scholarly journals A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

2021 ◽  
Author(s):  
Dunhuang Wang ◽  
Weiping Wang ◽  
Xiaoliang Liu ◽  
Kang Ren ◽  
Yongguang Liang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Target Volume ◽  
Locally Advanced ◽  
Target Volume ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

scholarly journals The Relationship Between Late Morbidity and Dose–Volume Parameter of Rectum in Combined Intracavitary/Interstitial Cervix Cancer Brachytherapy: A Mono-Institutional Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Ning Zhang ◽  
Ying Liu ◽  
Dongmei Han ◽  
Xin Guo ◽  
Zhuang Mao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
At Risk ◽  
Clinical Target Volume ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Probit Model ◽  
Target Volume ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Dose Volume

PurposeTo establish a dose volume–effect relationship for predicting late rectal complication (LRC) in locally advanced cervical cancer patients treated with external beam radiotherapy (EBRT) followed by combined intracavitary/interstitial brachytherapy (IC/IS-BT).Materials and MethodsA retrospective analysis was performed in 110 patients with locally advanced cervical cancer who underwent definitive radiotherapy combined with IC/IS-BT from July 2010 to September 2018. We report the 90% of the target volume receiving the minimum dose for high risk clinical target volume (HR-CTV D90) and intermediate risk clinical target volume (IR-CTV D90), and the minimum doses to the most exposed 0.1, 1, and 2 cm³ D0.1cm3,D1cm3,D2cm3 doses at the International Commission on Radiation Units and Measurements (DICRU) for organs at risk (OARs). The total dose of EBRT plus brachytherapy was transformed to the biologically equivalent dose in 2 Gy fractions (EQD2) with α/β value of 10 Gy for target, 3 Gy for organs at risk using the linear quadratic model. The morbidity was scored according to the Radiation Therapy Oncology Group (RTOG) criteria. The Probit model was used to establish a prediction model on rectum between the organs at risk for dose and LRC. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of dose volume parameters for LRC.ResultsThe median follow-up time was 72.3 months. The mean ( ± standard deviation) D2cm3,D1cm3,D0.1cm3, and DICRU values of rectum were 64.72 ± 7.47 GyEQD2, 70.18 ± 5.92 GyEQD2, 79.32 ± 7.86 GyEQD2, and 67.22 ± 7.87 GyEQD2, respectively. The Probit model showed significant relationships between D1cm3 or D0.1cm3, and the probability of grade1–4, grade 2–4 rectal events at 1 year, and between D1cm3and the probability of grade2–4 rectal events at 3 and 5 years. The dose values for 10% complication rates (ED10) of D1cm3were 74.18 (70.42–76.71) GyEQD2, 67.80 (59.91, 71.08) GyEQD2, 66.37 (52.00, 70.27) GyEQD2 for grade 2–4 with rectal morbidity at 1, 3, and 5 years, respectively.ConclusionOur study proved that D1cm3 andD0.1cm3were considered as useful dosimetric parameters for predicting the risk of grade1–4 and grade2–4 LRC at 1-year, and D1cm3might be an indicator for predicting grade2-4 LRC at 3/5years. The patients with rectal D1cm3>66.37–74.18 GyEQD2 should be closely observed for grade2–4 LRC.

scholarly journals Reduction of dose to duodenum with a refined delineation method of Para-aortic region in patients with locally advanced cervical Cancer receiving prophylactic extended-field radiotherapy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bo Yang ◽  
Xiaoliang Liu ◽  
Ke Hu ◽  
Jie Qiu ◽  
Fuquan Zhang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Irradiation Dose ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Vena Cava ◽  
Target Volume ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Extended Field

