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Objective: Cervical carcinoma is one of the leading causes of cancer-related deaths. This study evaluates improvement of quality of life, response to treatment, and compliance of concurrent weekly cisplatin with intracavitary brachytherapy (ICRT) in patients with cervical carcinoma, pre-treated with concurrent chemo- radiotherapy. Materials and Methods: This study was conducted in the Department of Radiotherapy, Government Medical College, from October 2018 to March 2020, meeting specified inclusion and exclusion criteria; patients willing to participate in the study were included. Results: On analyzing the pattern of response, 91.0% of patients have a complete response. The incidence of nausea and vomiting was observed at grade 1 or 2 in 80.0% of patients, grade 3 in 17.0% of patients, and more than grade 3 in 3.0% of patients. Neutropenia is occurred at less than grade 3 in 30.0% of patients and grade 3 or more in 3.3% of patients. Vaginal mucositis was also observed in 85.0% of the patients in less than grade 3 and 11.6% in grade 3 or more. The incidence of renal dysfunction less than grade 3 was seen in 35.0% of the patients and grade 3 or more in 5.0% of the patients. After 6months, there was cystitis found in less than grade 3 in 10.0% of the patients and more than grade 3 in 3.3% of the patients. Conclusion: In locally advanced squamous cell carcinoma of the uterine cervix, the addition of concurrent injection of cisplatin to ICRT significantly improves locoregional response but increases the incidence of hematological and mucosal toxicity, which is manageable.
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Objective:Investigate the safety and feasibility of using the new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, and to explore the clinical value of the self-designed implanting applicator.Methods:Sixty-two gynecological cancer patients who underwent brachytherapy in Sun Yat-sen University Cancer Center were selected in this study. Each patient received three-dimensional intracavitary brachytherapy because of the indication of postoperative radiotherapy. Each patient was treated with different types of self-designed implanting applicators according the condition of postoperative vagina,and the vaginal tube and implant needle were placed in the template according to the preset channnel. Based on the actual CT images, the high-risk clinical target volume (HR-CTV), and organs at risk were defined according to unified target area delineation criteria and then the brachytherapy plan was conducted. The prescription dose of high-risk clinical target volume (HR-CTV) was 5.5 Gy/time. The parameters such as target area, organs at risk volume and irradiated dose were evaluated by DVH diagram.Results:Sixty-two patients successfully completed brachytherapy under the guidance of self-designed implanting applicator. A total of 140 implantation treatments were performed. The total average dose of HR-CTV D90% was (575.48±22.30) cGy, the mean dose D 2cm3 of bladder, rectum and sigmoid colon were (328.69±102.71), (369.14±46.59) and (27.28±71.27) cGy, the small intestine did not drop the target area, so there was no statistics. There was statistical significance between target volume and organs at risk dose ( P<0.05). Conclusions:The new self-designed implanting applicator has obvious clinical advantages in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, meets the requirements of the preset planning dose,and it is sample to operate and highly safe,which indicated a bright future of the clinical application.
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Cervical cancer is a common female reproductive system malignant in developing countries. Radiotherapy plays a very important role in the treatment of cervical cancer, and brachytherapy is an essential part of cervical cancer radiotherapy. With the rapid development of CT and MRI imaging technology, brachytherapy cervical cancer has gradually developed from the traditional two-dimensional image-guided technology to three-dimensional image-guided technology. There are more and more treatment methods, including intracavitary brachytherapy, interstitial brachytherapy and intracavitary/interstitial brachytherapy. This paper reviews several common techniques of three-dimensional brachytherapy for cervical cancer, and discusses the dosimetric feasibility of internal and external integration irradiation.
