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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2019
vol. 11
 
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abstract:
Original paper

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

Jean-Guy Belliveau
1
,
Kundan Thind
1, 2, 3
,
Robyn Banerjee
3, 4
,
Sarah Quirk
1, 2, 3
,
Corinne Doll
3, 4
,
Tien Phan
3, 4
,
Tyler Meyer
1, 2, 3
,
Michael Roumeliotis
1, 2, 3

  1. Division of Medical Physics, Tom Baker Cancer Centre, Calgary, Canada
  2. Department of Physics & Astronomy, University of Calgary, Calgary, Canada
  3. Department of Oncology, University of Calgary, Calgary, Canada
  4. Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Canada
J Contemp Brachytherapy 2019; 11, 2: 122–127
DOI: https://doi.org/10.5114/jcb.2019.84420
Online publish date: 2019/04/10
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Purpose
Perineal template-based interstitial gynecologic brachytherapy (ISBT) treatments are evaluated to determine whether adaptive inter-fraction re-planning is beneficial and necessary to meet the treatment aims of the American Brachytherapy Society (ABS) consensus guidelines for interstitial brachytherapy. Adherence to the EMBRACE II protocol is also assessed.

Material and methods
Ten patients receiving radical intent treatment for locally advanced or recurrent gynecologic malignancies underwent a three-fraction ISBT treatment with an ABS-recommended prescription regimen of 21 to 24 Gy. Clinical treatment plans were created according to a computed tomography (CT) acquired immediately post-implant. The first fraction was delivered on the same day as the implant (Day 1). The remaining two fractions were delivered on the next day (Day 2), at least six hours apart. Prior to treating on Day 2, a verification CT was acquired, permitting assessment of over-night changes. The Day 2 CT was used to evaluate deviations in 2-Gy-per-fraction equivalent dose (EQD2) from the clinically intended dosimetry for clinical target volume (CTV), bladder, rectum, and sigmoid.

Results
For all patients, the median (range) difference between the intended and the delivered dosimetry for the CTV D90% was 1.4 Gy10 (0.3-4.4 Gy10). For all normal tissues, the median (range) difference from the intended normal tissue dose was 2.6 Gy3 (0.1-15.5 Gy3). In all cases, the deviation from clinically intended dosimetry did not lead to a violation of recommended normal tissue dose guidelines. For two of 10 patients with large normal tissue differences (> 10 Gy3 from the intended dose), inter-fraction adaptive planning did improve the plan quality, but was not strictly required to meet the normal tissue dose planning aims.

Conclusions
The implementation of perineal template-based ISBT treatment without inter-fraction adaptive planning can be delivered to comply with the ABS normal tissue dose guidelines and EMBRACE II limits for prescribed dose.

keywords:

brachytherapy, interstitial, adaptive, gynecologic, EMBRACE, inter-fraction, template

  
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