Abstract Background To compare irradiation dose to the second and third portions of duodenum (Duo2 and Duo3) with a new refined and old delineation method of para-aortic region for patients with locally advanced cervical cancer (LACC) receiving prophylactic extended-field radiotherapy (EFRT). Methods Twenty consecutive patients with LACC were treated with prophylactic EFRT from January 2016 to January 2017 at our institute. Two delineation methods of para-aortic region were designed for each patient, the old delineation method ensured a full coverage of aortic and inferior vena cava, while the right paracaval region above L3 was omitted from CTV in the new delineation method. Patients received a dose of 50.4Gy in 28 fractions for PCTV and a dose of 60.2Gy in 28 fractions for PGTV with volumetric-modulated arc therapy (VMRT). The dose delivered to Duo2 and Duo3 with these two delineation methods were compared. Results All treatment plans achieved excellent target volume coverage with 95% of PCTV receiving 50.4Gy and 95% of PGTV receiving 60.2Gy. There was no difference between delineation methods in low dose level (V5, V10, V15, V20, V25) for Duo2 and Duo3. The V30, V35, V40, V45, V50, Dmax, Dmean and D2cc for Duo2 with the new and old delineation methods were 55.76% vs 80.54% (P = 0.009), 34.72% vs 70.91% (P < 0.001), 18.69% vs 55.46% (P < 0.001), 8.20% vs 41.49% (P < 0.001), 1.86% vs 21.60% (P < 0.001), 49.58Gy vs 52.91Gy (P = 0.002), 30.38Gy vs 39.22Gy (P = 0.001) and 37.90Gy vs 48.64Gy (P < 0.001) respectively. For Duo3, the new delineation method achieved significant advantages in V30, V35, V40, V45, V50 and Dmean over the old one (96.82% vs 99.25%, P = 0.021; 89.65% vs 97.21%, P = 0.001; 79.50% vs 93.18%, P < 0.001; 65.63% vs 82.93%, P < 0.001; 43.39% vs 65.60%, P < 0.001; 46.09Gy vs 49.24Gy, P < 0.001), no deference was observed regarding D2cc and Dmax with these two delineation methods. Conclusion With the new delineation method of para-aortic area in prophylactic EFRT, significant reduction of irradiation dose to the second and third portions of duodenum in high dose area was obtained. This may further lower the incidence of duodenal toxicity when performing prophylactic EFRT for patients with LACC.

scholarly journals THE ROLE OF HYBRID BRACHYTHERAPY IN MANAGEMENT OF LOCALLY ADVANCED CERVICAL CANCER: DOSIMETRIC STUDY AND INITIAL RESULTS

2021 ◽  
Vol 9 (01) ◽  
pp. 931-940
Author(s):  
M. Hommadi ◽  
◽  
H. Bakkali ◽  
O. Houessou ◽  
M. Benlemlih ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Residual Disease ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Target Volume ◽  
Intracavitary Brachytherapy ◽  
Preliminary Treatment ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Study Plan

Purpose: The aims of this study were to investigate the clinical feasibility and to report our preliminary treatment outcomes of combined intracavitary/interstitial brachytherapy (IC/IS BT), using a hybrid applicator and magnetic resonance imaging (MRI)based treatment planning in patients with locally advanced cervical cancer. Materials and Methods: Between January 2017 and December 2018, eight patients with locally advanced uterine cervical cancer were treated with primary radiation therapy including hybrid BT. Patients with distant metastasis other than para-aortic lymph node spread were excluded from this study. A hybrid applicator for guidance of parametrial needles was used to perform highdoseratebrachytherapy (HDR BT) with MRIbased treatment pre-planning. Parametrial extent of the disease or large residual disease in these patients was judged to exceed the coverage limit of intracavitary brachytherapy alone. The number of needles, chosen guiding holes through the ovoids, and insertion depths were based on the extent of residual disease. We investigated the dosimetric gain by comparing the clinical IC/IS optimized plan (IC/IS clinical) with an additionally generated optimized plan without needle use (ICstudy). Results: The clinical use of the hybrid applicator system proved to be feasible in all 32 treatment fractions. The applicator Fletcher interstitial 6mm or Utrecht interstitial consists of the IC tandem and two ovoids thatserves as a template for needle insertion. MRI preplanning was performed the week before the implant in 5 cases and the day ofapplication with applicator in place in 3 cases. Four to eight needles were placed per fraction, and overall a total of 152 needles were used. Significant differences in (IC/IS) plan and (IC study) plan were derived for dose application to the target volume D90 high-riskclinical target volume (D90 CTV HR) was 90.1Gy in (IC/ISclinical) plan vs 85.36 Gy in (IC study) plan with an average gain of 4.74 Gy. Likewise, sparing of organs at risk (OAR) differed significantly for bladder D2cc:82,5 Gy(IC/ISclinical) vs95.7 Gy (IC study) and rectum D2cc: 65,5 Gy (IC/ISclinical) vs 67.8 Gy (IC study).With an average follow-up of 27,25 months (range 18–34 months): no patient experienced local relapse, three patients experienced distantmetastasis two of them died, no acute complications such as bleeding or organ penetration occurred due to needle placement, one patient developed recto-vaginal fistula. Conclusions: Our preliminary clinical experience indicates that combined intracavitary and interstitial MRI based brachytherapy in patients with significant residual disease extending up to the distal third of parametriaafter externalbeam therapy is feasible and allows excellent local control and a low rate of morbidity.

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