Vaginal cuff brachytherapy in endometrial cancer &amp;ndash; a technically easy treatment?

Sabater, S.; Andrés, Ignacio; Lopez-Honrubia, Veronica; Berenguer, R.; Sevillano, M.; Jimenez-Jimenez, E.; Rovirosa, Á.; Arenas, Meritxell

doi:10.2147/cmar.s119125

Cited by 23 publications

(25 citation statements)

References 117 publications

(139 reference statements)

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“…It is the fifth most common cancer worldwide in women. In 2015 it is estimated that 54,870 women were diagnosed with and 10,170 died of endometrial cancer [18]. The primary management of endometrial cancer is total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAH-BSO).…”

Section: Endometrial Cancermentioning

confidence: 99%

“…The primary management of endometrial cancer is total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAH-BSO). The role of pelvic and para-aortic lymph node dissection is controversial in the surgical management of endometrial cancer [18]. Adjuvant radiation therapy for endometrial cancer is also controversial but is routinely recommended based upon presence of adverse risk factors such as higher stage, increased depth of myometrial invasion (MMI), higher grade, presence of lymphovascular space invasion (LVSI), increasing age, increasing tumor size, histology, and lymph node positivity [18].…”

Section: Endometrial Cancermentioning

confidence: 99%

“…Despite its radiobiological disadvantages mentioned by Eifel [24], the possibility of optimizing dose distribution and the lesser chance of applicator displacement seem to outweigh these disadvantages. Furthermore, the variation of dwell time with the single stepping source permits an almost infinite variation on the effective source strength and source positions, which allows for greater control of dose distribution and potentially less morbidity [18].…”

Section: Treatment In the Developing Worldmentioning

confidence: 99%

“…The incidences of lower 5-year rectal complications in patients from the HDR group were probably the result of the relatively low dose delivered to the rectum with the HDR brachytherapy fractionation. In LDR brachytherapy, the total rectal dose is commonly limited to 70 Gy [18]. The optimization of HDR brachytherapy can be further improved with 3D CT or MRI imaging to increase the delivered dose to the target volume, while minimizing the dose to the adjacent normal tissues [18].…”

Section: Treatment In the Developing Worldmentioning

confidence: 99%

“…In LDR brachytherapy, the total rectal dose is commonly limited to 70 Gy [18]. The optimization of HDR brachytherapy can be further improved with 3D CT or MRI imaging to increase the delivered dose to the target volume, while minimizing the dose to the adjacent normal tissues [18].…”

Section: Treatment In the Developing Worldmentioning

confidence: 99%

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High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

2018

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Brachytherapy as a form of treatment for gynecological tumors has been used for a long time in Brazil (since 1991) and can be considered as a form of radiotherapy treatment. High Dose Rate (HDR) brachytherapy aims at delivering high dose rates of radiation in restricted volumes of the body, thereby increasing disease control and lower treatment toxicity for adjacent normal tissues. Cervical cancer (CC) is a disease that still affects women in developing countries and, despite being detected by laboratory and imaging tests, in many developing countries these techniques are not yet accessible to all that are affected by cervical cancer. HDR presents important results when isolated or in association with other treatment techniques. Numerous studies have shown that HDR for gynecological cancer presents results that can reach up to 85% cure, and with this it is concluded that there are few complications during or after treatment, since adjacent tissues are preserved, making HDR a safe procedure for patients and professionals.

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Section: Endometrial Cancermentioning

confidence: 99%

Section: Endometrial Cancermentioning

confidence: 99%

Section: Treatment In the Developing Worldmentioning

confidence: 99%

Section: Treatment In the Developing Worldmentioning

confidence: 99%

Section: Treatment In the Developing Worldmentioning

confidence: 99%

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High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

2018

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The effect of vaginal cylinder inhomogeneity on the HDR brachytherapy dose calculations using Monte Carlo simulations

