Comparative analysis of image-guided adaptive interstitial brachytherapy and intensity-modulated arc therapy versus conventional treatment techniques in cervical cancer using biological dose summation

Georgina Fröhlich, Júlia Vízkeleti, Anhhong Nhung Nguyen, T. Major, C. Polgár

Research output: Contribution to journalArticle

Abstract

Purpose: To compare image-guided adaptive interstitial brachytherapy (BT) and intensity-modulated arc therapy (IMAT) with conventional treatment techniques in cervical cancer using an alternative biological dose summation method. Material and methods: Initially, 21 interstitial BT and IMAT plans of patients with cervical cancer were included and additional plans were created (inverse optimized interstitial, optimized intracavitary, non-optimized intracavitary BT plans, and conformal external beam radiotherapy [EBRT]). The most exposed volume of critical organs in BT were identified manually on EBRT CT images. Biological total doses (EQD2) were calculated and compared between each combination of BT and EBRT plans. This method was compared with uniform dose conception (UDC) in IMAT and conformal EBRT plans. Results: The D90 of high-risk CTV and D2 of bladder and sigmoid were different in BT techniques only: p = 0.0149, < 0.001, < 0.001, respectively. The most advantageous values were obtained in the interstitial treatment plans and inverse optimized interstitial plans did not differ dosimetrically from these, while optimized intracavitary plans resulted in worse dose-volume parameters, and the worst of all were intracavitary plans without optimization. The D2 of rectum was significantly lower with IMAT than with conformal EBRT plans (p = 0.037) and showed the same trend in BT plans as the other parameters (p < 0.001). The UDC dose summation method overestimated D2 of bladder, rectum, and sigmoid (p < 0.001 for all). Conclusions: Although optimization improves the quality of conventional BT plans, interstitial plans produce significantly higher dose coverage of high-risk clinical target volume (HR-CTV) and lower doses to organs at risk (OARs). IMAT plans decrease the dose to the rectum. UDC overestimates OARs doses.

Original languageEnglish
Pages (from-to)69-75
Number of pages7
JournalJournal of Contemporary Brachytherapy
Volume11
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Intensity-Modulated Radiotherapy
Brachytherapy
Uterine Cervical Neoplasms
Radiotherapy
Rectum
Organs at Risk
Sigmoid Colon
Therapeutics
Urinary Bladder
Organ Size

Keywords

  • Cervical cancer
  • Dose summation
  • Integrated biological doses
  • Intensity-modulated arc therapy
  • Interstitial brachytherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Comparative analysis of image-guided adaptive interstitial brachytherapy and intensity-modulated arc therapy versus conventional treatment techniques in cervical cancer using biological dose summation",
abstract = "Purpose: To compare image-guided adaptive interstitial brachytherapy (BT) and intensity-modulated arc therapy (IMAT) with conventional treatment techniques in cervical cancer using an alternative biological dose summation method. Material and methods: Initially, 21 interstitial BT and IMAT plans of patients with cervical cancer were included and additional plans were created (inverse optimized interstitial, optimized intracavitary, non-optimized intracavitary BT plans, and conformal external beam radiotherapy [EBRT]). The most exposed volume of critical organs in BT were identified manually on EBRT CT images. Biological total doses (EQD2) were calculated and compared between each combination of BT and EBRT plans. This method was compared with uniform dose conception (UDC) in IMAT and conformal EBRT plans. Results: The D90 of high-risk CTV and D2 of bladder and sigmoid were different in BT techniques only: p = 0.0149, < 0.001, < 0.001, respectively. The most advantageous values were obtained in the interstitial treatment plans and inverse optimized interstitial plans did not differ dosimetrically from these, while optimized intracavitary plans resulted in worse dose-volume parameters, and the worst of all were intracavitary plans without optimization. The D2 of rectum was significantly lower with IMAT than with conformal EBRT plans (p = 0.037) and showed the same trend in BT plans as the other parameters (p < 0.001). The UDC dose summation method overestimated D2 of bladder, rectum, and sigmoid (p < 0.001 for all). Conclusions: Although optimization improves the quality of conventional BT plans, interstitial plans produce significantly higher dose coverage of high-risk clinical target volume (HR-CTV) and lower doses to organs at risk (OARs). IMAT plans decrease the dose to the rectum. UDC overestimates OARs doses.",
keywords = "Cervical cancer, Dose summation, Integrated biological doses, Intensity-modulated arc therapy, Interstitial brachytherapy",
author = "Georgina Fr{\"o}hlich and J{\'u}lia V{\'i}zkeleti and Nguyen, {Anhhong Nhung} and T. Major and C. Polg{\'a}r",
year = "2019",
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language = "English",
volume = "11",
pages = "69--75",
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T1 - Comparative analysis of image-guided adaptive interstitial brachytherapy and intensity-modulated arc therapy versus conventional treatment techniques in cervical cancer using biological dose summation

