AbstractObjective To analyze the advantages of IPSA combined with increasing cervical center dose in intracavitary and interstitial brachytherapy (IC/IS) for locally advanced cervical cancer. Methods A total of 46stage ⅡB cervical cancer patients with, local lesion size≥5cm after 45Gy/25f external intensity-modulated radiotherapy (IMRT) were recruited. Uterine tandem and needles were implanted, CT was performed, and then HR-CTV, rectum, bladder, sigmoid colon and the area of cervix increased dose (HR-cervix) were delineated, IPSA was used for optimization. According to whether the dose of HR-cervix was increased or not, all patients were divided into IC/IS+HR-cervix group (group A) and IC/IS group (group B). The differences in dosimetric parameters were compared between two groups. Results The relative uterine tandem dwell time was significantly extended in group A (P<0.001). In group B, the V150% and V200% volumes of HR-cervix were increased from 63.94% and 30.80% to 91.54% and 64.06%. The D90% and D100% in group A were significantly lower than those in group B (both P<0.05). There was no statistical difference in organ at risk (OAR) dose. Conclusion IPSA combined with increasing cervical center dose can meet the HR-CTV D90% dose requirement, normal tissue dose limits, and can escalate the doses to local areas of the cervix.
Corresponding Authors:
Wang Tiejun,Email:m13943016598@163.com
Cite this article:
Lin Xia,Wang Tiejun,Wang Jiapeng et al. Application IPSA combined with increasing cervical center dose in intracavitary and interstitial brachytherapy for locally advanced cervical cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(3): 249-252.
Lin Xia,Wang Tiejun,Wang Jiapeng et al. Application IPSA combined with increasing cervical center dose in intracavitary and interstitial brachytherapy for locally advanced cervical cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(3): 249-252.
[1] Pötter R,Georg P,Dimopoulos JC,et al.Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer[J].Radiother Oncol,2011,100(1):116-123.DOI:10.1016/j.radonc.2011.07.012. [2] Charra-Brunaud C,Harter V,Delannes M,et al.Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France:results of the French STIC prospective study[J].Radiother Oncol,2012,103(3):305-313.DOI:10.1016/j.radonc.2012.04.007. [3] Kirisits C,La-ng S,Dimopoulos J,et al.The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervicalcancer:design,application,treatment planning,and dosimetric results[J].Int J Radiat Oncol Biol Phys,2006,65(2):624-630.DOI:10.1016/j.ijrobp.2006.01.036. [4] Dimopoulos JC,Kirisits C,Petric P,et al.The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer:clinical feasibility and preliminary results[J].Int J Radiat Oncol Biol Phys,2006,66(1):83-90.DOI:10.1016/j.ijrobp.2006.04.041. [5] Fokdal L,Tanderup K,Hokland SB,et al.Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer employing MRI with a tandem/ring applicator in situ and virtual preplanning of the interstitial component[J].Radiother Oncol,2013,107(1):63-68.DOI:10.1016/j.radonc.2013.01.010. [6] Walter F,Maihöfer C,Schüttrumpf L,et al.Combined intracavitary and interstitial brachytherapy of cervical cancer using the novel hybrid applicator Venezia:Clinical feasibility and initial results[J].Brachytherapy,2018,17(5):775-781.DOI:10.1016/j.brachy.2018.05.009. [7] Murakami N,Kobayashi K,Shima S,et al.A hybrid technique of intracavitary and interstitial brachytherapy for locally advanced cervical cancer:initial outcomes of a single-institute experience[J].BMC Cancer,2019,19(1):221.DOI:10.1186/s12885-019-5430-x. [8] Trnková P,Baltas D,Karabis A,et al.A detailed dosimetric comparison between manual and inverse plans in HDR intracavitary/interstitial cervical cancer brachytherapy[J].J Contemp Brachyther,2010,2(4):163-170.DOI:10.5114/jcb.2010.19497. [9] Haie-Meder C,Pötter 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.DOI:10.1016/j.radonc.2004.12.015. [10] 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. [11] Hsu ICJ,Speight J,Hai J,et al.A comparison between tandem and ovoids and interstitial gynecologic template brachytherapy dosimetry using a hypothetical computer model[J].Int J Radiat Oncol Biol Phys,2002,52(2):538-543.DOI:10.1016/s0360-3016(01)02691-8. [12] Trnková P,Baltas D,Karabis A,et al.A detailed dosimetric comparison between manual and inverse plans in HDR intracavitary/interstitial cervical cancer brachytherapy[J].J Contemp Brachyther,2010,2(4):163-170.DOI:10.5114/jcb.2010.19497. [13] Roy S,Subramani V,Singh K,et al.Study of the effects of dwell time deviation constraints on inverse planning simulated annealing optimized plans of intracavitary brachytherapy of cancer cervix[J].J Canc Res Ther,2019,15(6):1370-1376.DOI:10.4103/jcrt.JCRT-246-18. [14] Schnell E,Thompson S,Ahmad S,et al.Dosimetric considerations when utilizing Venezia,Capri,Rotte double tandem,and tandem and ring with interstitial needles for the treatment of gynecological cancers with high dose rate brachytherapy[J].Med Dosim,2020,45(1):21-27.DOI:10.1016/j.meddos.2019.04.001.
2021, Vol. 30 