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@#This is a retrospective study, the organ doses of the bladder and the rectum were compared between routine PLATO V14.2.3 (Nucletron B.V., Veenendaal, The Netherlands) and newer version software Oncentra MasterPlan (OMP) V4.3 (Nucletron B.V., Veenendaal, The Netherlands) treatment planning systems (TPS). The treatment data of 32 intracavitary brachytherapy patients at Hospital Universiti Sains Malaysia from January 2010 to June 2015 were used. These data sets were used for catheter reconstruction for both PLATO and OMP TPS followed by independent verification using Excel. There was no significant difference in mean doses to organs at risk (OARs) that calculated by both TPS (p>0.05). The mean percentage of doses calculated by PLATO TPS for bladder and rectum were 66.58 ± 27.42% and 46.27 ± 14.47%, respectively. While, the mean percentage of doses for bladder and rectum calculated by OMP TPS were 65.68 ± 24.24% and 46.46 ± 16.66%, respectively. The mean percentage difference in doses comparison between independent verification calculation and PLATO TPS was 1.96 ± 6.00% and then became 6.37 ± 5.17% when it was compared with OMP TPS. Overall, the dose calculation differences for both versions of TPS were within the range recommended by Nuclear Regulatory Commission (NRC). The dose calculations of the two treatment planning systems showed good agreement and both could be used in planning intracavitary brachytherapy for cervical cancer. Whereas, Excel based independent verification is suitable to be implemented as routine dose verification programme prior to treatment delivery.
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Purpose: High Dose Rate (HDR) remote afterloading brachytherapy machine and advanced treatment planning system have made it possible to make variations in individual dwell times across a catheter according to tumour density and for sparing normal structures. New inverse planning technique such as Inverse Planning Simulated Annealing (IPSA) has also been introduced. But very few institutions are venturing towards volume based IPSA optimised intracavitary brachytherapy. This study focuses on dwell time deviation constraint (DTDC) feature of IPSA based optimization which restricts the large variation of dwell time across the catheter. Methods and Material: For this retrospective study we have generated IPSA optimised intracavitary brachytherapy plans for 20 cancer cervix applications. The initial DTDC value of each IPSA plan was kept 0.0. Later on gradual increment was made in DTDC values in step of 0.2. Plan modulation index (M) defined by Ryan L. Smith et al was used for characterising the variation of dwell time modulation with respect to gradual increase in DTDC parameter. Results: Plan modulation index gradually decreases with increasing value of DTDC from 0.0 to 1.0. There was the 83% decrease in M value from IPSA of DTDC 0.0 to fully constrained IPSA of DTDC1.0. There is reduction of 8.26% and 6.95% for D2cc values of rectum and bladder respectively for DTDC 1.0 compared to DTDC 0.0. Conclusions: One of the benefits of applying DTDC constrained in IPSA plan is that, it removes local hot spots. It's another advantage is the reduction in rectum and bladder dose.
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Introduction: Variation of doses due to positional uncertainties of applicators based on orthogonal radiograph has been evaluated by several researchers. The present study has analyzed the various possibilities of special alterations of applicator placements in intracavitary brachytherapy (ICBT) and its impact on the dose to target volume, rectum, and bladder. An innovative approach has been suggested to quantify and utilize the special coordinates for reproducibility of applicator based on the pelvic bone landmark. Materials and Methods: A total of 27 fractions of 9 (n = 9) cancer cervix patients treated with external beam radiotherapy followed by ICBT have been evaluated retrospectively. The first fraction of each patient was planned as per the International Commission on Radiation Units and Measurements report 38 guidelines and was considered reference for consecutive fractions regarding dwell positions, dose to target volume, bladder, and rectum points. For each fraction, positioning of applicators regarding their spatial orientations with respect to pelvic bone landmarks and their correlation with dose