AU - Fröhlich, Georgina

AU - Vízkeleti, Júlia

AU - Nguyen, Anhhong Nhung

AU - Major, T.

AU - Polgár, C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To compare image-guided adaptive interstitial brachytherapy (BT) and intensity-modulated arc therapy (IMAT) with conventional treatment techniques in cervical cancer using an alternative biological dose summation method. Material and methods: Initially, 21 interstitial BT and IMAT plans of patients with cervical cancer were included and additional plans were created (inverse optimized interstitial, optimized intracavitary, non-optimized intracavitary BT plans, and conformal external beam radiotherapy [EBRT]). The most exposed volume of critical organs in BT were identified manually on EBRT CT images. Biological total doses (EQD2) were calculated and compared between each combination of BT and EBRT plans. This method was compared with uniform dose conception (UDC) in IMAT and conformal EBRT plans. Results: The D90 of high-risk CTV and D2 of bladder and sigmoid were different in BT techniques only: p = 0.0149, < 0.001, < 0.001, respectively. The most advantageous values were obtained in the interstitial treatment plans and inverse optimized interstitial plans did not differ dosimetrically from these, while optimized intracavitary plans resulted in worse dose-volume parameters, and the worst of all were intracavitary plans without optimization. The D2 of rectum was significantly lower with IMAT than with conformal EBRT plans (p = 0.037) and showed the same trend in BT plans as the other parameters (p < 0.001). The UDC dose summation method overestimated D2 of bladder, rectum, and sigmoid (p < 0.001 for all). Conclusions: Although optimization improves the quality of conventional BT plans, interstitial plans produce significantly higher dose coverage of high-risk clinical target volume (HR-CTV) and lower doses to organs at risk (OARs). IMAT plans decrease the dose to the rectum. UDC overestimates OARs doses.

AB - Purpose: To compare image-guided adaptive interstitial brachytherapy (BT) and intensity-modulated arc therapy (IMAT) with conventional treatment techniques in cervical cancer using an alternative biological dose summation method. Material and methods: Initially, 21 interstitial BT and IMAT plans of patients with cervical cancer were included and additional plans were created (inverse optimized interstitial, optimized intracavitary, non-optimized intracavitary BT plans, and conformal external beam radiotherapy [EBRT]). The most exposed volume of critical organs in BT were identified manually on EBRT CT images. Biological total doses (EQD2) were calculated and compared between each combination of BT and EBRT plans. This method was compared with uniform dose conception (UDC) in IMAT and conformal EBRT plans. Results: The D90 of high-risk CTV and D2 of bladder and sigmoid were different in BT techniques only: p = 0.0149, < 0.001, < 0.001, respectively. The most advantageous values were obtained in the interstitial treatment plans and inverse optimized interstitial plans did not differ dosimetrically from these, while optimized intracavitary plans resulted in worse dose-volume parameters, and the worst of all were intracavitary plans without optimization. The D2 of rectum was significantly lower with IMAT than with conformal EBRT plans (p = 0.037) and showed the same trend in BT plans as the other parameters (p < 0.001). The UDC dose summation method overestimated D2 of bladder, rectum, and sigmoid (p < 0.001 for all). Conclusions: Although optimization improves the quality of conventional BT plans, interstitial plans produce significantly higher dose coverage of high-risk clinical target volume (HR-CTV) and lower doses to organs at risk (OARs). IMAT plans decrease the dose to the rectum. UDC overestimates OARs doses.

KW - Cervical cancer

KW - Dose summation

KW - Integrated biological doses

KW - Intensity-modulated arc therapy

KW - Interstitial brachytherapy

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