Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer

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Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer. / Serban, Monica; Fokdal, Lars; Nielsen, Søren Kynde; Hokland, Steffen Bjerre; Hansen, Anders Traberg; Spejlborg, Harald; Rylander, Susanne; Petric, Primoz; Lindegaard, Jacob Christian; Tanderup, Kari.

In: Brachytherapy, Vol. 20, No. 4, 07.2021, p. 796-806.

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@article{bf7d5bc964444a6c9f26b5295cdbf913,
title = "Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer",
abstract = "PURPOSE: To characterize and report on dosimetric outcomes of image guided adaptive brachytherapy (IGABT) using intracavitary and interstitial (IC/IS) applicators including oblique needles (O-needles) in locally advanced cervical cancer (LACC). METHODS AND MATERIALS: Twenty LACC patients treated with radio-chemotherapy and offered IC/IS-IGABT including O-needles were analyzed. An in-house 3D-printed vaginal template was used to steer the needles parallel and obliquely in relation to the tandem, supplemented with free-hand needles if needed. Implant characteristics and loading patterns were analyzed. Using the equivalent dose in 2Gy-fractions (EQD2) concept, cumulative (EBRT+BT) V85, V75, V60Gy, targets/OARs doses and high dose volumes (150%, 200% and 300% (100% = 85 Gy EQD210)) were evaluated. RESULTS: Median(range) tumor width at diagnosis was 5.5(3.6; 7.5)cm; CTVHR volume was 45(23; 136)cm3 with maximum distance from tandem to CTVHR border of 3.4(2.5; 4.8)cm. T-stage distribution was IIB/III/IVA in 6(30%)/9(45%)/5(25%) of patients. At BT, 13(65%) patients had distal parametrial/pelvic wall infiltration. Median(range) number of needles per patient was 11(8–18). Average distribution of intrauterine, vaginal and interstitial dwell times were 31%, 25% and 44%, respectively. Median(range) dwell-time per dwell position was 11(2–127)% of average point-A based standard loading. Median V85Gy/V150%/V200%/V300% were 85(38; 171)/41(21; 93)/22(12; 41)/7(4; 19) cm3; CTVHR D90% was 93(83; 97)Gy EQD210; bladder/rectum/sigmoid/bowel D2cm3 were 78(64; 104)/65(52; 76)/59(53; 69)/61(47; 76)Gy EQD23. CONCLUSIONS: The use of O-needles in patients with large and/or unfavorable tumors resulted in excellent target coverage and OARs sparing. Intrauterine and vaginal loadings were reduced compared to standard loading and almost half of the loading was shifted into IS needles. This was achieved with gentle loading in the majority of dwell positions.",
keywords = "Cervix cancer, Intracavitary and interstitial brachytherapy, MR-guided adaptive brachytherapy, Parallel and oblique needles",
author = "Monica Serban and Lars Fokdal and Nielsen, {S{\o}ren Kynde} and Hokland, {Steffen Bjerre} and Hansen, {Anders Traberg} and Harald Spejlborg and Susanne Rylander and Primoz Petric and Lindegaard, {Jacob Christian} and Kari Tanderup",
note = "Publisher Copyright: {\textcopyright} 2021 American Brachytherapy Society",
year = "2021",
month = jul,
doi = "10.1016/j.brachy.2021.03.019",
language = "English",
volume = "20",
pages = "796--806",
journal = "Brachytherapy",
issn = "1538-4721",
publisher = "Elsevier Inc.",
number = "4",

