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Comparative dosimetry of brachytherapy treatment planning between a volume-based plan by CT and a point-based plan by TAUS in CT datasets for brachytherapy

Published online by Cambridge University Press:  26 November 2021

Chaiyaporn Pintakham Open the ORCID record for Chaiyaporn Pintakham [Opens in a new window] ,
Ekkasit Tharavichitkul Open the ORCID record for Ekkasit Tharavichitkul [Opens in a new window] ,
Somsak Wanwilairat Open the ORCID record for Somsak Wanwilairat [Opens in a new window]  and
Wannapha Nobnop Open the ORCID record for Wannapha Nobnop [Opens in a new window]
Chaiyaporn Pintakham
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Graduate School, Chiang Mai University, Chiang Mai, Thailand
Ekkasit Tharavichitkul*
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Somsak Wanwilairat
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wannapha Nobnop
Affiliation:
The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Northern Thailand Radiation Oncology Group, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*
Author for Correspondence: Ekkasit Tharavichitkul, MD, The Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Tel: +66-53-935456. E-mail: paan_31@hotmail.com
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Abstract

Aim:

To evaluate comparative dosimetry of brachytherapy treatment planning between a volume-based plan by computed tomography (CT) and a point-based plan by transabdominal ultrasound (TAUS) in CT datasets for brachytherapy.

Materials and methods:

From 2019 to 2021, 59 different datasets of CT images were collected from 38 patients treated by intracavitary brachytherapy with tandem ovoid or tandem ring applicators. At that time, TAUS was performed to prevent uterine perforation and to evaluate topography of the cervix during application. In volume-based planning by CT, the target dose was used to keep the dose at 90% of high-risk clinical target volume (HR-CTV), to give a dose of at least 7Gy, while in the point-based plan by TAUS, the target dose was used to keep the minimum dose to eight cervix reference points (measured by TAUS), to give a dose of at least 7Gy. The doses to targets and organs at risk were evaluated and compared between volume-based planning by CT and the point-based plan by TAUS.

Results:

Of 59 fractions, a tandem ovoid applicator was used in 48 fractions (81·3%). In the volume-based plan by CT, the mean doses to HR-CTV(D90), intermediate-risk clinical target volume (IR-CTV)(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 7·0, 3·9, 4·9, 2·9 and 3·3 Gy, respectively, while in the point-based plan by TAUS, the mean doses to HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 8·2, 4·6, 5·9, 3·4 and 3·9 Gy, respectively. The percentages of mean dose differences between TAUS and CT of HR-CTV(D90), IR-CTV(D90), bladder(D2cc), rectum(D2cc) and sigmoid colon(D2cc) were 17·7, 19·5, 20·5, 19·5, 21·3 and 19·8%, respectively. With the target dose to the point-based plan by TAUS (7 Gy to the cervix reference points), this was close to D98 of HR-CTV with a mean percentage of difference of 0·6%.

Findings:

The point-based plan by TAUS showed higher values to targets and organs at risk than the volume-based plan by CT. With the point-based plan by TAUS, it was close to D98 of HR-CTV.

