[an error occurred while processing this directive] | [an error occurred while processing this directive]
A clinical study of CT image-based 3D brachytherapy for cervical cancer
Yan Junfang, Yu Lang, Sun Yuliang, Li Wenbo, Zhang Fuquan
Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100730,China
Abstract Objective To evaluate the feasibility and significance of CT image-based three-dimensional (3D) brachytherapy for cervical cancer. Methods Three-dimensional (3D) plan and two-dimensional (2D) plan were designed for 55 CT images of brachytherapy from 12 cervical cancer patients who received radical radiotherapy in 2013. Dosimetric comparison was performed between the 3D plan and 2D plan, and paired t-test, Wilcoxon signed rank test, Pearson correlation analysis, and Spearman correlation analysis were performed. Results A point dose, D90, V100, CI, and CI′ in 3D plan were higher than those in 2D plan (P=0.015,0.016,0.000,0.000,0.000). Bladder point dose, rectal point dose, and rectal D2 cm3 in 3D plan were slightly higher than those in 2D plan, but hot spot dose was significantly reduced in 3D plan (P=0.140,0.123,0.214). Bladder D2 cm3 was significantly higher than bladder point dose (P=0.000). Sigmoid colon D2 cm3 was more correlated with the average doses of the three highest rectal points than rectal D2 cm3(r=0.314,0.630, P=0.000,0.000). V100 showed a linear relationship with high-risk CTV (r=0.981, P=0.000). Bladder D2 cm3 was higher than 430 cGy when the bladder volume was more than 80 cm3;small intestinal D2 cm3 did not change significantly when the bladder volume was less than 115 cm3, but decreased significantly once the volume exceeded the value. Conclusions Compared with the traditional 2D plan, the 3D plan for CT image-based cervical cancer brachytherapy significantly increases the target coverage and conformity index, but does not significantly increase the doses to organs at risk. Point dose evaluation is confirmed to be inaccurate. The doses to the bladder, rectum, and small intestine can be adjusted by controlling the bladder volume.
Yan Junfang,Yu Lang,Sun Yuliang et al. A clinical study of CT image-based 3D brachytherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(5): 377-381.
Yan Junfang,Yu Lang,Sun Yuliang et al. A clinical study of CT image-based 3D brachytherapy for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(5): 377-381.
[1] Ptter 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 chemth-erpay in patients with locally adavanced cervical cancer[J].Radiother Oncol,2011,100:116-123. [2] Haie-Meder C,Ptter R,Van Limbergen E,et al. Gynaecological (GYN) GEC-ESTRO working group 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,2005,74:235-245. [3] Viswanathan AN, Dimopoulos J, Kirisits C, et al. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy:results of a prospective trial and preliminary guidelines for standardized contours[J].Int J Radiat Oncol Biol Phys,2007,68:491-498. [4] Viswanathan AN, Erickson BA. Three-dimensional imaging in gynecologic brachtherapy:a survey of the American brachytherapy society[J]. Int J Radiat Oncol Biol Phys,2009,76:106-109. [5] Pavamani S, D′Souza DP, Portelance L,et al. Image-guided brachytherapy for cervical cancer:a Canadian Brachytherapy Group survey[J].Brachytherapy,2011,10:345-351. [6] Petri P, Hudej R, Rogelj P, et al. Uncertainties of target volume delineation in MRI guided adaptive brachytherapy of cervix cancer:a multi-institutional study[J].Radiother Oncol,2013,107:6-12. [7] Tan LT, Coles CE, Hart C, et al. Clinical impact of computed tomography-based image-guided brachytherapy for cervix cancer using the tandem-ring applicator-the addenbrooke′s experience[J].Clin Oncol,2009,21:175-182. [8] Hegazy N, Ptter R,Krisits C, et al. High-risk clinical target volume delineation in CT-guided cervical cancer brachytherapy:impact of information from FIGO stage with or without systematic inclusion of 3D documentation of clinical gynecological examination[J].Acta Oncol,2013,52:1345-1352. [9] Dolezel M, Odrazka K, Zizka J, et al. MRI-based preplanning using CT and MRI data fusion in patients with cervical cancer treated with 3D-based brachytherapy:feasibility and accuracy study[J].Int J Radiat Oncol Biol Phys,2012,84:146-152. [10] Shin KH, Kim TH, Cho JK, et al. CT-guided intracavitary radiotherapy for cervical cancer:comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters[J].Int J Radiat Oncol Biol Phys,2006,64:197-204. [11] Wang B, Kwon A, Zhu Y, et al. Image-guided intracavitary high-dose-rate brachytherapy for cervix cancer:a single institutional experience with three-dimensional CT-based planning[J].Brachytherapy,2009,8:240-247. [12] Ptter R1, 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 cervial cancer[J]. Radiother Oncol,2011,100:116-123. [13] Cengiz M,Gürdalli S,Selek U,et al. Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer:three-dimensional computed tomography plan evaluation[J]. Int J Radiat Oncol Biol Phys,2008,70:464-468. [14] Saha S, Gangopadhyay A, Ghoshdastidar A, et al. Image-guided HDR intracavitary and interstitial brachytherapy for locally advanced cervix cancer-correlation of late toxicity with DVH data and 3-year outcome analysis[J].Brachytherapy,2008,7:98.
2014, Vol. 23 