to bladder and rectum was recorded and analyzed. Results: It was found that mean angulations between (1) the two applicator points with respect to tip of central tandem (α), (2) the two applicator points with junction point situated on the sacrum bone (β) and (3) the angle between the line joining applicator points and a point defined on pelvic bone (γ) is 62.20° ± 5.74°, 37.13° ± 5.64° and 105.51° ± 6.58°, respectively. Bladder dose increased with increment in α but decreased with increase of β and γ. Dose to rectum remained unaffected for γ. Mean distance from couch top to tip of central tandem and two ovoids is, respectively, 11.17 cm and 8.70 cm. Conclusion: Optimal plans even with orthogonal radiographs may be generated by verifying the application based on the parameters mentioned in the present study and computed tomography-based plans could be utilized more effectively instead of doing automatic or manual optimization. Whereever orthogonal radiograph based or template based ICBT practices is performed this study may create a dataset to have an optimal treatment plan even without three-dimensional images
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Background: The distension of the bladder during intracavitary brachytherapy (ICBT) affects the applicator position and in turn the dose to tumour and normal structures. Aims and Objectives: To quantify the changes in the dose to high risk clinical target volume (HRCTV) and organs at risk (OARs) due to bladder filling. Methods and Materials: In this prospective study, dosimetric parameters of 40 cervical cancer patients treated with (ICBT) were studied. Two sets of CT images with empty and bladder filled with 100 ml of contrast were used for analysis of doses to HRCTV and organs at risk OARs. The distance between posterior wall of the bladder and reference point on the flange was recorded in X,Y and Z. Results: Target coverage between bladder distension and empty bladder was 84.15 vs 84.85 % (P=0.003) respectively. Mean dose to bladder was 1.57vs 2Gy (P=0.000), median dose was 6 vs7.25Gy (P=0.000), D5cc was 3.94 vs 4.17 Gy (P=0.103) and D2cc was 4.5 vs 5 Gy (P=0.01) respectively. The doses to rectum was D2cc - 3.76 vs 4.07Gy (P=0.000), Sigmoid was D2cc - 2.18 vs 2.43Gy (P=0.005), bowel D2cc was 2.81 vs 3.43Gy (P=0.000). The mean distance of the posterior wall of the bladder from reference point was 0.042 vs -0.079cm (P=0.391) in the X-axis, -0.618 vs -0.630cm (P=0.603) in Z-axis and 0.19 vs 0.26cm (P=0.009) in the Y-axis between two status of the bladder. Conclusions: Smaller volume of bladder receive higher dose and larger volumes a lower dose with bladder distension, while dose is same for rectum, sigmoid and bowel. The applicators shift posteriorly when the bladder is distended
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Cervical cancer is one of the leading causes of cancer-related deaths in developing countries. Between 80% and 90% of cervical carcinomas are squamous cell carcinomas. Concurrent chemo radiation with Inj. Cisplatin given every week followed by intracavitary Brachytherapy has become the standard of treatment in locally advanced cervical carcinoma Methods: 60 biopsy proven cases of locally advanced cervical cancer attending the Out Patient Department of Radiotherapy from November 2017 to April 2019, meeting specified Inclusion and Exclusion Criteria, willing to participate in the study were included. Acute toxicities and locoregional control were assessed using the common terminology criteria for adverse events (CTCAE) version 4.0. During treatment patients will be reviewed weekly. After treatment completion, patients will be reviewed monthly for six months. And after that, they will be reviewed every 3 months for 9 months. Results: The median age was 50 years (range: 40–60 years) in both the arms. On analysing the pattern of response, in Arm A the number of patients having complete response was 29 (96.66%), partial response was 1 (3.34%). In the Arm B all patients have complete response. The incidence of Emesis, Dermatitis, Neutropenia, and Vaginal Mucocytis were more in Arm B as compared to Arm A. Conclusion: In locally advanced squamous cell carcinoma of uterine cervix, addition of concurrent injection Cisplatin to ICRT did not significantly improve loco regional response but increases incidence of haematological and mucosal toxicity, which being manageable, were not associated with increased mortality.
