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• W2094083054 abstract "The dose received by normal tissues in the pelvis can vary considerably from fraction to fraction over the course of vaginal cuff high-dose-rate (HDR) brachytherapy. A number of factors may contribute to this variation, namely, changes in bladder and rectum filling, inconsistencies in patient orientation, i.e., rotation/tilt of the pelvis, and differences in cylinder position within the vagina. The aim of this study is to investigate the effect of the different geometric variables on the interfractional dosimetric parameters in normal tissues. 5 endometrial cancer patients undergoing postoperative adjuvant HDR vaginal cuff brachytherapy (VB) were studied. The median prescribed VB dose was 18 Gy (range, 18–37.5) in 3–5 weekly fractions prescribed and optimized to the surface of 2.5–3.5 cm vaginal cylinder. CT simulation was performed before each VB. In total, 15 planning CT scans were acquired. For each scan, a geometric method was used to quantify the location of the superior end of the vaginal cylinder relative to the pelvis. In order to create an anatomically aligned coordinate system, 3 points were chosen on the pelvis-- the right and left anterior-superior-iliac-spine and the right posterior-superior-iliac-spine. These points were then used to form a plane. The perpendicular distance from this plane to the tip of the cylinder was calculated to obtain the position of the cylinder for each treatment. Dose-volume histograms (DVH) were generated for the organs at risk (OAR); bladder, rectum, and rectosigmoid, and were individually evaluated for each cylinder position. There was a noticeable difference in the position of the cylinder for each patient as well as for each fraction within a given treatment. The calculated distances ranged from 3.29 cm–8.63 cm. Additionally, large variations in doses to OAR were observed for each cylinder position. The maximum relative dose to the bladder ranged from 46.9– 212.9% of the prescribed dose. The max relative dose to the rectum was between 60.8% and 114.1%, and for the rectosigmoid, the range of relative max doses was 13.5–127.8%. An assessment of the relative average dose to the nearest 1cc3 volume of bladder, rectum, and rectosigmoid also showed significant variation. These doses ranged from 34.2–92.9%, from 16–87.4%, and from 9.6–77.8% to the bladder, rectum and rectosigmoid, respectively. These preliminary data show a large variation in doses to the bladder, rectum and rectosigmoid for VB utilizing CT planning. Interfraction vaginal cylinder placement inconsistencies and variable rectal and bladder fillings can potentially cause high variability in dosimetric parameters to surrounding OAR. Additional patient data will be included in the final analysis." @default.
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• W2094083054 date "2009-11-01" @default.
• W2094083054 modified "2023-10-16" @default.
• W2094083054 title "Interfraction Geometric and Dosimetric Variations in Vaginal Cuff High Dose-rate Brachytherapy using CT Based Planning: A Prospective Study" @default.
• W2094083054 doi "https://doi.org/10.1016/j.ijrobp.2009.07.874" @default.
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