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KMID : 0191120180330180135
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Journal of Korean Medical Science
2018 Volume.33 No. 18 p.135 ~ p.135
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Who Really Benefits from 3D-Based Planning of Brachytherapy for Cervical Cancer?
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Ha In-Bong
Jeong Bae-Kwon
Kang Ki-Mun
Jeong Ho-Jin
Lee Yun-Hee
Choi Hoon-Sik
Lee Jong-Hak
Choi Won-Jun
Shin Jeong-Kyu
Song Jin-Ho
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Abstract
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Background: Although intracavitary radiotherapy (ICR) is essential for the radiation therapy of cervical cancer, few institutions in Korea perform 3-dimensional (3D)-based ICR. To identify patients who would benefit from 3D-based ICR, dosimetric parameters for tumor targets and organs at risk (OARs) were compared between 2-dimensional (2D)- and 3D-based ICR.
Methods: Twenty patients with locally advanced cervical cancer who underwent external beam radiation therapy (EBRT) following 3D-based ICR were retrospectively evaluated. New 2D-based plans based on the Manchester system were developed. Tumor size was measured by magnetic resonance imaging.
Results: The mean high risk clinical target volume (HR-CTV) D90 value was about 10% lower for 2D- than for 3D-based plans (88.4% vs. 97.7%; P = 0.068). Tumor coverage did not differ between 2D- and 3D-based plans in patients with tumors ≤ 4 cm at the time of brachytherapy, but the mean HR-CTV D90 values in patients with tumors > 4 cm were significantly higher for 3D-based plans than for 2D-based plans (96.0% vs. 78.1%; P = 0.017). Similar results were found for patients with tumors > 5 cm initially. Other dosimetric parameters for OARs were similar between 2D- and 3D-based plans, except that mean sigmoid D2cc was higher for 2D- than for 3D-based plans (67.5% vs. 58.8%; P = 0.043).
Conclusion: These findings indicate that 3D-based ICR plans improve tumor coverage while satisfying the dose constraints for OARs. 3D-based ICR should be considered in patients with tumors > 4 cm size at the time of brachytherapy or > 5 cm initially.
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KEYWORD
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Cervical Cancer, Brachytherapy, 3-D Imaging, Radiotherapy Planning
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