1Gynecological Onclolgy Center, Chongqing University Cancer Hospital, Chongqing 400030, China; 2Bioengineering College of Chongqing University, Chongqing 400030, China; 3Radiation Oncology Center, Chongqing University Affiliated Cancer Hospital, Chongqing 400030, China
Abstract：Objective To evaluate the difference of dosimetry between three-dimensional and two-dimensional plans based on CT images of occult perforation in brachytherapy of cervical cancer, aiming to provide clinical reference. Methods A total of 817 patients with cervical cancer received simple intrauterine (intrauterine tandem plus vaginal colpostats) three-dimensional brachytherapy in Chongqing University Cancer Hospital from January 2019 to December 2020 were retrospectively reviewed. Among them, 16 patients had occul uterine perforation. Based on Oncentra Brachy Therapy plan system, the single prescription dose was 6Gy. Three-dimensional (3D group) and two-dimensional (2D group) plans were designed on the perforated CT images The target volume, conformal index (CI), conformal index coformity index (COIN) and organs-at-risk (OAR) D2cm3 parameters were used to assess the plans between two groups. Results The incidence of pccult uterine perforation was 1.96%(16/817) during brachytherapy for cervical cancer. The volume of prescription dose curve in the 3D group was(40.74±14.98) cm3, significantly smaller compared with (91.46±19.71) cm3 in the 2D group (P<0.05), whereas the volume of the high-risk clinical target area wrapped by prescription dose curve did not significantly differ between two groups (P>0.05). The CI and COIN in the 3D group were 0.79±0.10 and 0.72±0.96, significantly higher compared with 0.38±0.09 and 0.37±0.18 in the 2D group (both P<0.05). The D2cm3 of bladder, rectum, sigmoid colon, small intestine in the 3D group were (306.06±77.57) cGy,(252.27±72.60) cGy,(127.25±62.84) cGy and (228.79±94.90) cGy, significantly lower than (548.03±164.21) cGy,(411.16±118.74) cGy,(227.45±94.48) cGy and (450.95±157.96) cGy in the 2D group (all P<0.05). Conclusions Application of image guidance in brachytherapy of cervical cancer is helpful to detect occult uterine perforation. When occult uterine perforation occurs, the use of three-dimensional plan can basically meet the clinical needs, which is significantly better than the two-dimensional plan.
Zhao Xiujuan,Wu Haiyan,Zhong Mingsong et al. Study of occult uterine perforation in brachytherapy of cervical cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(7): 682-687.
[1] 施丹,赵志鹏,何明远,等. 宫颈癌三维适形近距离治疗膀胱体积变化对正常组织受量影响[J]. 中华放射肿瘤学杂志,2015, 24(2):159-162. DOI:10.3760/cma.j.issn.1004-4221.2015.02.013. Shi D, Zhao ZP, He MY, et al. Effect of bladder volume change on normal tissue doses in 3D conformal brachytherapy for cervical cancer[J]. Chin J Radiat Oncol, 2015, 24(2):159-162. DOI:10.3760/cma.j.issn.1004-4221.2015.02.013. [2] Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations fromGynaecological (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. [3] 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 3 D image-based anatomy, radiation physics, radiobiology[J]. Radiother Oncol, 2006, 78(1):67-77. DOI:10.1016/j.radonc.2005.11.014. [4] 何明远,汤玉环,赵红福,等. ICRU89号报告解读(宫颈癌近距离治疗处方、记录和报告)——放射生物篇[J]. 中华放射肿瘤学杂志, 2019, 28(2):140-145. DOI:10.3760/cma.j.issn.1004-4221.2019.02.012. He MY, Tang YH, Zhao HF, et al. Interpretation of ICRU Report No.89(prescribing, recording, and reporting brachytherapy for cancer of the cervix)—radiobiology[J]. Chin J Radiat Oncol, 2019, 28(2):140-145. DOI:10.3760/cma.j.issn.1004-4221.2019.02.012. [5] International Commission on Radiation Units and Measurements. Prescribing, recording, and reporting brachytherapy for cancer of the cervix[J]. J ICRU, 2013, 13(1-2):23. [6] Baltas D, Kolotas C, Geramani K, et al. A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy[J]. Int J Radiat Oncol Biol Phys, 1998, 40(2):515-524. DOI:10.1016/s0360-3016(97)00732-3. [7] Palmqvist T, Dybdahl Wanderâs A,, Langeland Marthinsen AB, et al. Dosimetric evaluation of manually and inversely optimized treatment planning for high dose rate brachytherapy of cervical cancer[J]. Acta Oncol, 2014, 53(8):1012-1018. DOI:10.3109/0284186X.2014.928829. [8] 赵漫,胡逸民. IMRT或3DCRT计划评估——适形指数(CI)[J]. 