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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}


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

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  • The authors declare no conflicts of interest.