Simulation analysis of optimized brachytherapy for uterine cervical cancer: Can we select the best brachytherapy modality depending on tumor size?

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• 作者：Ken Yoshida¹ ; ^{rad113@poh.osaka-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hideya Yamazaki² ; Tadayuki Kotsuma³ ; Tadashi Takenaka⁴ ; Mari Mikami Ueda⁵ ; Shunsuke Miyake⁵ ; Yutaka Tsujimoto⁵ ; Koji Masui² ; Yasuo Yoshioka⁶ ; Iori Sumida⁶ ; Yasuo Uesugi¹ ; Taiju Shimbo¹ ; Nobuhiko Yoshikawa¹ ; Hiroto Yoshioka¹ ; Eiichi Tanaka³ ; Yoshifumi Narumi⁷
• 关键词：Brachytherapy ; Simulation analysis ; Dose-volume histograms ; Uterine cervical cancer
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：January-February 2016
• 年：2016
• 卷：15
• 期：1
• 页码：57-64
• 全文大小：1045 K

文摘

To choose the optimal brachytherapeutic modality for uterine cervical cancer, we performed simulation analysis.

Methods and Materials

For each high-risk clinical target volume (HR CTV), we compared four modalities [classical conventional intracavitary brachytherapy (_ConvICBT), Image-guided ICBT (IGICBT), intracavitary/interstitial brachytherapy (ICISBT), and interstitial brachytherapy (ISBT) with perineal approach] using dose-volume histograms using eight sizes of HR CTV (2 × 2 × 2 cm to 7 × 4 × 4 cm) and organs at risk model.

Results

In _ConvICBT, the doses covered 90% of the HR CTV [D₉₀(HR CTV)] decreased from 197% prescribed dose (PD) for the HR CTV size (2 × 2 × 2 cm) to 73% PD for 5 × 4 × 4 cm, whereas the other three modalities could achieve 100% PD for all HR CTV sizes. The minimum doses received by the maximally irradiated 2-cm³ volumes for organs at risks of IGICBT demonstrated lower values than those of _ConvICBT for the HR CTV size of 4 × 3 × 3 cm or smaller. ICISBT demonstrated lower values than those of IGICBT for 4 × 3 × 3 cm or larger. ISBT demonstrated lowest values for 5 × 4 × 4 cm or larger.

Conclusions

HR CTV size of 4 × 3 × 3 cm seems to be a threshold volume in this simulation analysis, and IGICBT is a better choice for smaller HR CTV than the threshold volume. On larger HR CTV, ICISBT or ISBT is the better choice.