Prolonged treatment planning can increase real rectal dose in 3D brachytherapy for cervical cancer

Zuzana Vlachová; Martin Dolezel; Katerina Svozilova; Paulina Jaskova; Denisa Vitaskova; Marcel Matzenauer; Jan Stuk; Igor Hartmann

doi:10.5114/jcb.2020.94580

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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2/2020
vol. 12

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abstract:

Original paper

Prolonged treatment planning can increase real rectal dose in 3D brachytherapy for cervical cancer

Zuzana Vlachová

^{1, 2}

,

Martin Dolezel

^{1, 2, 3}

,

Katerina Svozilova

¹

,

Paulina Jaskova

¹

,

Denisa Vitaskova

¹

,

Marcel Matzenauer

⁴

,

Jan Stuk

⁵

,

Igor Hartmann

²

Department of Oncology, Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic
Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
First Faculty of Medicine, Charles University, Prague, Czech Republic
Comprehensive Cancer Centre, Novy Jicin, Czech Republic
Comprehensive Cancer Centre Multiscan, Pardubice, Czech Republic

J Contemp Brachytherapy 2020; 12, 2: 118–123

DOI: https://doi.org/10.5114/jcb.2020.94580

Online publish date: 2020/04/30

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Purpose
The purpose of this study was to evaluate the influence of 3D brachytherapy planning time on the real dose distribution.

Material and methods
10 patients with cervical cancer were evaluated using 2 computed tomography (CT) scans brachytherapy. The first scan was performed after the insertion of UVAG applicators, and the second was done after creating the treatment plan, just before the irradiation of first and third fraction. Both plans were compared in terms of changes of volumes and differences in the dose for high-risk organs using GEC-ESTRO Working Group parameters.

Results
The median planning time was 54 minutes (36-64 minutes). The absolute median change of volume for bladder, rectum, and sigmoid was 32.1 cm3 (1.6-108.6 cm3), 5.6 cm3 (0.4-61.8 cm3), and 8.4 cm3 (0.2-74.1 cm3), respectively. This difference led to an increased dose for bladder and sigmoid for D0.1cc by 46.7 cGy and 25.7 cGy, for D1cc by 59.2 cGy and 11.8 cGy, and for D2cc by 44.7 cGy and 10 cGy, respectively, per each fraction. Measured volume change in case of rectum led to a decreased dose per each fraction for D0.1cc with 7.1 cGy, for D1cc with 3.5 cGy, and for D2cc with 4.8 cGy. We observed that statistically significant dependency between the planning time and the dose was proved for rectum. The longer time for planning, the higher dose for rectum. The correlation coefficient for D0.1cc was 0.6715 (p = 0.0061), for D1cc was 0.6404 (p = 0.011), and for D2cc was 0.5891 (p = 0.0197).

Conclusions
Extended treatment planning time for brachytherapy due to the changes in topography of small pelvis can lead to different dose in high-risk organs than previously planned. It seems that the most significant changes are related to rectum.

keywords:

Prolonged treatment planning can increase real rectal dose in 3D brachytherapy for cervical cancer

Zuzana Vlachová 1, 2 , Martin Dolezel 1, 2, 3 , Katerina Svozilova 1 , Paulina Jaskova 1 , Denisa Vitaskova 1 , Marcel Matzenauer 4 , Jan Stuk 5 , Igor Hartmann 2

cervical cancer, 3D brachytherapy, treatment planning

Zuzana Vlachová

^{1, 2}

,

Martin Dolezel

^{1, 2, 3}

,

Katerina Svozilova

¹

,

Paulina Jaskova

¹

,

Denisa Vitaskova

¹

,

Marcel Matzenauer

⁴

,

Jan Stuk

⁵

,

Igor Hartmann

²