Point vs. volumetric bladder and rectal doses in combined intracavitary-interstitial high-dose-rate brachytherapy: Correlation and comparison with published Vienna applicator data

Ravindra Yaparpalvi, Subhakar Mutyala, Giridhar R. Gorla, James Butler, Dennis Mah, Madhur K. Garg, Shalom Kalnicki

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Abstract

Purpose: We correlated rectal and bladder point and volumetric dose data in patients treated for advanced cervix cancers with combined intracavitary-interstitial high-dose-rate (HDR) brachytherapy (BT). The results are compared with published Vienna applicator data. Methods and Materials: We retrospectively analyzed 30 individual combined intracavitary plus interstitial implants from 10 patients treated with external beam radiation therapy (EBRT) followed by HDR BT for locally advanced cervix carcinoma. EBRT consisted of 45 Gy to the pelvis followed by 9-14.4 Gy boost to involved parametria. BT consisted of a total dose of 21 Gy delivered in 7 Gy fraction. For each implant, CT-image-based simulation and image-guided BT treatment planning was performed. Bladder and rectal doses were evaluated and analyzed using both International commission on Radiation Units and Measurements (ICRU) reference points and dose-volume histograms. The cumulative doses to the rectum and bladder were calculated by combining contributions from external beam therapy and BT. To facilitate comparison with published literature, the total doses were normalized to equivalent dose in 2-Gy fractions (EQD2) using the equation EQD2total = EQD2EBRT + EQD2BT. Results: For the patient population considered, the mean ICRU bladder dose was 75 (±4) Gy3 compared to bladder D0.1 cc and D2 cc doses of 84 (±4) and 78 (±3) Gy3, respectively. The mean ICRU rectal dose was 73 (±4) Gy3 compared to rectal D0.1 cc and D2 cc doses of 79 (±5) and 74 (±4) Gy3, respectively. For rectum, the mean dose ratios (D0.1 cc/DICRU) and (D2 cc/DICRU) were 1.08 and 1.01, respectively, compared to Vienna applicator study mean dose ratios of 1.08 and 0.93, respectively. ICRU rectal dose correlated with volumetric rectal doses and best with volumetric D2 cc dose (rS = 0.91, p = 0.0003); however, ICRU bladder dose did not correlate with volumetric bladder dose. Conclusions: Our study findings reveal a strong correlation between ICRU rectal reference dose and volumetric rectal D2 cc dose in combined intracavitary-interstitial HDR brachytherapy. This surrogate rectal-dose relationship is valuable in establishing rectal tolerance dose levels in transitioning from traditional two-dimensional to image-based three-dimensional dose planning.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalBrachytherapy
Volume7
Issue number4
DOIs
StatePublished - Oct 2008

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Brachytherapy
Urinary Bladder
Radiation
Rectum
Radiotherapy
Three-Dimensional Imaging
Peritoneum
Pelvis
Cervix Uteri
Uterine Cervical Neoplasms
Carcinoma
Therapeutics
Population

Keywords

  • Bladder
  • Cervix
  • ICRU reference dose
  • Intracavitary-interstitial brachytherapy
  • Rectum
  • Volumetric dose

