Toxicity Outcome Using Bladder-Rectum Spacer Balloon Versus Vaginal Gauze Packing in Brachytherapy in Cervical Cancer.

Abstract BACKGROUNDTo compare the clinical impact in terms of toxicity outcomes with RayshieldTM bladder rectum spacer balloon (BRSB) versus vaginal gauze packing (VGP) in patients treated with high dose rate intracavitary brachytherapy for carcinoma cervix.RESULTSFollow-up and dosimetric data of patients in whom BRSB and VGP were used in a previously reported randomized study were retrieved, 8. Out of 80 patients analysed, late toxicities assessment (according to Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). was possible in 65 patients as 14 patients were lost to follow-up and one patient died. Grade 2 bladder toxicity was observed in 2 patients in each arm. Only 1 patient in VGP arm experienced grade 3 proctitis while none of the patient in BRSB arm had ³Grade 2 rectal toxicity. Vaginal toxicity was comparable in both the arms.CONCLUSION No significant difference was observed in bladder and rectal toxicities using the BRSB versus VGP. BRSB can be considered as an alternative to VGP in intracavitary brachytherapy for cervical cancer using tandem- ovoid applicatorsThe study was approved by the institute ethics committee and registered under Clinical Trial Registry of India (CTRI/2009/091/000840).

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Impact of different treatment plans on EQD2 for intracavitary brachytherapy of cervical cancer

Journal of the Egyptian National Cancer Institute ◽

10.1186/s43046-021-00084-2 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Osman Vefa Gul ◽

Gokcen Inan ◽

Hamit Basaran

Keyword(s):

Cervical Cancer ◽

Small Intestine ◽

Organs At Risk ◽

External Beam Radiotherapy ◽

High Dose Rate ◽

Intracavitary Brachytherapy ◽

High Dose ◽

Dose Volume Histograms ◽

Significant Difference ◽

Treatment Plans

Abstract Background Cancer is one of the leading causes of death worldwide. According to GLOBOCAN estimates, there were 341,831 deaths from cervical cancer in 185 countries in 2020. The aim of this study was to compare equieffective dose (EQD2) at 2 Gy per fraction by using dose volume histograms (DVHs) derived from external beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR-BRT) treatment plans used in cervical cancer radiotherapy. Methods Fifteen patients with stage IIB-IIIB cervical cancer were included in this retrospective study. Treatment with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) was planned for all patients in 28 fractions, with a total of 50.4 Gy to be delivered to the whole pelvic region. After EBRT, manual optimization (MO) or inverse optimization (IO) HDR-BRT plans were created in 4 fractions with a total of 28 Gy. The plans obtained were grouped as IMRT + IO, IMRT + MO, 3DCRT + IO, and 3DCRT + MO by calculating EQD2s among these plans. D90, D95, and D98 values were compared in all plans for CTVHR total EQD2. In addition, EQD2 values for critical organs at risk (OARs) such as rectum, bladder, small intestine, and sigmoid were compared in all plans for volumes of 2 cm3, 1 cm3, and 0.1 cm3, respectively. Results There was no significant difference between the treatment groups in terms of CTVHR D90 and CTVIR D90 values; However, CTVHR D95 (p = 0.000) and CTVHR D98 (p = 0.000) values were found to be better in IMRT + IO technique. The IMRT + IO technique provided better protection for 2 cm3, 1 cm3, and 0.1 cm3 volumes of OARs compared to other techniques. Conclusions Considering all parameters such as CTVHR, CTVIR, rectum, bladder, small intestine, and sigmoid, combination of IMRT + IO treatment option was found to be significantly superior in total EQD2 calculations compared to other plans.

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