CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer

• Published in: BMC cancer Vol. 14; no. 1; p. 447
• Main Authors: Murakami, Naoya, Kasamatsu, Takahiro, Wakita, Akihisa, Nakamura, Satoshi, Okamoto, Hiroyoki, Inaba, Koji, Morota, Madoka, Ito, Yoshinori, Sumi, Minako, Itami, Jun
• Format: Journal Article
• Language: English
• Published: England BioMed Central 17.06.2014
• Subjects: Acquisitions & mergers; Adult; Aged; Aged, 80 and over; Bladder; Brachytherapy - methods; Cancer therapies; Cervical cancer; Chemoradiotherapy; Chemotherapy; Cisplatin - administration & dosage; Dose-Response Relationship, Radiation; Female; Humans; Medical imaging; Middle Aged; Radiation therapy; Radiotherapy Dosage; Radiotherapy, Computer-Assisted - methods; Studies; Survival Analysis; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/1471-2407-14-447

In this study, high risk clinical target volumes (HR-CTVs) according to GEC-ESTRO guideline were contoured retrospectively based on CT images taken at the time of high-dose rate intracavitary brachytherapy (HDR-ICBT) and correlation between clinical outcome and dose of HR-CTV were analyzed. Our study population consists of 51 patients with cervical cancer (Stages IB-IVA) treated with 50 Gy external beam radiotherapy (EBRT) using central shield combined with 2-5 times of 6 Gy HDR-ICBT with or without weekly cisplatin. Dose calculation was based on Manchester system and prescribed dose of 6 Gy were delivered for point A. CT images taken at the time of each HDR-ICBT were reviewed and HR-CTVs were contoured. Doses were converted to the equivalent dose in 2 Gy (EQD2) by applying the linear quadratic model (α/β = 10 Gy). Three-year overall survival, Progression-free survival, and local control rate was 82.4%, 85.3% and 91.7%, respectively. Median cumulative dose of HR-CTV D90 was 65.0 Gy (52.7-101.7 Gy). Median length from tandem to the most lateral edge of HR-CTV at the first ICBT was 29.2 mm (range, 18.0-51.9 mm). On univariate analysis, both LCR and PFS was significantly favorable in those patients D90 for HR-CTV was 60 Gy or greater (p = 0.001 and 0.03, respectively). PFS was significantly favorable in those patients maximum length from tandem to edge of HR-CTV at first ICBT was shorter than 3.5 cm (p = 0.042). Volume-dose showed a relationship to the clinical outcome in CT based brachytherapy for cervical carcinoma.