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Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
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Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
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Objective To study the dosimetric peculiarity of 3D intracavitary brachytherapy in the application of endometrial carcinoma comparing with traditional 2D plans. Method 39 3D brachytherapy treatment plans of 11 patients with endometrial carcinoma were retrospectively analyzed with re?planning 2D treatment plan, the dose volume histogram ( DVH) parameters such as the target dose volume parameters V150 and D90 , the 2?cc doses to organs such as bladder, small intestine, rectum and sigmoid and the total reference air kerma TRAK were analyzed. The differences between the two groups are compared by paired samples T test. Results For target with V<60 cm3 ,there is no statistically significant difference between 2D and 3D plans,the D90 is (551?17±90?33) cGy and (574?15±117?18) cGy,respectively (P=0?390). As the increase of target volume,the D90 came to be significantly different ( P=0?001) , high dose region V150 for 3D and 2D plans is (51?05±21?61) cm3 and (53?41±11?71) cm3, respectively (P=0?482). With the target volume larger than 60 cm3 ,compare to 2D plans, the 3D plan can increase the target coverage as well as OAR dose except for small intestine ( P=0?128) . In addition, with different plan mode,the BMI did not affect the crisis organ dose such as rectum, small intestine, bladder and sigmoid, the P value is 0?239, 0?198,0?744 and 0?834,respectively. Conclusions For endometrial carcinoma,compared with traditional two?dimensional plans,the 3D brachytherapy treatment plans can significantly improve the target coverage and avoiding overdose of organs, clinical curative effect and side effect still needs further observation.
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OBJETIVO: Avaliar uma alternativa de braquiterapia para tumores do colo uterino acometendo a porção distal da vagina, sem aumentar os riscos de toxicidade. MATERIAIS E MÉTODOS: Estudo teórico comparando três diferentes aplicadores de braquiterapia intracavitária de alta taxa de dose: sonda intrauterina e cilindro vaginal (SC); sonda e anel associado ao cilindro vaginal (SA+C) e um aplicador virtual com sonda, anel e cilindro vaginal em um único conjunto (SAC). Foram prescritas doses de 7 Gy no ponto A e 5 Gy na superfície ou a 5 mm de profundidade na mucosa vaginal, mantendo as doses nos pontos de reto, bexiga e sigmoide abaixo dos limites de tolerância. Foram comparados os volumes englobados pelas isodoses de 50 por cento (V50), 100 por cento (V100), 150 por cento (V150) e 200 por cento (V200), respectivamente. RESULTADOS: Tanto SA+C quanto SAC apresentaram melhor distribuição de dose quando comparados ao aplicador SC. A distribuição de dose obtida com SA+C foi semelhante à do aplicador SAC, sendo V150 e V200 cerca de 50 por cento maiores para SA+C, todavia, dentro do cilindro. CONCLUSÃO: A utilização de SA+C em uma única aplicação em dois tempos pode ser uma alternativa de tratamento para pacientes que apresentam tumores de colo uterino com acometimento distal da vagina.
OBJECTIVE: To evaluate an alternative brachytherapy technique for uterine cervix cancer involving the distal vagina, without increasing the risk of toxicity. MATERIALS AND METHODS: Theoretical study comparing three different high-dose rate intracavitary brachytherapy applicators: intrauterine tandem and vaginal cylinder (TC); tandem/ring applicator combined with vaginal cylinder (TR+C); and a virtual applicator combining both the tandem/ring and vaginal cylinder in a single device (TRC). Prescribed doses were 7 Gy at point A, and 5 Gy on the surface or at a 5 mm depth of the vaginal mucosa. Doses delivered to the rectum, bladder and sigmoid colon were kept below the tolerance limits. Volumes covered by the isodoses, respectively, 50 percent (V50), 100 percent (V100), 150 percent (V150) and 200 percent (V200) were compared. RESULTS: Both the combined TR+C and TRC presented a better dose distribution as compared with the TC applicator. The TR+C dose distribution was similar to the TRC dose, with V150 and V200 being about 50 percent higher for TR+C (within the cylinder). CONCLUSION: Combined TR+C in a two-time single application may represent an alternative therapy technique for patients affected by uterine cervix cancer involving the distal vagina.