Keywords

brachytherapycomputed tomographydosimetric comparisontransabdominal ultrasound
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e20
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Arbyn, M, Weiderpass, E, Bruni, L et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8 (2): e191–e203.CrossRefGoogle ScholarPubMed
Phoolcharoen, N, Kantathavorn, N, Sricharunrat, T et al. A population-based study of cervical cytology findings and human papillomavirus infection in a suburban area of Thailand. Gynecol Oncol Rep 2017; 21: 73–77.CrossRefGoogle Scholar
Viswanathan, A N, Beriwal, S, Jennifer, F et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy. Brachytherapy 2012; 11 (1): 47–52.CrossRefGoogle ScholarPubMed
International Commission on Radiation Units and Measurement. Dose and Volume Parameters for Prescribing, Recording, and Reporting Brachytherapy, Alone and Combined with External-Beam Radiotherapy. J ICRU 2016; 13: 105–122.Google Scholar
Haie-Meder, C, Pötter, R, Van Limbergen, E et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image-based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005; 74 (3): 235–245.CrossRefGoogle Scholar
Pötter, R, Haie-Meder, C, Van Limbergen, E et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy—3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78 (1): 67–77.CrossRefGoogle Scholar
Pötter, R, Dimopoulos, J, Georg, P et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol 2007; 83 (2): 148–155.CrossRefGoogle ScholarPubMed
Pötter, R, Georg, P, Dimopoulos, JC et al. Clinical outcome of protocol-based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 2011; 100(1): 116–123.CrossRefGoogle ScholarPubMed
Lindegaard, J C, Fokdal, L U, Nielsen, S K et al. MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective. Acta Oncol 2013; 52 (7): 1510–1519.CrossRefGoogle ScholarPubMed
Sturdza, A, Pötter, R, Fokdal, L U et al. Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in Retro-EMBRACE, a multicenter cohort study. Radiother Oncol 2016; 120 (3): 428–433.CrossRefGoogle Scholar
Tinkle, C L, Weinberg, V, Chen, L M et al. Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical Cancer: 4-Year Outcomes. Int J Radiat Oncol Biol Phys 2015; 92 (5): 1093–1100.CrossRefGoogle ScholarPubMed
Gill, B S, Kim, H, Houser, C J et al. MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: The University of Pittsburgh experience. Int J Radiat Oncol Biol Phys 2015; 91 (3): 540–547.CrossRefGoogle ScholarPubMed
Castelnau-Marchand, P, Chargari, C, Maroun, P et al. Clinical outcomes of definitive chemoradiation followed by intracavitary pulsed-dose rate image-guided adaptive brachytherapy in locally advanced cervical cancer. Gynecol Oncol 2015; 139 (2): 288–294.CrossRefGoogle ScholarPubMed
Mahanshetty, U, Krishnatry, R, Hande, V et al. Magnetic resonance image guided adaptive brachytherapy in locally advanced cervical cancer: an experience from a tertiary cancer center in a low-and middle-income countries setting. Int J Radiat Oncol Biol Phys 2017; 99 (3): 608–617.CrossRefGoogle Scholar
Pötter, R, Tanderup, K, Schmid, M P et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multi-centre prospective cohort study. Lancet Oncol 2021; 22 (4): 538–547.CrossRefGoogle Scholar
Hegazy, N, Pötter, R, Kirisits, C et al. High-risk clinical target volume delineation in CT-guided cervical cancer brachytherapy: impact of information from FIGO stage with or without systematic inclusion of 3D documentation of clinical gynecological examination. Acta Oncol 2013; 52 (7): 1345–1352.CrossRefGoogle ScholarPubMed
Hellebust, T. Place of modern imaging in brachytherapy planning. Cancer/Radiothérapie 2018; 22 (4): 326–333.CrossRefGoogle ScholarPubMed
Tan, L T, Coles, C E, Hart, C et al. Clinical impact of computed tomography-based imaged-guided brachytherapy for cervix cancer using the tandem-ring applicator-the Addenbrooke’s experience. Clin Oncol 2009; 21 (3): 175–182.CrossRefGoogle Scholar
Kang, H C, Shin, K H, Park, S Y et al. CT-based high-dose-rate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control. Radiother Oncol 2010; 97 (3): 507–513.CrossRefGoogle ScholarPubMed
Murakami, N, Kanamatsu, T, Wakita, A et al. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer. BMC Cancer 2014; 14: 447.CrossRefGoogle ScholarPubMed
Tharavichitkul, E, Chakrabandhu, S, Wanwilairat, S et al. Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience. Gynecol Oncol 2013; 130 (1): 81–85.CrossRefGoogle Scholar
Kusada, T, Toita, T, Ariga, T et al. Computed tomography–based image-guided brachytherapy for cervical cancer: correlations between dose–volume parameters and clinical outcomes. J Radiat Res 2018; 59 (1): 67–76.CrossRefGoogle ScholarPubMed