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{3c121350024f41cfb30151d84b5de5a5,
title = "Point vs. volumetric bladder and rectal doses in combined intracavitary-interstitial high-dose-rate brachytherapy: Correlation and comparison with published Vienna applicator data",
abstract = "Purpose: We correlated rectal and bladder point and volumetric dose data in patients treated for advanced cervix cancers with combined intracavitary-interstitial high-dose-rate (HDR) brachytherapy (BT). The results are compared with published Vienna applicator data. Methods and Materials: We retrospectively analyzed 30 individual combined intracavitary plus interstitial implants from 10 patients treated with external beam radiation therapy (EBRT) followed by HDR BT for locally advanced cervix carcinoma. EBRT consisted of 45 Gy to the pelvis followed by 9-14.4 Gy boost to involved parametria. BT consisted of a total dose of 21 Gy delivered in 7 Gy fraction. For each implant, CT-image-based simulation and image-guided BT treatment planning was performed. Bladder and rectal doses were evaluated and analyzed using both International commission on Radiation Units and Measurements (ICRU) reference points and dose-volume histograms. The cumulative doses to the rectum and bladder were calculated by combining contributions from external beam therapy and BT. To facilitate comparison with published literature, the total doses were normalized to equivalent dose in 2-Gy fractions (EQD2) using the equation EQD2total = EQD2EBRT + EQD2BT. Results: For the patient population considered, the mean ICRU bladder dose was 75 (±4) Gy3 compared to bladder D0.1 cc and D2 cc doses of 84 (±4) and 78 (±3) Gy3, respectively. The mean ICRU rectal dose was 73 (±4) Gy3 compared to rectal D0.1 cc and D2 cc doses of 79 (±5) and 74 (±4) Gy3, respectively. For rectum, the mean dose ratios (D0.1 cc/DICRU) and (D2 cc/DICRU) were 1.08 and 1.01, respectively, compared to Vienna applicator study mean dose ratios of 1.08 and 0.93, respectively. ICRU rectal dose correlated with volumetric rectal doses and best with volumetric D2 cc dose (rS = 0.91, p = 0.0003); however, ICRU bladder dose did not correlate with volumetric bladder dose. Conclusions: Our study findings reveal a strong correlation between ICRU rectal reference dose and volumetric rectal D2 cc dose in combined intracavitary-interstitial HDR brachytherapy. This surrogate rectal-dose relationship is valuable in establishing rectal tolerance dose levels in transitioning from traditional two-dimensional to image-based three-dimensional dose planning.",
keywords = "Bladder, Cervix, ICRU reference dose, Intracavitary-interstitial brachytherapy, Rectum, Volumetric dose",
author = "Ravindra Yaparpalvi and Subhakar Mutyala and Gorla, {Giridhar R.} and James Butler and Dennis Mah and Garg, {Madhur K.} and Shalom Kalnicki",
year = "2008",
month = "10",
doi = "10.1016/j.brachy.2008.05.005",
language = "English (US)",
volume = "7",
pages = "336--342",
journal = "Brachytherapy",
issn = "1538-4721",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Point vs. volumetric bladder and rectal doses in combined intracavitary-interstitial high-dose-rate brachytherapy

T2 - Correlation and comparison with published Vienna applicator data

AU - Yaparpalvi, Ravindra

AU - Mutyala, Subhakar

AU - Gorla, Giridhar R.

AU - Butler, James

AU - Mah, Dennis

AU - Garg, Madhur K.

