-fractional variation of markers and applicators in single-implant high-dose-rate interstitial brachytherapy for gynecologic malignancies

Cited by 3 publications

References 27 publications

Proton Arc Therapy vs Interstitial HDR Brachytherapy in Gynecologic Cancer with Parametrial/pelvic Side Wall Extension

Proton Arc Therapy vs Interstitial HDR Brachytherapy in Gynecologic Cancer with Parametrial/pelvic Side Wall Extension

High-dose-rate brachytherapy boost for locally advanced cervical cancer: Oncological outcome and toxicity analysis of 4 fractionation schemes

Comparison of the Dosimetric Influence of Applicator Displacement on 2D and 3D Brachytherapy for Cervical Cancer Treatment

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