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Abstract
Introduction/Background Intermediate-high and high-risk endometrial cancer often require adjuvant treatments such as radiotherapy (RT) or brachytherapy to reduce loco-regional relapse risk. Inter- and intra-fraction variability of pelvic anatomy are the largest source of error affecting RT. The implantation of Fiducial Makers (FMs) in the vaginal cuff of patients receiving radiotherapy or brachytherapy could help patient daily setup, image guidance and intra-fraction detection of radiation targets.
Methodology We evaluated an 80-year-old woman treated with surgery for endometrioid adenocarcinoma G2 (stage pT1bNx LVSI+) who underwent adjuvant pelvic Intensity Modulated Radiation Therapy after the implantation of vaginal cuff FMs. Planning Computed Tomography scan was performed 10 days after FMs implantation. RT consisted of 45Gy in 25 daily fractions to pelvic lymph nodes and surgical bed with integrated boost up to 52.5Gy to vaginal cuff and upper two-thirds of the vagina. Cone beam Computed Tomography (CBCT) was acquired prior to every RT fraction for Image Guided Radiotherapy (IGRT). Bladder and rectum were re-contoured on every CBCTs. Bladder and rectal volumes and median shifts were used to quantify pelvic organ variations.
Results No discomfort during the FMs implantation, nor complications nor evidence of FMs migration were reported. Bladder and rectal volumes planned contours were 245 and 55.3cc. Median bladder volumes for approved and ‘not acceptable’ CBCTs were 222cc (range: 130–398) and 131cc (range: 65–326). Median rectal volumes for approved and ‘not acceptable’ CBCTs were 75cc (range: 58–117) and 90cc (range: 54–189). The median values of the anterior-posterior, superior-inferior, lateral direction shifts were 3.4, 1.8, 2.11 mm, respectively.
Conclusion The implantation of FMs in the vaginal cuff of a patient who underwent pelvic adjuvant RT was well tolerated and reported no complications. IGRT procedures based on FMs surrogating the vaginal vault may reduce inter-observer variability and pave the way for adaptive strategies or stereotactic treatments in gynecological field.
Disclosures The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as potential conflict of interest.