Zolciak-Siwinska, A, Gruszczynska, E, Bijok, M et al. Computed tomography–planned high-dose-rate brachytherapy for treating uterine cervical cancer. Int J Radiat Oncol Biol Phys 2016; 96 (1): 87–92.CrossRefGoogle ScholarPubMed
Ohno, T, Noda, S E, Okonogi, N et al. In-room computed tomography-based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study. J Radiat Res 2017; 58 (4): 543–551.CrossRefGoogle ScholarPubMed
van Dyk, S, Bernshaw, D. Ultrasound-based conformal planning for gynaecological brachytherapy. J Med Imaging Radiat Oncol 2008; 52 (1): 77–84.CrossRefGoogle ScholarPubMed
van Dyk, S, Narayan, K, Fisher, R et al. Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound. Int J Radiat Oncol Biol Phys 2009; 75 (1): 64–70.CrossRefGoogle ScholarPubMed
Narayan, K, van Dyk, S, Bernshaw, D et al. Ultrasound guided conformal brachytherapy of cervix cancer: survival, patterns of failure, and late complications. J Gynecol Oncol 2014; 25 (3): 206–213.CrossRefGoogle ScholarPubMed
Tharavichitkul, E, Tippanya, D, Jayavasti, R et al. Two-year results of transabdominal ultrasound-guided brachytherapy for cervical cancer. Brachytherapy 2015; 14 (2): 238–244.CrossRefGoogle ScholarPubMed
Spartacus, R, Dana, R, Gaur, P et al. Ultrasound Image Based High Dose Rate (HDR) Brachytherapy in Locally Advanced Cancer Cervix. International Journal of Cancer Management 2017; 10 (8): e7392 CrossRefGoogle Scholar
Nayak, A, Engineer, R, Mahantshetty, U et al. Transabdominal ultrasonography based high dose rate conformal intracavitary brachytherapy in cervical carcinoma. Int J Radiat Oncol Biol Phys. 2017; 99: e304.CrossRefGoogle Scholar
Tharavichitkul, E, Chakrabandhu, S, Klunklin, P et al. Intermediate-term results of trans-abdominal ultrasound (TAUS)-guided brachytherapy in cervical cancer. Gynecol Oncol 2018; 148 (3): 468–473.CrossRefGoogle ScholarPubMed
Viswanathan, A N, Erickson, B, Gaffney, D K et al. Comparison and consensus guidelines for delineation of clinical target volume for CT-and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2014; 90 (2): 320–328.CrossRefGoogle ScholarPubMed
Westerveld, H, Pötter, R, Berger, D et al. Vaginal dose point reporting in cervical cancer patients treated with combined 2D/3D external beam radiotherapy and 2D/3D brachytherapy. Radiother Oncol 2013; 107 (1): 99–105.CrossRefGoogle ScholarPubMed
Poddar, J, Sharma, A D, Suryanarayan, U et al. Calculation of dose volume parameters and indices in plan evaluation of HDR interstitial brachytherapy by MUPIT in carcinoma cervix. Indian J Cancer 2018; 55 (3): 238.CrossRefGoogle ScholarPubMed
Pötter, R, Tanderup, K, Kirisits, C et al. The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9: 48–60.CrossRefGoogle Scholar
De Brabandere, M, Mousa, A G, Nulens, A et al. Potential of dose optimization in MRI-based PDR brachytherapy of cervix carcinoma. Radiother Oncol 2008; 88 (2): 217–226.CrossRefGoogle Scholar
Lindegaard, JC, Tanderup, K, Nielsen, S K et al. MRI-guided 3D optimization significantly improves DVH parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71 (3): 756–764.CrossRefGoogle ScholarPubMed
Zwahlen, D, Jezioranski, J, Chan, P et al. Magnetic resonance imaging-guided intracavitary brachytherapy for cancer of the cervix. Int J Radiat Oncol Biol Phys 2009; 74 (4): 1157–1164.CrossRefGoogle ScholarPubMed
Tharavichitkul, E, Mayurasakorn, S, Lorvidhaya, V et al. Preliminary results of conformal computed tomography (CT)-based intracavitary brachytherapy (ICBT) for locally advanced cervical cancer: a single institution’s experience. J Radiat Res 2011; 52 (5): 634–640.CrossRefGoogle ScholarPubMed
Viswanathan, AN, Dimopoulos, J, Kirisits, C, Berger, D, Pötter, R. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys 2007; 68 (2): 491–498.CrossRefGoogle ScholarPubMed
Eskander, RN, Scanderbeg, D, Saenz, CC, Brown, M, Yashar, C. Comparison of computed tomography and magnetic resonance imaging in cervical cancer brachytherapy target and normal tissue contouring. Int J Gynecol Cancer 2010; 20 (1): 47–53.CrossRefGoogle ScholarPubMed
Mahantshetty, U, Khanna, N, Swamidas, J et al. Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol 2012; 102 (1): 130–134.CrossRefGoogle ScholarPubMed
Schmid, M P, Nesvacil, N, Pötter, R et al. Transrectal ultrasound for image-guided adaptive brachytherapy in cervix cancer–an alternative to MRI for target definition? Radiother Oncol 2016; 120 (3): 467–472 CrossRefGoogle ScholarPubMed
Mahantshetty, U, Khadanga, C, Gudi, S et al. A Prospective Comparison of Computed Tomography with Transrectal Ultrasonography Assistance and Magnetic Resonance Imaging-Based Target-Volume Definition During Image Guided Adaptive Brachytherapy for Cervical Cancers. Int J Radiat Oncol Biol Phys 2018; 102 (5): 1448–1456.CrossRefGoogle ScholarPubMed