中华放射肿瘤学杂志,2017, 26(10):1177-1181. DOI:10.3760/cma.j.issn.1004-4221.2017.10.015. Zhao M, Hu YM. A new set of conformity indices for evaluating intensity-modulated radiotherapy or three-dimensional conformal radiotherapy plans[J]. Chin J Radiat Oncol, 2017, 26(10):1177-1181. DOI:10.3760/cma.j.issn.1004-4221.2017.10.015. [9] 张永侠,袁香坤,苗珺珺,等.3D打印模板应用于局部晚期宫颈癌后装放疗的剂量学研究[J]. 中华放射医学与防护杂志, 2020, 40(7):519-523. DOI:10.3760/cma.j.issn.0254-5098.2020.07.005. Zhang YX, Yuan XK, Miao JJ, et al. Dosimetric analysis of 3D-printed minimally invasive-guided template in the brachytherapy treatment of locally advanced cervical cancer[J]. Chin J Radiol Med Protect, 2020, 40(7):519-523. DOI:10.3760/cma.j.issn.0254-5098.2020.07.005. [10] Irvin W, Rice L, Taylor P, et al. Uterine perforation at the time of brachytherapy for carcinoma of the cervix[J]. Gynecol Oncol, 2003, 90(1):113-122. DOI:10.1016/S0090-8258(03)00230-0. [11] Patel FD, Kumar P, Karunanidhi G, et al. Optimization of high-dose-rate intracavitary brachytherapy schedule in the treatment of carcinoma of the cervix[J]. Brachytherapy, 2011, 10(2):147-153. DOI:10.1016/j.brachy.2010.05.003. [12] Barnes EA, Thomas G, Ackerman I, et al. Prospective comparison of clinical and computed tomography assessment in detecting uterine perforation with intracavitary brachytherapy for carcinoma of the cervix[J]. Int J Gynecol Cancer, 2007, 17(4):821-826. DOI:10.1111/j.1525-1438.2007.00888.x [13] Sahinler I, Cepni I, Oksuz DC, et al. Tandem application with transvaginal ultrasound guidance[J]. Int J Radiat Oncol Biol Phys, 2004, 59(1):190-196. DOI:10.1016/j.ijrobp.2003.10.028. [14] Jhingran A, Eifel PJ. Perioperative and postoperative complications of intracavitary radiation for FIGO stage Ⅰ-Ⅲ carcinoma of the cervix[J]. Int J Radiat Oncol Biol Phys, 2000, 46(5):1177-1183. DOI:10.1016/S0360-3016(99)00545-3. [15] 程光惠. 宫颈癌4D近距离放射治疗[M]. 吉林:吉林大学出版社,2019:257. Cheng GH. Near-range radiotherapy D cervical cancer[M]. Jilin:Jilin University Press, 2019:257. [16] Mayadev J, Benedict SH, Kamrava M. Handbook of image-guided brachytherapy[M]. Berlin:Springer, 2017:69-98. [17] 张宁,韩东梅,程光惠. 超声引导施源器植入在宫颈癌BT的应用[J]. 中华放射肿瘤学杂志, 2018, 27(6):616-620. DOI:10.3760/cma.j.issn.1004-4221.2018.06.017. Zhang N, Han DM, Cheng GH. Application of ultrasound-guided applicator placement in brachytherapy for cervical cancer[J]. Chin J Radiat Oncol, 2018, 27(6):616-620. DOI:10.3760/cma.j.issn.1004-4221.2018.06.017. [18] Corn BW, Shaktman BD, Lanciano RM, et al. Intra-and perioperative complications associated with tandem and colpostat application for cervix cancer[J]. Gynecol Oncol, 1997, 64(2):224-229. DOI:10.1006/gyno.1996.4564. [19] Watkins JM, Kearney PL, Opfermann KJ, et al. Ultrasound-guided tandem placement for low-dose-rate brachytherapy in advanced cervical cancer minimizes risk of intraoperative uterine perforation[J]. Ultrasound Obstet Gynecol, 2011, 37(2):241-244. DOI:10.1002/uog.8805. [20] Schaner PE, Caudell JJ, De Los Santos JF, et al. Intraoperative ultrasound guidance during intracavitary brachytherapy applicator placement in cervical cancer:the University of Alabama at Birmingham experience[J]. Int J Gynecol Cancer, 2013, 23(3):559-566. DOI:10.1097/IGC.0b013e3182859302. [21] Akbas T, Ugurluer G, Acil M, et al. Intraoperative sonographic guidance for intracavitary brachytherapy of cervical cancer[J]. J Clin Ultrasound, 2018, 46(1):8-13. DOI:10.1002/jcu.22510.
2021, Vol. 30 
