Comparison of 2D and 3D imaging and treatment planning for postoperative vaginal apex high-dose rate brachytherapy for endometrial cancer

To evaluate bladder and rectal doses using two-dimensional (2D) and 3D treatment planning for vaginal cuff high-dose rate (HDR) in endometrial cancer. Ninety-one consecutive patients treated between 2000 and 2007 were evaluated. Seventy-one and 20 patients underwent 2D and 3D planning, respectively....

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Bibliographic Details
Published in:International journal of radiation oncology, biology, physics Vol. 83; no. 1; p. e75
Main Authors: Russo, James K, Armeson, Kent E, Richardson, Susan
Format: Journal Article
Language:English
Published: United States 01.05.2012
Subjects:
Brachytherapy - methods
Carcinoma - radiotherapy
Carcinoma - surgery
Dose Fractionation
Endometrial Neoplasms - radiotherapy
Endometrial Neoplasms - surgery
Female
Fiducial Markers
Humans
Organs at Risk - radiation effects
Postoperative Care - methods
Rectum - radiation effects
Retrospective Studies
Urinary Bladder - radiation effects
ISSN:1879-355X, 1879-355X
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Summary:To evaluate bladder and rectal doses using two-dimensional (2D) and 3D treatment planning for vaginal cuff high-dose rate (HDR) in endometrial cancer. Ninety-one consecutive patients treated between 2000 and 2007 were evaluated. Seventy-one and 20 patients underwent 2D and 3D planning, respectively. Each patient received six fractions prescribed at 0.5 cm to the superior 3 cm of the vagina. International Commission on Radiation Units and Measurements (ICRU) doses were calculated for 2D patients. Maximum and 2-cc doses were calculated for 3D patients. Organ doses were normalized to prescription dose. Bladder maximum doses were 178% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were no different than ICRU doses (p = 0.22). Two-cubic centimeter doses were 59% of maximum doses (p < 0.0001). Rectal maximum doses were 137% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were 87% of ICRU doses (p < 0.0001). Two-cubic centimeter doses were 64% of maximum doses (p < 0.0001). Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final bladder dose to within 10% for 44%, 59%, 83%, 82%, and 89% of patients by using the ICRU dose, and for 45%, 55%, 80%, 85%, and 85% of patients by using the maximum dose, and for 37%, 68%, 79%, 79%, and 84% of patients by using the 2-cc dose. Using the first 1, 2, 3, 4 or 5 fractions, we predicted the final rectal dose to within 10% for 100%, 100%, 100%, 100%, and 100% of patients by using the ICRU dose, and for 60%, 65%, 70%, 75%, and 75% of patients by using the maximum dose, and for 68%, 95%, 84%, 84%, and 84% of patients by using the 2-cc dose. Doses to organs at risk vary depending on the calculation method. In some cases, final dose accuracy appears to plateau after the third fraction, indicating that simulation and planning may not be necessary in all fractions. A clinically relevant level of accuracy should be determined and further research conducted to address this issue.
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ISSN:1879-355X
1879-355X
DOI:10.1016/j.ijrobp.2011.11.029