Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies

Nikhila Radhakrishna; Siddanna Rudrappa Palled; Tanvir Pasha; Rekha Reddy Buchapudi; Govardhan H.B.; Naveen Thimmaiah; Lokesh Viswanath

doi:10.5114/jcb.2021.109788

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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Original paper

Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies

Nikhila Radhakrishna

¹

,

Siddanna Rudrappa Palled

¹

,

Tanvir Pasha

¹

,

Rekha Reddy Buchapudi

²

,

Govardhan H.B.

¹

,

Naveen Thimmaiah

¹

,

Lokesh Viswanath

¹

Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

J Contemp Brachytherapy 2021; 13, 5: 519–525

DOI: https://doi.org/10.5114/jcb.2021.109788

Online publish date: 2021/10/07

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AMA

Radhakrishna N, Rudrappa Palled S, Pasha T, et al. Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies. Journal of Contemporary Brachytherapy. 2021;13(5):519-525. doi:10.5114/jcb.2021.109788.

APA

Radhakrishna, N., Rudrappa Palled, S., Pasha, T., Reddy Buchapudi, R., H.B., G.,  & Thimmaiah, N. et al. (2021). Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies. Journal of Contemporary Brachytherapy, 13(5), 519-525. https://doi.org/10.5114/jcb.2021.109788

Chicago

Radhakrishna, Nikhila, Siddanna Rudrappa Palled, Tanvir Pasha, Rekha Reddy Buchapudi, Govardhan H.B., Naveen Thimmaiah,  and Lokesh Viswanath. 2021. "Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies". Journal of Contemporary Brachytherapy 13 (5): 519-525. doi:10.5114/jcb.2021.109788.

Harvard

Radhakrishna, N., Rudrappa Palled, S., Pasha, T., Reddy Buchapudi, R., H.B., G., Thimmaiah, N.,  and Viswanath, L. (2021). Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies. Journal of Contemporary Brachytherapy, 13(5), pp.519-525. https://doi.org/10.5114/jcb.2021.109788

MLA

Radhakrishna, Nikhila et al. "Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies." Journal of Contemporary Brachytherapy, vol. 13, no. 5, 2021, pp. 519-525. doi:10.5114/jcb.2021.109788.

Vancouver

Radhakrishna N, Rudrappa Palled S, Pasha T, Reddy Buchapudi R, H.B. G, Thimmaiah N et al. Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies. Journal of Contemporary Brachytherapy. 2021;13(5):519-525. doi:10.5114/jcb.2021.109788.

Introduction
Interstitial brachytherapy (ISBT) is often used as post-external beam radiotherapy (EBRT) to treat locally advanced gynecological malignancies. Female urethra is in close proximity to the target during ISBT. However, it has not been evaluated as an organ-at-risk (OAR). Overlapping symptoms caused by radiation-induced bladder toxicity vs. urethral toxicity make it difficult to identify and report urethral toxicities separately. This was a retrospective study to estimate dose-volume parameters of female urethra during high-dose-rate ISBT.

Material and methods
Data of 24 patients with gynecological malignancies treated by ISBT were selected. Urethra and periurethral regions were retrospectively contoured. Mean volume, Dmax, Dmean, D2cc, D1cc, D0.5cc, D0.2cc, and D0.1cc were documented. Unpaired t-test was used for comparison of means.

Results
20/24 Ca. cervix, 1/24 Ca. vagina, and 3/24 Ca. vaginal vault received 6-6.5 Gy in 4 ISBT fractions. Mean urethral length was 3.54 ±0.55 cm. Mean doses received by urethra per BT fraction were Dmax = 4.23 ±1.32 Gy, Dmean = 2.71 ±1.01 Gy, D0.2cc = 3.31 ±1.07, and D0.1cc = 3.54 ±1.09 Gy. Comparison of total BT 2 Gy equivalent dose (EQD2) with 4 fractions for urethra between patients with (9/24) and without anterior vaginal wall (15/24) involvement included Dmean = 18.79 ±7.49 Gy vs. 11.14 ±6.15 Gy*, D1cc = 10.90 ±10.03 Gy vs. 4.54 ±3.93 Gy*, D0.5cc = 19.50 ±8.69 Gy vs. 11.97 ±6.54 Gy*, D0.2cc = 23.78 ±8.94 Gy vs. 15.51 ±7.39 Gy*, and D0.1cc = 25.88 ±9.37 Gy vs. 17.39 ±8.03 Gy*, respectively (*p < 0.05).

Conclusions
Female urethra receives significant doses during ISBT for gynecological malignancies, especially when the anterior vaginal wall is within the target volume. Reporting doses to urethra would enable to develop clinical correlation and dose-volume constraints for urethra as organ-at-risk in future.

keywords:

Estimation of dose-volume parameters of female urethra as organ-at-risk during interstitial brachytherapy in gynecological malignancies

Nikhila Radhakrishna 1 , Siddanna Rudrappa Palled 1 , Tanvir Pasha 1 , Rekha Reddy Buchapudi 2 , Govardhan H.B. 1 , Naveen Thimmaiah 1 , Lokesh Viswanath 1

female urethra, interstitial brachytherapy, dose-volume parameters, gynecological malignancies, organ-at-risk

Nikhila Radhakrishna

¹

,

Siddanna Rudrappa Palled

¹

,

Tanvir Pasha

¹

,

Rekha Reddy Buchapudi

²

,

Govardhan H.B.

¹

,

Naveen Thimmaiah

¹

,

Lokesh Viswanath

¹