Dosimetric feasibility of computed tomography-based image-guided brachytherapy in locally advanced cervical cancer: a Japanese prospective multi-institutional study

Author:

Otani Yuki12,Ohno Tatsuya3,Ando Ken34,Murata Kazutoshi3,Kato Shingo5,Noda Shin-ei5,Murofushi Keiko67,Ushijima Hiroki8,Yoshida Daisaku910,Okonogi Noriyuki11,Isohashi Fumiaki1,Wakatsuki Masaru11,Nakano Takashi12

Affiliation:

1. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka 565-0871, Japan

2. Department of Radiology, Kaizuka city hospital, 3-10-20 Hori, Kaizuka, Osaka, 597-0015, Japan

3. Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan

4. Department of Radiation Oncology, Gunma Prefectural Cancer Center, 617-1 Takabayashinishi-machi, Ota, Gunma 373-8550, Japan

5. Department of Radiation Oncology, Saitama Medical Univercity International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan

6. Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan

7. Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Honkomagome 3-18-22 Bunkyo, Tokyo 113-8677, Japan

8. Department of Radiation Oncology, Saitama Cancer Center, 780 Komuro, Ina, Kita Adachi-gun, Saitama 362-0806, Japan

9. Department of Radiation Oncology, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano 385-0051, Japan

10. Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan

11. QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan

12. Department of Molecular Imaging and Theranostics, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan

Abstract

ABSTRACT The aim of this study was to assess the feasibility of planning dose–volume histogram (DVH) parameters in computed tomography-based 3D image-guided brachytherapy for locally advanced cervical cancer. In a prospective multi-institutional study, 60 patients with stage IIA2–IVA cervical cancer from eight institutions were treated with external beam radiotherapy using central shielding and intracavitary or hybrid (combined intracavitary/interstitial) brachytherapy (HBT). The dose constraints were set as a cumulative linear quadratic equivalent dose (EQD2) of at least 60 Gy for high-risk clinical target volume (HR-CTV) D90, D2cc ≤ 75 Gy for rectum, D2cc ≤ 90 Gy for bladder and D2cc ≤ 75 Gy for sigmoid. The median HR-CTV D90 was 70.0 Gy (range, 62.8–83.7 Gy) in EQD2. The median D2cc of rectum, bladder and sigmoid was 57.1 Gy (range, 39.8–72.1 Gy), 68.9 Gy (range, 46.5–84.9 Gy) and 57.2 Gy (range, 39.2–71.2 Gy) in EQD2, respectively. In 76 of 233 sessions (33%), 23 patients underwent HBT, and the median number of interstitial needles was 2 (range, 1–5). HBT for a bulky HR-CTV (≥40 cm3) significantly improved the HR-CTV D90 compared with intracavitary brachytherapy alone (P = 0.010). All patients fulfilled the dose constrains for target and at risk organs by undergoing HBT in one-third of sessions. We conclude that the planning DVH parameters used in our protocol are clinically feasible.

Funder

JSPS KAKENHI

Japan mHDR Research Fund

Publisher

Oxford University Press (OUP)

Subject

Health, Toxicology and Mutagenesis,Radiology Nuclear Medicine and imaging,Radiation

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