Abstract:Objective To explore the correlation between the dose measured in the rectum and reference dose in three-dimensional brachytherapy (3DBT) for cervical cancer, and to evaluate the significance of the dose measured in the rectum. Methods Fifty patients receiving radiotherapy for cervical cancer were selected, and 3DBT was performed after pelvic external beam radiotherapy. According to the rectal monitoring method recommended in the report ICRU38, in vivo monitoring was applied to obtain the dose measured in the rectum, reference point dose (DICRU), and D2 cm3, and the planned dose was obtained from the planning system. The differences in these values were determined by the paired t-test and correlation analysis was performed with Pearson test. Results The dose measured in the rectum was higher than the planned dose (3.48 vs. 3.25, P=0.000), and lower than DICRU (3.48 vs. 3.71, P=0.000) and D2 cm3(3.48 vs. 3.87, P=0.002). A linear relationship existed between the dose measured in the rectum and the planned dose, with a deviation percentage of -20% to 40% and an average deviation of 8.16%;63% of the patients with cervical cancer had a deviation of<±10%;the maximum deviation was 60%. The dose measured in the rectum had a strong correlation with DICRU (r=0.722), but a weak correlation with D2 cm3(r=0.284). Conclusions During 3DBT for cervical cancer, the dose measured in the rectum has certain deviations, but has a linear correlation with the planned dose. Both the dose measured and the planned dose underestimate the dose at the reference point in the rectum, and in vivo rectal monitoring may be an effective method for quality control.
Liu Liqiong,Zhao Zhipeng,Cheng Guanghui et al. Correlation between the dose measured in the rectum and reference dose in three-dimensional brachytherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(6): 649-652.
[1] ICRU Report 38.Dose and volume specification for reporting intracavitary therapy in gynecology,1985[C].Bethesda,Maryland:International Commission on Radiation Units and Measurements,1985. [2] Haie-Meder C, Ptter 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[J]. Radiother Oncol, 2005,74(3):235-245. [3] Ptter 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[J]. Radiother Oncol,2006,78(1):67-77. [4] Eng TY, Fuller CD, Cavanaugh SX, et al. Significant rectal and bladder dose reduction via utilization of Foley balloon catheters in high dose-rate tandem and ovoid intracavitary brachytherapy of the uterine cervix[J]. Int J Radiat Oncol Biol Phys,2004,59(1):174-178. [5] Souhami L, Seymour R, Roman TN, et al. Weekly cisplatin plus external beam radiotherapy and high dose rate brachytherapy in patients with locally advanced carcinoma of the cervix[J]. Int J Radiat Oncol Biol Phys,1993,27(4):871-878. [6] Levitchi M, Charra-Brunaud C, Quetin P, et al. Impact of dosimetric and clinical parameters on clinical side effects in cervix cancer patients treated with 3D pulse-dose-rate intracavitary brachytherapy[J]. Radiother Oncol,2012,103(3):314-321.DOI:10.1016/j.radonc.2012.04.008. [7] Ptter R, Dimopoulos J, Georg P, et al. Clinical impact of MRI assisted dose volume adaptation in brachytherapy of locally advancedcervix cancer[J]. Radiother Oncol,2007,83(2):148-155. [8] Petra G,Ptter R,Dietmar G,et al. Dose effect relationship for late side effects of the rectum and urinary bladder in magnetic resonance image-guided adaptive cervix cancer brachytherapy[J]. Int J Radiat Oncol Biol Phys,2012,82(2):653-657.DOI:10.1016/j.ijrobp.2010.12.029 [9] Haughey A, Coalter G, Mugabe K.Evaluation of linear array MOSFET detectors for in vivo dosimetry to measure rectal dose in HDR brachytherapy[J]. Australas Phys Eng Sci Med,2011,34(3):361-366.DOI:10.1007/s13246-011-0084-2. [10] Allahverdi M, Sarkhosh M, Aghili M, et al. Evaluation of treatment planning system of brachytherapy according to dose to the rectum delivered[J].Radiat Prot Dosimetry,2012,150(3):312-315.DOI:10.1093/rpd/ncr415. [11] Guanghui Cheng, et al. Utrecht interstitial applicator shifts and DVH parameter changes in 3D CT-based HDR brachytherapy of cervical cancer[J].Asian Pac J Cancer Prev,2015,16(9):3945-9. [12] 雷新,单锦露,赵可伟.252Cf中子后装治疗宫颈癌直肠钡灌肠与插铅丝监测直肠前壁受量的差异[J]. 中华放射肿瘤学杂志,2005,14(3):201-203.