A Comprehensive Evaluation of Adaptive Daily Planning for Cervical Cancer HDR Brachytherapy

Overview

Journal J Appl Clin Med Phys

Specialties Biophysics
General Medicine

Date 2016 Dec 9

PMID 27929505

Citations 3

Authors

Rebecca Meerschaert

Adrian Nalichowski

Jay Burmeister

Arun Paul

Steven Miller

Zhenghui Hu

Ling Zhuang

Affiliations

Soon will be listed here.

Abstract

The purpose of this study was to evaluate adaptive daily planning for cervi-cal cancer patients who underwent high-dose-rate intracavitary brachytherapy (HDR-BT) using comprehensive interfractional organ motion measurements. This study included 22 cervical cancer patients who underwent 5 fractions of HDR-BT. Regions of interest (ROIs) including high-risk clinical tumor volume (HR-CTV) and organs at risk (OARs) were manually contoured on daily CT images. All patients were clinically treated with adaptive daily plans (ADP), which involved ROI delineation and dose optimization at each treatment fraction. Single treatment plans (SP) were retrospectively generated by applying the first treatment fraction's dwell times adjusted for decay and dwell positions of the applicator to subsequent treatment fractions. Various existing similarity metrics were calculated for the ROIs to quantify interfractional organ variations. A novel similarity (JRARM) score was established, which combined both volumetric overlap metrics (DSC, JSC, and RVD) and distance metrics (ASD, MSD, and RMSD). Linear regression was performed to determine a relationship between interfractional organ varia-tions of various similarity metrics and D2cc variations from both plans. Wilcoxon signed-rank tests were used to assess ADP and SP by comparing EQD2 D2cc (α/β = 3) for OARs. For interfractional organ variations, the sigmoid demonstrated the greatest variations based on the JRARM, DSC, and RMSD metrics. Comparisons between paired ROIs showed differences in metrics at each treatment fraction. RVD, MSD, and RMSD were found to be significantly correlated to D2cc varia-tions for bladder and sigmoid. The comparison between plans found ADP provided lower EQD2 D2cc of OARs than SP. Specifically, the sigmoid demonstrated sta-tistically significant dose variations (p = 0.015). Substantial interfractional organ motion occurs during HDR-BT based on comprehensive measurements and may significantly affect D2cc of OARs. Adaptive daily planning provides improved dose sparing for OARs compared to single planning with the extent of sparing being different among OARs.

Citing Articles

Four-Dimensional Image-Guided Adaptive Brachytherapy for Cervical Cancer: A Systematic Review and Meta-Regression Analysis.

Li F, Shi D, Bu M, Lu S, Zhao H Front Oncol. 2022; 12:870570.

PMID: 35860574 PMC: 9291247. DOI: 10.3389/fonc.2022.870570.

Predictive value of Excel forms based on an automatic calculation of dose equivalent in 2 Gy per fraction in adaptive brachytherapy for cervical cancer.

Cheng G, Mu X, Liu Y, Mao Z, Zhao H J Contemp Brachytherapy. 2020; 12(5):454-461.

PMID: 33299434 PMC: 7701924. DOI: 10.5114/jcb.2020.100378.

Evaluation of offline adaptive planning techniques in image-guided brachytherapy of cervical cancer.

Liu H, Kinard J, Maurer J, Shang Q, Vanderstraeten C, Hayes L J Appl Clin Med Phys. 2018; 19(6):316-322.

PMID: 30284370 PMC: 6236843. DOI: 10.1002/acm2.12462.

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