AU - Kalnicki, Shalom

PY - 2008/10

Y1 - 2008/10

N2 - Purpose: We correlated rectal and bladder point and volumetric dose data in patients treated for advanced cervix cancers with combined intracavitary-interstitial high-dose-rate (HDR) brachytherapy (BT). The results are compared with published Vienna applicator data. Methods and Materials: We retrospectively analyzed 30 individual combined intracavitary plus interstitial implants from 10 patients treated with external beam radiation therapy (EBRT) followed by HDR BT for locally advanced cervix carcinoma. EBRT consisted of 45 Gy to the pelvis followed by 9-14.4 Gy boost to involved parametria. BT consisted of a total dose of 21 Gy delivered in 7 Gy fraction. For each implant, CT-image-based simulation and image-guided BT treatment planning was performed. Bladder and rectal doses were evaluated and analyzed using both International commission on Radiation Units and Measurements (ICRU) reference points and dose-volume histograms. The cumulative doses to the rectum and bladder were calculated by combining contributions from external beam therapy and BT. To facilitate comparison with published literature, the total doses were normalized to equivalent dose in 2-Gy fractions (EQD2) using the equation EQD2total = EQD2EBRT + EQD2BT. Results: For the patient population considered, the mean ICRU bladder dose was 75 (±4) Gy3 compared to bladder D0.1 cc and D2 cc doses of 84 (±4) and 78 (±3) Gy3, respectively. The mean ICRU rectal dose was 73 (±4) Gy3 compared to rectal D0.1 cc and D2 cc doses of 79 (±5) and 74 (±4) Gy3, respectively. For rectum, the mean dose ratios (D0.1 cc/DICRU) and (D2 cc/DICRU) were 1.08 and 1.01, respectively, compared to Vienna applicator study mean dose ratios of 1.08 and 0.93, respectively. ICRU rectal dose correlated with volumetric rectal doses and best with volumetric D2 cc dose (rS = 0.91, p = 0.0003); however, ICRU bladder dose did not correlate with volumetric bladder dose. Conclusions: Our study findings reveal a strong correlation between ICRU rectal reference dose and volumetric rectal D2 cc dose in combined intracavitary-interstitial HDR brachytherapy. This surrogate rectal-dose relationship is valuable in establishing rectal tolerance dose levels in transitioning from traditional two-dimensional to image-based three-dimensional dose planning.

AB - Purpose: We correlated rectal and bladder point and volumetric dose data in patients treated for advanced cervix cancers with combined intracavitary-interstitial high-dose-rate (HDR) brachytherapy (BT). The results are compared with published Vienna applicator data. Methods and Materials: We retrospectively analyzed 30 individual combined intracavitary plus interstitial implants from 10 patients treated with external beam radiation therapy (EBRT) followed by HDR BT for locally advanced cervix carcinoma. EBRT consisted of 45 Gy to the pelvis followed by 9-14.4 Gy boost to involved parametria. BT consisted of a total dose of 21 Gy delivered in 7 Gy fraction. For each implant, CT-image-based simulation and image-guided BT treatment planning was performed. Bladder and rectal doses were evaluated and analyzed using both International commission on Radiation Units and Measurements (ICRU) reference points and dose-volume histograms. The cumulative doses to the rectum and bladder were calculated by combining contributions from external beam therapy and BT. To facilitate comparison with published literature, the total doses were normalized to equivalent dose in 2-Gy fractions (EQD2) using the equation EQD2total = EQD2EBRT + EQD2BT. Results: For the patient population considered, the mean ICRU bladder dose was 75 (±4) Gy3 compared to bladder D0.1 cc and D2 cc doses of 84 (±4) and 78 (±3) Gy3, respectively. The mean ICRU rectal dose was 73 (±4) Gy3 compared to rectal D0.1 cc and D2 cc doses of 79 (±5) and 74 (±4) Gy3, respectively. For rectum, the mean dose ratios (D0.1 cc/DICRU) and (D2 cc/DICRU) were 1.08 and 1.01, respectively, compared to Vienna applicator study mean dose ratios of 1.08 and 0.93, respectively. ICRU rectal dose correlated with volumetric rectal doses and best with volumetric D2 cc dose (rS = 0.91, p = 0.0003); however, ICRU bladder dose did not correlate with volumetric bladder dose. Conclusions: Our study findings reveal a strong correlation between ICRU rectal reference dose and volumetric rectal D2 cc dose in combined intracavitary-interstitial HDR brachytherapy. This surrogate rectal-dose relationship is valuable in establishing rectal tolerance dose levels in transitioning from traditional two-dimensional to image-based three-dimensional dose planning.

KW - Bladder

KW - Cervix

KW - ICRU reference dose

KW - Intracavitary-interstitial brachytherapy

KW - Rectum

KW - Volumetric dose

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U2 - 10.1016/j.brachy.2008.05.005

DO - 10.1016/j.brachy.2008.05.005

M3 - Article

C2 - 18782683

AN - SCOPUS:53349146617

VL - 7

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JO - Brachytherapy

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