Parametrial Boost Using Midline Shielding Results in an Unpredictable Dose to Tumor and Organs at Risk in Combined External Beam Radiotherapy and Brachytherapy for Locally Advanced Cervical Cancer

Fenkell, Louis; Assenholt, M.S.; Nielsen, S.K.; Haie-Méder, Christine; Pötter, Richard; Lindegaard, J.C.; Tanderup, Kari

doi:10.1016/j.ijrobp.2010.05.031

Cited by 53 publications

(34 citation statements)

References 26 publications

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“…One potential limitation to our study was that the application of a MB might have introduced some degree of uncertainty with respect to the EBRT dose to the cervical tumor (38). This uncertainty resulted from the difficulty in confirming that the MB completely covered the cervix in every patient during every EBRT fraction in this study.…”

Section: Discussionmentioning

confidence: 92%

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Toita

Kato²,

Niibe

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 92%

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Toita

Kato²,

Niibe

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…They found the contributions from central block of PM boost plan were on average 9% (5%–6%) and 28%–32% (11%–16%), for the D2cc EQD2 values of the rectum and bladder, respectively, when a 3 cm (4 cm) central block was used 17. Fenkell et al 18. also reported that an EBRT PM boost caused D2 cc EQD2 dose to increase by more than 50% over the boost prescription dose in four out of six patients and that the central PM boost shield does not predictably protect the high dose regions (D2 cc) of OARs.…”

Section: Resultsmentioning

confidence: 99%

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Gelover

Katherine

Mart

et al. 2018

J Applied Clin Med Phys

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The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD 2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.

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“…External beam boost performed with midline block fields has been used to boost parametrial extension in patients in whom the contribution from ICBT was insufficient [10,11]. However, its effectiveness is poorly documented [12], and there is no strong evidence to validate its routine use. Interstitial brachytherapy is helpful in patients with bulky or an obliterated endocervical canal, vaginal spread disease; it can be combined with ICBT by placing needles in the parametrial region or in large tumor.…”

Section: Purposementioning

confidence: 99%

Image Guided Radiation Therapy Boost in Combination With High-Dose-Rate Intracavitary Brachytherapy for the Treatment of Cervical Cancer

Wang

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: The purpose of this study was to demonstrate the dosimetric and clinical feasibility of image guided radiation therapy (IGRT) combined with high-dose-rate (HDR) intracavitary brachytherapy (ICBT) to improve dose distribution in cervical cancer treatment.Material and methods: For 42 cervical cancer patients, magnetic resonance imaging (MRI) scans were acquired after completion of whole pelvic irradiation 45-46 Gy and 5 fractions of B + I (ICBT + IGRT) treatment were subsequently received. The high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV), bladder, rectum, and sigmoid were contoured on the computed tomography (CT) scans. The total planning aim doses for HRCTV was D 90% > 85 Gy, whilst constraints for rectum and sigmoid were D 2cc < 75 Gy and D 2cc < 90 Gy for bladder in terms of an equivalent dose in 2 Gy (EQD2) for external beam radiotherapy (EBRT) and brachytherapy boost. The IGRT plan was optimized on top of the ICBT dose distribution. A dosimetric comparison was made between B + I and optimized ICBT (O-ICBT) only.Results: The mean D 90% of HRCTV was comparable for B + I and O-ICBT (p = 0.82). For B + I plan, HRCTV D 100% , IRCTV D 100% , and IRCTV D 90% were significantly increased by a mean of 10.52 Gy, 5.61 Gy, and 2.70 Gy, respectively (p < 0.01). The D 2cc for bladder, rectum, and sigmoid were lower by a mean of 21.36, 6.78, and 10.65 Gy, respectively (p < 0.01). The mean rectum V60 Gy value over 42 patients was almost the same for both techniques but for bladder and sigmoid B + I had higher V60 Gy mean values as compared with the O-ICBT.Conclusions: B + I can improve dose distribution in cervical cancer treatment; it could be useful for tumors extended beyond the reach of intracavitary/interstitial brachytherapy (IC/ISBT) or for centers that are inexperienced or illequipped with IC/ISBT techniques. Additional confirmatory prospective studies with larger numbers of patients and longer follow-up are required to validate the durability.

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Parametrial Boost Using Midline Shielding Results in an Unpredictable Dose to Tumor and Organs at Risk in Combined External Beam Radiotherapy and Brachytherapy for Locally Advanced Cervical Cancer

Cited by 53 publications

References 26 publications

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image‐guided brachytherapy for cervical cancer

Image Guided Radiation Therapy Boost in Combination With High-Dose-Rate Intracavitary Brachytherapy for the Treatment of Cervical Cancer

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