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Clinical application of new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytheraypy after hysterectomy for gynecological cancer
Ling Baozhen, Mai Miaoqing, Cao Xinping, Ye Weijun, Ouyang Yi, Guo Xuan
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
AbstractObjective Investigate the safety and feasibility of using the new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, and to explore the clinical value of the self-designed implanting applicator. Methods Sixty-two gynecological cancer patients who underwent brachytherapy in Sun Yat-sen University Cancer Center were selected in this study. Each patient received three-dimensional intracavitary brachytherapy because of the indication of postoperative radiotherapy. Each patient was treated with different types of self-designed implanting applicators according the condition of postoperative vagina,and the vaginal tube and implant needle were placed in the template according to the preset channnel. Based on the actual CT images, the high-risk clinical target volume (HR-CTV), and organs at risk were defined according to unified target area delineation criteria and then the brachytherapy plan was conducted. The prescription dose of high-risk clinical target volume (HR-CTV) was 5.5 Gy/time. The parameters such as target area, organs at risk volume and irradiated dose were evaluated by DVH diagram. Results Sixty-two patients successfully completed brachytherapy under the guidance of self-designed implanting applicator. A total of 140 implantation treatments were performed. The total average dose of HR-CTV D90% was (575.48±22.30) cGy, the mean dose D2cm³ of bladder, rectum and sigmoid colon were (328.69±102.71), (369.14±46.59) and (27.28±71.27) cGy, the small intestine did not drop the target area, so there was no statistics. There was statistical significance between target volume and organs at risk dose (P<0.05). Conclusions The new self-designed implanting applicator has obvious clinical advantages in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, meets the requirements of the preset planning dose,and it is sample to operate and highly safe,which indicated a bright future of the clinical application.
Corresponding Authors:
Mai Miaoqing, Email: maimq@sysucc.org.cn
Cite this article:
Ling Baozhen,Mai Miaoqing,Cao Xinping et al. Clinical application of new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytheraypy after hysterectomy for gynecological cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(7): 622-627.
Ling Baozhen,Mai Miaoqing,Cao Xinping et al. Clinical application of new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytheraypy after hysterectomy for gynecological cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(7): 622-627.
[1] Williamson CW, Liu HC, Mayadev J, et al.Advances in external beam radiation therapy and brachytherapy for cervical cancer[J]. Clin Oncol (R Coll Radiol), 2021, 33(9):567-578. DOI: 10.1016/j.clon.2021.06.012. [2] Beriwal S, Demanes DJ, Erickson B, et al.American brachytherapy society consensus guidelines for interstitial brachytherapy for vaginal cancer[J]. Brachytherapy, 2012, 11(1):68-75. DOI: 10.1016/j.brachy.2011.06.008. [3] Small W, Beriwal S, Demanes DJ, et al.American brachytherapy society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy[J]. Brachytherapy, 2012, 11(1):58-67. DOI: 10.1016/j.brachy.2011.08.005. [4] 李龙婕, 邓晓琴. 宫颈癌近距离放射治疗进展[J]. 大连医科大学学报, 2019, 41(3): 193-198. DOI: 10.11724/jdmu.2019.03.01. Li LJ, Deng XQ.Progress in brachytherapy for cervical cancer[J]. J Dalian Med Univers,2019,41(3):193-198. DOI: 10.11724/jdmu.2019.03.01. [5] 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. [6] Hellebust TP, Kirisits C, Berger D, et al.Recommendations from gynaecological (GYN) GEC-ESTRO working group: considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy[J]. Radiother Oncol, 2010, 96(2):153-160. DOI: 10.1016/j.radonc.2010.06.004. [7] 石梅,魏丽春,刘隽悦,等. 局部晚期宫颈癌CT图像引导下192Ir三维腔内后装治疗剂量体积参数与疗效关系[J]. 