Subject(s)
Humans , Brachytherapy , Dosimetry , Uterine Cervical Neoplasms/radiotherapy , Uterine Cervical Neoplasms/therapy , Brachytherapy/instrumentation , Combined Modality Therapy , Radiotherapy DosageABSTRACT
Commercially available rectal retractors can be used in high dose rate intracavitary brachytherapy (HDR ICR) as one of the methods for reducing the rectal dose in radiotherapy for a uterine cervical cancer. However, the extent of the rectal protection achieved using these rectal retractors has not been reported. The aim of the study was to examine the effect of a rectal retractor on reducing the rectal dose in HDR ICR. Thirty patients were treated with HDR ICR using rectal retractors. Tandem and ovoids were applied in 15 patients and ovoids only were used in the other 15 patients. During the simulation, the rectum was filled with barium, and anteroposterior and lateral radiographs were then taken with and without the rectal retractor. Along the anterior rectal wall outlined, 4 to 8 points (median 6) were chosen to calculate the dose for each patient including the rectal point (RP), which is an author-defined rectal point modified from the definition of the rectal reference point in the ICRU report 38. The length of the measured rectum was 3-7 cm (median 5 cm). The bladder point (BP) dose was measured as recommended by the ICRU. The prescription doses to point A varied from 3.5 to 5 Gy (median 4 Gy). Paired comparisons were made on the individual patients by calculating the normalized mean doses of the RP, the maximal point (MP), and the longitudinal average (LA) with and without the rectal retractor. The doses to the bladder points (BP) were also calculated in parallel to the rectal points. The anterior rectal walls were displaced posteriorly after inserting the rectal retractor. In the tandem and ovoids group, the number of patients with a reduced dose in the RP, MP and LA were 14 (93.3%), 12 (80.0%) and 13 (86.7%), respectively. In the ovoids only group, the corresponding figures were 14 (93.3%), 14 (93.3%) and 14 (93.3%). In the tandem and ovoids group, the reduced dose in the RP, MP, and LA dose were 0.52 Gy (13.0%), 0.50 Gy (12.5%), and 0.39 Gy (9.8%), respectively (p 0.05). The mean RP, MP, and LA dose reduction rates of the patient subgroup where the RP dose was 70%. The effect of the rectal dose reduction was significant only in the subgroup of patients who received > 70% of the prescription dose (p < 0.05). The use of the rectal retractor was a simple and an effective method for reducing the rectal dose. It was also considered to be a highly reproducible method, which can replace the time-consuming vaginal gauze packing in HDR-ICR.
Subject(s)
Female , Humans , Brachytherapy/instrumentation , Uterine Cervical Neoplasms/radiotherapy , Radiotherapy Dosage , Rectum , Surgical Instruments , VaginaABSTRACT
Objective To evaluate the clinical curative effect and methods for recurring NPC with treatment of intracavitary radiotherapy after interventional chemotherapy. Methods 32 cases of recurring NPC were divided into two groups, each of which consisted of 16 cases. Group one was treated with intracavitary chemotherapy plus intracavitary radiotherapy. On the third day after interventional chemotherapy, the first intracavitary radiotherapy was performed (5 Gy) and the second treatment was done next day. Group two was only performed with intracavitary radiotherapy. The dose and interval were the same. The time of re examination was two weeks later. Results In the first group, clinical symptoms were improved, local swelling lymph nodes were shrunk, secretion on the nasopharyngeal surface was hardly left or disappeared. Tumours were shrunk and atrophy. On the intracavitary radiotherapy group, clinical symptoms changed a little, except the secretion on the mass surface was reduced. The white blood counts of the two groups showed no difference and there were no functional changes of liver, kidney and digestive system in the interventional group. Conclusions It is a new and effective therapy to treat recurring NPC with interventional chemotherapy plus intracavitary radiotherapy.
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Objective To study the therapeutic effect and complication of external beam radiotherapy (EBR) plus intracavitary brachytherapy (IB) on nasopharyngeal carcinoma(NPC). Methods 52 patients with stage T 1,T 2 NPC were divided into two groups, 26 patients treated by EBR and the other 26 patients treated by EBR plus IB (combined radiotherapy group). IB was given to the patients of combined radiotherapy group when the external radiotherapy dose amounted to 40Gy,50Gy and 60Gy, respectively. Results The 3-year local control rates of combined radiotherapy group and EBR group were 100% and 73.08%, respectively (P0.05). Conclusions External beam radiotherapy combined with intacavitary brachytherapy for stage T 1, T 2 NPC may rise the local control rates, and reduce the exteral beam radiation dose and the complication.