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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2020
vol. 12
 
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abstract:
Original paper

Adjuvant vaginal cuff brachytherapy: dosimetric comparison of conventional versus 3-dimensional planning in endometrial cancer

Melis Gultekin
1
,
Melek Tugce Yilmaz
1
,
Fatih Biltekin
1
,
Deniz Yuce
2
,
Sezin Yuce Sari
1
,
Fadil Akyol
1
,
Ferah Yildiz
1

  1. Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  2. Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
J Contemp Brachytherapy 2020; 12, 6: 601–605
DOI: https://doi.org/10.5114/jcb.2020.101694
Online publish date: 2020/12/18
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Purpose
To evaluate dosimetric differences between point-based 2-dimensional (2D) vaginal brachytherapy (VBT) treatment planning technique and volume-based 3-dimensional (3D) VBT method for endometrial cancer (EC).

Material and methods
Ten patients with uterine-confined EC treated with VBT were included in this study. All patients received 27.5 Gy in 5 fractions. Three different treatment plans were performed for each patient: plan A for dose prescribed to the entire vaginal wall thickness delineated via computed tomography guidance, plan B for dose prescribed to the vaginal mucosa/cylinder surface, and plan C for dose prescribed to 5 mm beyond the vaginal mucosa/cylinder surface. Dose-volume histograms (DVH) of treatment volumes and organs at risk (OARs) were evaluated and compared.

Results
DVH analysis of target volume doses (D100, D95, and D90) showed a significant difference between plan A and plan B (p = 0.005), and plan B was found lower. D100 for plan C was significantly higher than plan A (p = 0.009), but for D95 and D90, no statistically significant difference was found (p = 0.028 and p = 0.028, respectively). In terms of OARs doses, including vagina, rectum, bladder, and sigmoid, D2cm3 doses were significantly higher in plan A than plan B (p = 0.009, p = 0.009, p = 0.005, and p = 0.005, respectively). All these doses were also significantly lower than in plan C (p = 0.005, p = 0.012, and p = 0.013, respectively), except for sigmoid (p = 0.155).

Conclusions
In this dosimetric analysis, we have shown that the volume-based 3D VBT technique provides the ability to balance the target dose against the sparing of OARs. Therefore, in the new modern 3D treatment era, instead of normalization of the dose to standard reference points, customized 3D volume-based VBT planning should be recommended.

keywords:

endometrial cancer, brachytherapy, vaginal cuff brachytherapy, three-dimensional planning, dosimetric comparison

  
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