中华放射肿瘤学杂志,2011,20(1):49-53. DOI:10.3760/cma.j.issn.1004-4221.2011.01.017. Shi M,Wei LC,Liu JY,et al.The correlation between DVH at CT-image based 192Ir intracavitary brachytherapy and effects or complications for patients with locally advanced cervical cancer[J]. Chin J Radiat Oncol,2011,20(1):49-53. DOI:10.3760/cma.j.issn.1004-4221.2011.01.017. [8] Dimopoulos JC, Pötter R, Lang S, et al.Dose-effect relationship for local control of cervical cancer by magnetic resonance image-guided brachytherapy[J]. Radiother Oncol, 2009, 93(2):311-315. DOI: 10.1016/j.radonc.2009.07.001. [9] Haie-Meder C, Chargari C, Rey A, et al.MRI-based low dose-rate brachytherapy experience in locally advanced cervical cancer patients initially treated by concomitant chemoradiotherapy[J]. Radiother Oncol, 2010, 96(2):161-165. DOI: 10.1016/j.radonc.2010.04.015. [10] 赵秀娟,吴海燕,钟明松,等. 宫颈癌近距离治疗中隐匿性子宫穿孔研究[J]. 中华放射肿瘤学杂志,2021,30(7):682-687.DOI:10.3760/cma.j.cn113030-20210412-00157. Zhao XJ,Wu HY,Zhong MS,et al.Study of occult uterine perforation in brachytherapy of cervical cancer[J]. Chin J Radiat Oncol,2021,30(7):682-687.DOI:10.3760/cma.j.cn113030-20210412-00157. [11] 侯晓荣,于浪,单书灿,等. 子宫内膜癌单通道和六通道柱状施源器三维近距离照射的剂量学比较[J]. 中华放射肿瘤学杂志,2015,24(1):60-64.DOI:10.3760/cma.j.issn.1004- 4221.2015.01.017. Hou XR,Yu L,Shan SC,et al.Dosimetric comparison between single-channel and six-channel vaginal cylinders with three-dimensional treatment planning in postoperative brachytherapy for endometrial carcinoma[J]. Chin J Radiat Oncol,2015,24(1):60-64.DOI:10.3760/cma.j.issn.1004-4221.2015.01.017. [12] Kharouta MZ, Pham N, Nieto K, et al.Comparison of dosimetric and clinical outcomes between short- and long-channel cylinder applicators for vaginal brachytherapy in intermediate- and high-risk endometrial cancer[J]. Brachytherapy, 2018, 17(4):673-679. DOI: 10.1016/j.brachy.2018.04.003. [13] 侯彦杰, 于江平, 王俊杰. 3D打印技术在肿瘤放疗中的应用进展[J]. 中华放射肿瘤学杂志, 2021, 30(02):217-220.DOI:10.3760/cma.j.cn113030-20190805-00304. Hou YJ,Yu JP,Wang JJ.Research progress on application of 3D printing technique in radiotherapy[J]. Chin J Radiat Oncol,2021, 30(02):217-220.DOI:10.3760/cma.j.cn113030- 20190805-00304. [14] Tack P, Victor J, Gemmel P, et al.3D-printing techniques in a medical setting: a systematic literature review[J]. Biomed Eng Online, 2016, 15(1):115. DOI: 10.1186/s12938-016- 0236-4. [15] Li J, Xin M, Dang Y, et al.Pure interstitial brachytherapy using 3D-printed vaginal template for improved catheter tracks in treating cervical cancer[J]. J Biomater Tissue Engineer,2017,7(6):499-503.DOI:10.1166/jbt.2017.1591. [16] 于浪,连欣,晏俊芳,等. 3D打印技术在CT引导宫颈癌术后阴道残端肿瘤近距离治疗中应用[J]. 中华放射肿瘤学杂志,2016,25(9):965-967. DOI:10.3760/cma.j.issn.1004- 4221.2016.09.013. Yu L,Lian X,Yan JF,et al.Application of 3D printing technology in brachytherapy for vaginal stump tumor after CT-guided cervical carcinoma surgery[J]. Chin J Radiat Oncol,2016,25(9):965-967. DOI:10.3760/cma.j.issn.1004- 4221.2016.09.013. [17] 王凤玫,程惠华,冯静,等. 3D打印技术引导宫颈癌个体化近距离放疗应用研究[J]. 中华肿瘤防治杂志,2020,27(12):1003-1007.DOI:10.16073/j.cnki.cjcpt.2020.12.14. Wang FM,Cheng HH,Feng J,et al.Clinical observation of 3D printing-guided three-dimensional brachytherapy for cervical cancer[J]. Chin J Cancer Prev Treat,2020,27(12):1003-1007.DOI:10.16073/j.cnki.cjcpt.2020.12.14. [18] 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 Prot, 2020,40(7):519-523.DOI:10.3760/cma.j.issn.0254-5098.2020.07.005. [19] Tanderup K, Nielsen SK, Nyvang GB, et al.From point A to the sculpted pear: MR image guidance significantly improves tumour dose and sparing of organs at risk in brachytherapy of cervical cancer[J]. Radiother Oncol, 2010, 94(2):173-180. DOI: 10.1016/j.radonc.2010.01.001. [20] Dimopoulos JC, Pötter R, Lang S, et al.Dose-effect relationship for local control of cervical cancer by magnetic resonance image-guided brachytherapy[J]. Radiother Oncol, 2009, 93(2):311-315. DOI: 10.1016/j.radonc.2009.07.001. [21] Murakami N, Kasamatsu T, Wakita A, et al.CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer[J]. BMC Cancer, 2014, 14:447. DOI: 10.1186/1471-2407-14-447.