}

RIS

TY - JOUR

T1 - Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer

AU - Serban, Monica

AU - Fokdal, Lars

AU - Nielsen, Søren Kynde

AU - Hokland, Steffen Bjerre

AU - Hansen, Anders Traberg

AU - Spejlborg, Harald

AU - Rylander, Susanne

AU - Petric, Primoz

AU - Lindegaard, Jacob Christian

AU - Tanderup, Kari

N1 - Publisher Copyright: © 2021 American Brachytherapy Society

PY - 2021/7

Y1 - 2021/7

N2 - PURPOSE: To characterize and report on dosimetric outcomes of image guided adaptive brachytherapy (IGABT) using intracavitary and interstitial (IC/IS) applicators including oblique needles (O-needles) in locally advanced cervical cancer (LACC). METHODS AND MATERIALS: Twenty LACC patients treated with radio-chemotherapy and offered IC/IS-IGABT including O-needles were analyzed. An in-house 3D-printed vaginal template was used to steer the needles parallel and obliquely in relation to the tandem, supplemented with free-hand needles if needed. Implant characteristics and loading patterns were analyzed. Using the equivalent dose in 2Gy-fractions (EQD2) concept, cumulative (EBRT+BT) V85, V75, V60Gy, targets/OARs doses and high dose volumes (150%, 200% and 300% (100% = 85 Gy EQD210)) were evaluated. RESULTS: Median(range) tumor width at diagnosis was 5.5(3.6; 7.5)cm; CTVHR volume was 45(23; 136)cm3 with maximum distance from tandem to CTVHR border of 3.4(2.5; 4.8)cm. T-stage distribution was IIB/III/IVA in 6(30%)/9(45%)/5(25%) of patients. At BT, 13(65%) patients had distal parametrial/pelvic wall infiltration. Median(range) number of needles per patient was 11(8–18). Average distribution of intrauterine, vaginal and interstitial dwell times were 31%, 25% and 44%, respectively. Median(range) dwell-time per dwell position was 11(2–127)% of average point-A based standard loading. Median V85Gy/V150%/V200%/V300% were 85(38; 171)/41(21; 93)/22(12; 41)/7(4; 19) cm3; CTVHR D90% was 93(83; 97)Gy EQD210; bladder/rectum/sigmoid/bowel D2cm3 were 78(64; 104)/65(52; 76)/59(53; 69)/61(47; 76)Gy EQD23. CONCLUSIONS: The use of O-needles in patients with large and/or unfavorable tumors resulted in excellent target coverage and OARs sparing. Intrauterine and vaginal loadings were reduced compared to standard loading and almost half of the loading was shifted into IS needles. This was achieved with gentle loading in the majority of dwell positions.

AB - PURPOSE: To characterize and report on dosimetric outcomes of image guided adaptive brachytherapy (IGABT) using intracavitary and interstitial (IC/IS) applicators including oblique needles (O-needles) in locally advanced cervical cancer (LACC). METHODS AND MATERIALS: Twenty LACC patients treated with radio-chemotherapy and offered IC/IS-IGABT including O-needles were analyzed. An in-house 3D-printed vaginal template was used to steer the needles parallel and obliquely in relation to the tandem, supplemented with free-hand needles if needed. Implant characteristics and loading patterns were analyzed. Using the equivalent dose in 2Gy-fractions (EQD2) concept, cumulative (EBRT+BT) V85, V75, V60Gy, targets/OARs doses and high dose volumes (150%, 200% and 300% (100% = 85 Gy EQD210)) were evaluated. RESULTS: Median(range) tumor width at diagnosis was 5.5(3.6; 7.5)cm; CTVHR volume was 45(23; 136)cm3 with maximum distance from tandem to CTVHR border of 3.4(2.5; 4.8)cm. T-stage distribution was IIB/III/IVA in 6(30%)/9(45%)/5(25%) of patients. At BT, 13(65%) patients had distal parametrial/pelvic wall infiltration. Median(range) number of needles per patient was 11(8–18). Average distribution of intrauterine, vaginal and interstitial dwell times were 31%, 25% and 44%, respectively. Median(range) dwell-time per dwell position was 11(2–127)% of average point-A based standard loading. Median V85Gy/V150%/V200%/V300% were 85(38; 171)/41(21; 93)/22(12; 41)/7(4; 19) cm3; CTVHR D90% was 93(83; 97)Gy EQD210; bladder/rectum/sigmoid/bowel D2cm3 were 78(64; 104)/65(52; 76)/59(53; 69)/61(47; 76)Gy EQD23. CONCLUSIONS: The use of O-needles in patients with large and/or unfavorable tumors resulted in excellent target coverage and OARs sparing. Intrauterine and vaginal loadings were reduced compared to standard loading and almost half of the loading was shifted into IS needles. This was achieved with gentle loading in the majority of dwell positions.

KW - Cervix cancer

KW - Intracavitary and interstitial brachytherapy

KW - MR-guided adaptive brachytherapy

KW - Parallel and oblique needles

UR - http://www.scopus.com/inward/record.url?scp=85105826037&partnerID=8YFLogxK

U2 - 10.1016/j.brachy.2021.03.019

DO - 10.1016/j.brachy.2021.03.019

M3 - Journal article

C2 - 33994344

AN - SCOPUS:85105826037

VL - 20

SP - 796

EP - 806

JO - Brachytherapy

JF - Brachytherapy

SN - 1538-4721

IS - 4

ER -