Cumulative dosimetric investigation based on image deformable registration in radiotherapy for cervical cancer
Peng Qinghe1, Zhang Shili2, Peng Yinglin1, Liu Hui1, Ye Weijun1
1Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China; 274th Army Hospital of Liberation Army, Guangzhou 510318, China
Abstract：Objective To evaluate the differences in the cumulative doses for cervical cancer between two different methods, and analyze the correlation between the severity of radiation proctitis and the cumulative dose of the rectum. Methods. Clinical data of 278 patients with cervical cancer treated with radiotherapy were retrospectively analyzed. The total dose of radiotherapy was calculated by simple dose volume histogram parameter accumulation method (S-DVH group) and dose accumulation by deformation image registration (DIR group) in 49 patients with radiation proctitis. The rectal cumulative dose of the 278 patients with S-DVH was counted(D2.0cm3/D1.0cm3/D0.1cm3). The correlation analysis was performed by Spearman’s correlation analysis. Results The average cumulative dose(D90%) difference of high-risk clinical target volume (HRCTV) between the S-DVH and DIR groups was 2 Gy (EQD2Gy)[(88.66±5.75) vs. (86.66±5.54) Gy, P<0.05], and the average cumulative dose difference(D2.0cm3 and D1.0cm3) of bladder was 2.13 Gy[(82.46±6.91) vs.(80.33±6.86) Gy, P<0.05] and 2.35 Gy[(88.46±4.37) vs.(86.11±3.93) Gy, P<0.05], and the average cumulative dose difference(D2.0cm3 and D1.0cm3) of rectum was 1.99 Gy[(72.49±5.17) vs.(70.50±5.03) Gy, P<0.05] and 2.71 Gy[(78.87±4.50) vs.(76.16±4.14) Gy, P<0.05]. The rectal cumulative dose(D2.0cm3/D1.0cm3/D0.1cm3) was positively associated with the grade of radiation proctitis. Conclusions The cumulative doses differ between two groups, and are equally in an acceptable range. S-DVH method is a relatively simple method to evaluate the cumulative exposure dose. The cumulative doses of the rectum(D2.0cm3/D1.0cm3/D0.1cm3) can be used to predict the incidence of radiation proctitis.
Peng Qinghe,Zhang Shili,Peng Yinglin et al. Cumulative dosimetric investigation based on image deformable registration in radiotherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 451-454.
[1] Banerjee R, Kamrava M. Brachytherapy in the treatment of cervical cancer:a review[J]. Int J Womens Health, 2014, 6(5):555-564. DOI:10.2147/IJWH. S46247. [2] Murakami N, Kato S, Nakano T, et al. A phase Ⅰ/Ⅱ clinical trial for the hybrid of intracavitary and interstitial brachytherapy for locally advanced cervical cancer[J]. Bmc Cancer, 2016, 16(1):640. DOI:10.1186/s12885-016-2543-3. [3] Vízkeleti J, Fröhlich G, Nhung NA, et al. Clinical results of combined intracavitary-interstitial image-guided adaptive brachytherapy in locally advanced cervical cancer[J]. Magy Onkol, 2018, 62(4):249-257. [4] 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[J]. Radiother Oncol, 2006, 78(1):67-77. DOI:10.1016/j.radonc.2005.11.014. [5] Dimopoulos JCA, Lang S, Kirisits C, et al. Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy[J]. Int J Radiat Oncol Biol Phys, 2009, 75(1):56-63. DOI:10.1016/j.ijrobp.2008.10.033. [6] Pavy JJ, Denekamp J, Letschert J, et al. EORTC late effects working group. Late effects toxicity scoring:the SOMA scale[J]. Int J Radiat Oncol Biol Phys, 1995, 35(1):1043-1047. DOI:10.1016/0167-8140(95)97448-m. [7] Rubin P, Constine LS 3rd, Fajardo LF, et al. EORTC late effects working group. Overview of late effects of normal tissues (LENT) scoring system[J]. Radiother Oncol, 1995, 35(1):9-10. DOI:10.1016/0167-8140(95)97447-l. [8] Routledge JA, Burns MP, Swindell R, et al. Evaluation of the LENT-SOMA scales for the prospective assessment of treatment morbidity in cervical carcinoma[J]. Int J Radiat Oncol Biol Phys, 2003, 56(2): 502-510. DOI: 10.1016/s0360-3016(02)04578-9. [9] Lim K, Small W, Portelance L, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer[J]. Int J Radiat Oncol Biol Phys, 2011, 79(2): 348-355. DOI: 10.1016/j.ijrobp.2009.10.075. [10] Haie-Meder C, Pötter R, Limbergen EV, et al. Recommen dations 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. DOI:10.1016/j.radonc.2004.12.015. [11] International commission on radiation units & measurements. Report 89:Prescribing, recording, and reporting brachytherapy for cancer of the cervix[J]. J ICRU, 2013, 13:1-258. DOI:10.1093/jicru/ndw027. [12] Fowler JF. 21 years of biologically effective dose[J]. Br J Radiol, 2010, 83(991):554-568. DOI:10.1259/bjr/31372149. [13] Teo BK, Millar LPB, Ding X, et al. Assessment of cumulative external beam and intracavitary brachytherapy organ doses in gynecologic cancers using deformable dose summation[J]. Radiother Oncol.2015, 115(2):195-202. DOI:10.1016/j.radonc.2015.04.002. [14] Van Heerden LE, Houweling AC, Koedooder K, et al. Structure-based deformable image registration:Added value for dose accumulation of external beam radiotherapy and brachytherapy in cervical cancer[J]. Radiother Oncol, 2017, 123(2):319-324. DOI:10.1016/j.radonc.2017.03.015. [15] Andersen ES, Noe KO, Sorensen TS, et al. Simple DVH parameter addition as compared to deformable registration for bladder dose accumulation in cervix cancer brachytherapy[J]. Radiother Oncol, 2013, 107(1):52-57. DOI:10.1016/j.radonc.2013.01.013. [16] Flower E, Do V, Sykes J, et al. Deformable image registration for cervical cancer brachytherapy dose accumulation:Organ at risk dose-volume histogram parameter reproducibility and anatomic position stability[J]. Brachytherapy, 2017, 16(2):387-392. DOI:10.1016/j.brachy.2016.12.006. [17] Kadoya N,Miyasaka YY, Yamamoto T, et al. Evaluation ofrectum and bladder dose accumulation from external beamradiotherapy and brachytherapy for cervical cancer using twodifferent deformable image registration techniques[J]. J Radiat Res, 2017, 58(5): 720-728. DOI: 10.1093/jrr/rrx028. [18] Abe T, Tamaki T, Makino S, et al. Assessing cumulative dose distributions in combined radiotherapy for cervical cancer using deformable image registration with pre-imaging preparations[J]. Radiat Oncol, 2014, 9(1):293. DOI:10.1186/s13014-014-0293-4. [19] Kim TG, Huh SJ, Park W. Endoscopic findings of rectal mucosal damage after pelvic radiotherapy for cervical carcinoma:Correlation of rectal mucosal damage with radiation dose and clinical symptoms[J]. Radiat Oncol J, 2013, 31(2):81-87. DOI:10.3857/roj.2013.31.2.81. [20] Georg P, Lang S, Dimopoulos JCA, et al. Dose-volume histogram parameters and late side effects in magnetic resonance image-guided adaptive cervical cancer brachytherapy[J]. Int J Radiat Oncol Biol Phys 2011, 79(2):356-362. DOI:10.1016/j.ijrobp.2009.11.002.
2020, Vol. 29 
