Article Text

Download PDFPDF
Computed Tomography–Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy
  1. Zhong-Shan Liu, MD*,
  2. Jie Guo, MD*,
  3. Yang-Zhi Zhao, MD,
  4. Xia Lin, BS*,
  5. Bing-Ya Zhang, MD*,
  6. Chu Zhang, BS*,
  7. Hong-Yong Wang, MD*,
  8. Lei Yu, MD*,
  9. Xiao-Jun Ren, MD* and
  10. Tie-Jun Wang, MD, PhD*
  1. * Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University; and
  2. Cancer Center, The First Affiliated Hospital of Jilin University, Changchun, China.
  1. Address correspondence and reprint requests to Tie-Jun Wang, MD, PhD, Department of Radiation Oncology, The Second Affiliated Hospital of Jilin University, 218 Zi Qiang St, Changchun 130041, China. E-mail: wangtiejunjlu{at}163.com.

Abstract

Objective We present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.

Materials/Methods Interstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT.

Results The mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications.

Conclusions The IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.

  • Computed tomography
  • Interstitial brachytherapy
  • Cervical cancer
  • BT-brachytherapy
  • 3D-3 dimensional
  • CT-computed tomography
  • EBRT-external beam radiotherapy
  • HR-CTV-high-risk clinical target volume
  • OAR-organ at risk
  • IBBT-image-based BT
  • MRI-magnetic resonance imaging
  • IC/IS-intracavitary/interstitial
  • DVH-dose-volume histogram
  • EQD2-the equivalent dose in 2 Gy
  • D90-the minimum dose delivered to 90% of the target volume

Statistics from Altmetric.com

Footnotes

  • The authors declare no conflicts of interest.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.