Minimizing urinary bladder radiation dose during brachytherapy for carcinoma of the cervix using balloon inflation technique

Malaker, K.; Shukla, Vishnu; D'Souza, Harold; Weatherburn, H.

doi:10.1016/j.ijrobp.2004.05.004

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…More recently, three-dimensional imaging has been offered as a way to minimize bladder dose in the treatment of cervical cancer (31). Bladder distention by use of a balloon inflated inside the bladder has also been used to standardize bladder volume in the treatment of cervical cancer (32). Despite the significant difference in simulated dose to the bladder across all analyzed plans in our study, genitourinary toxicity remained minimal and there were no other clinical Numbers in parentheses following dosimetry points correspond to Fig.…”

Section: Discussionmentioning

confidence: 73%

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Barney¹,

Macdonald²,

Lee³

et al. 2007

Brachytherapy

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Section: Discussionmentioning

confidence: 73%

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Barney¹,

Macdonald²,

Lee³

et al. 2007

Brachytherapy

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“…Haie-Meder et al have shown that the bladder and rectal doses can be reduced by adjusting the dwell positions and relative dwell times of source positions [4]. Studies have also shown that inflating the balloon of a foley catheter significantly reduces the dose to rectum and bladder [6, 7]. Studies concerning organ motion in intracavitary brachytherapy are very scarce in literature.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have shown that the dose distribution is affected by the geometry of the intracavitary applicators, age of patient [2], disease stage [2], length [2] and angulation of the tandem, size of the ovoids and tandem [2, 3], volume of bladder and rectum. Similarly dwell position of source [4], vaginal packing [5], balloon inflation technique [6, 7] and proximity of the applicator to the bladder and rectum do affect the dose to organs at risk. It is a well known fact that the abdominal and pelvic organs move during respiration and can therefore lead to changes in the dose to organs at risk.…”

Section: Purposementioning

confidence: 99%

Clinical Investigations A study on the variation of bladder and rectal doses with respiration in intracavitary brachytherapy for cervix cancer

Prabhakar

Pandjatcharam

Haresh

et al. 2010

jcb

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PurposeIn cervical intracavitary brachytherapy, it is mandatory to evaluate if the doses to bladder and rectum are within tolerance limits. In this study, an effort has been made to evaluate the effect of respiration on the doses to bladder and rectum in patients undergoing brachytherapy.Material and methodsFifteen patients with cervix cancer treated with concurrent chemoradiation followed by intracavitary brachytherapy were included in this study. At the time of brachytherapy, all patients underwent 4D computed tomography (CT) imaging. Five out of fifteen patients were scanned with empty bladder while the rest had full bladder during sectional imaging. Four sets of pelvic CT image datasets with applicators in place were acquired at equal interval in a complete respiratory cycle. Treatment plans were generated for all the CT datasets on a PlatoTM Sunrise planning system. A dose of 7 Gy was prescribed to Point A. Doses to ICRU (Report No.38) bladder (IBRP) and rectal (IRRP) reference points were calculated in all the CT datasets.ResultsThe mean of maximum dose to IBRP at four different respiratory phases for full and empty bladder were 53.38 ± 19.20%, 55.75 ± 16.71%, 56.13 ± 17.70%, 57.50 ± 17.48% and 60.93 ± 15.18%, 60.29 ± 16.28%, 60.86 ± 15.90%, 60.82 ± 15.42% of the prescribed dose respectively. Similarly, maximum dose to IRRP for full and empty bladder were 55.50 ± 18.66%, 57.38 ± 14.81%, 58.00 ± 14.97%, 58.38 ± 17.28% and 71.96 ± 6.90%, 71.58 ± 7.52%, 68.92 ± 6.21%, 71.45 ± 7.16% respectively.ConclusionsOur study shows that respiration affects the dose distribution to the bladder and rectum in intracavitary brachytherapy of cervix cancer. It is advisable to reduce the critical organ dose to account for the dose variation introduced by respiratory motion.

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“…Mechanical displacement of OAR is an effective method for reducing dose to the bladder and rectum in brachytherapy [ 5 , 6 , 7 ]. This follows from the inverse square law; the relative dose rate from a point source decreases exponentially with the distance from the source [ 8 ].…”

Section: Purposementioning

confidence: 99%

Initial experience using superflab as intravaginal packing during interstitial brachytherapy for advanced gynecologic cancer

Kharouta

Malin

Son

et al. 2018

jcb

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PurposeInterstitial brachytherapy implemented for locally advanced gynecologic cancer can result in toxicity due to the proximity of organs at risk (OAR). We report our experience using superflab bolus as vaginal packing to displace OAR during interstitial brachytherapy.Material and methodsTwelve patients with stage IB-IVA gynecologic cancer were treated with definitive chemoradiation including interstitial brachytherapy. A Syed template was used for a computed tomography (CT)-based pre-plan with magnetic resonance imaging (MRI) fusion. A 1-2 cm superflab bolus was cut and sterilized. The tandem and obturator were placed, and superflab was then inserted into the vagina. Interstitial needles were then placed through the template and superflab as per the pre-plan under transabdominal ultrasound guidance. Prescription doses ranged from 85-90 Gy EQD2 including external beam radiation therapy (EBRT). 5-6 Gy per fraction was delivered biologically effective dose (BID) over 2-3 days in 1-2 implants. Toxicities were evaluated post-treatment, 1 month, and 3 months.ResultsThe rectum, bladder, and sigmoid had significant average displacement from the prescription isodose line. The average reduction in D2cc between pre- and post-implant was 5.19 Gy per fraction (p < 0.0001), 7.19 Gy (p < 0.0004), and 1.78 Gy (p < 0.003) for the rectum, bladder, and sigmoid, respectively. The high-risk target volume (HR-TV) received a median D90 of 104% (range, 58-122%) of the prescription dose, and 92% (range, 71-131%) in the pre-/post-implant plans, respectively (p = 0.4).ConclusionsOur initial experience with superflab as vaginal packing demonstrates technical feasibility and dosimetric improvement for OAR.

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Minimizing urinary bladder radiation dose during brachytherapy for carcinoma of the cervix using balloon inflation technique

Cited by 8 publications

References 36 publications

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer

Clinical Investigations A study on the variation of bladder and rectal doses with respiration in intracavitary brachytherapy for cervix cancer

Initial experience using superflab as intravaginal packing during interstitial brachytherapy for advanced gynecologic cancer

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