Meftahi,

Song

2023

J Applied Clin Med Phys

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PurposeTo analytically assess the heterogeneity effect of vaginal cylinders (VC) made of high‐density plastics on dose calculations, considering the prescription point (surface or 5 mm beyond the surface), and benchmark the accuracy of a commercial model‐based dose calculation (MBDC) algorithm using Monte Carlo (MC) simulations.Methods and materialsThe GEANT4 MC code was used to simulate a commercial 192Ir HDR source and VC, with diameters ranging from 20 to 35 mm, inside a virtual water phantom. Standard plans were generated from a commercial treatment planning system [TPS—BrachyVision ACUROS (BV)] optimized for a treatment length of 5 cm through two dose calculation approaches: (1) assuming all the environment as water (i.e., Dw,w‐MC & Dw,w‐TG43) and (2) accounting for the heterogeneity of VC applicators (i.e., Dw,w‐App‐MC & Dw,w‐App‐MBDC). The compared isodose lines, and dose & energy difference maps were extracted for analysis. In addition, the dose difference on the peripheral surface, along the applicator and at middle of treatment length, as well as apical tip was evaluated.ResultsThe Dw,w‐App‐MC results indicated that the VC heterogeneity can cause a dose reduction of (up to) % 6.8 on average (for all sizes) on the peripheral surface, translating to 1 mm shrinkage of the isodose lines compared to Dw,w‐MC. In addition, the results denoted that BV overestimates the dose on the peripheral surface and apical tip of about 3.7% and 17.9%, respectively, (i.e., Dw,w‐App‐MBDC vs Dw,w‐App‐MC) when prescribing to the surface. However, the difference between the two were negligible at the prescription point when prescribing to 5 mm beyond the surface.ConclusionThe VCs’ heterogeneity could cause dose reduction when prescribing dose to the surface of the applicator, and hence increases the level of uncertainty. Thus, reviewing the TG43 results, in addition to ACUROS, becomes prudent, when evaluating the surface coverage at the apex.

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A novel multi‐channel applicator with a U‐shaped channel for vaginal intracavity brachytherapy

Lu,

Chen,

Wang

et al. 2024

J Applied Clin Med Phys

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BackgroundEndometrial cancer is one of the most common gynecological malignancies in the world. Vaginal brachytherapy is an important postoperative adjuvant treatment for endometrial cancer. However, a common problem with existing applicators is insufficient dose at the vaginal apex.PurposeThis study describes the Hangzhou (HZ) cylinder, a novel 3D printed vaginal intracavity brachytherapy applicator, detailing its characteristics, dose distribution, and clinical applications.Methods and MaterialsThe HZ cylinder is distinguished by its unique structure: a U‐shaped channel with a 2 mm diameter, a straight central axis channel of the same diameter, and 10 parallel straight channels. For comparison, standard plans were employed, designed to ensure that a minimum of 95% of the prescribed dose reached 5 mm beneath the mucosal surface. We conducted comparative analyses of mucosal surface doses and doses at a 5 mm depth below the mucosa between the HZ cylinder and a conventional single‐channel cylinder across various treatment schemes. Additionally, the study examined dose differences in target volume and organs at risk (OARs) between actual HZ cylinder plans and hypothetical single‐channel plans.ResultsIn the standard plans, mucosal surface doses at the apex of the vagina were 209.32% and 200.61% of the prescribed dose with the HZ and single‐channel cylinders, respectively. The doses on the left and right wall mucosal surfaces varied from 149.26% to 178.13% and 142.98% to 180.75% of the prescribed dose, and on the anterior and posterior wall mucosal surfaces varied from 128.87% to 138.50% and 142.98% to 180.75% of the prescribed dose. Analysis of 24 actual treatment plans revealed that when the vaginal tissue volume dose covering 98% (vaginal D98%) was comparable between the HZ cylinder and virtual single‐channel plans (6.74 ± 0.07 Gy vs. 6.69 ± 0.10 Gy, p = 0.24), rectum doses of HZ cylinder plans were significantly lower than those of single‐channel plans (D1cc, 5.96 ± 0.56 Gy vs. 6.26 ± 0.71 Gy, p = 0.02 and D2cc, 5.26 ± 0.52 Gy vs. 5.56 ± 0.62 Gy, p = 0.02).ConclusionsThe HZ cylinder demonstrates a reduction in dose to the rectum and bladder while maintaining adequate target volume coverage. Its mucosal surface dose is comparable to that of the traditional single‐channel cylinder. These findings suggest that the HZ cylinder is a viable and potentially safer alternative for vaginal brachytherapy, warranting further investigation with larger sample sizes.

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Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment?

Cited by 23 publications

References 117 publications

High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

The effect of vaginal cylinder inhomogeneity on the HDR brachytherapy dose calculations using Monte Carlo simulations

A novel multi‐channel applicator with a U‐shaped channel for vaginal intracavity brachytherapy

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