Template-Based Inverse PlanningSimulated Annealing for CT-Based High-Dose-Rate Brachytherapy of Cervical Cancer: Feasibility Study
Keywords:Inverse planning, High-dose-rate, brachytherapy, cervix cancer, ring and tandem.
Purpose:To investigate the feasibility of using an inverse planning technique for CT-based ring and tandem high-dose rate brachytherapy of cervical cancer.
Methods and Materials:Two patients previously treated with high-dose-rate brachytherapy for cervical cancer were retrospectively identified for this study. Each patient had five intracavitary insertions using CT/MR-compatible tandem and ring applicators. The 6Gy isodose lines from the original clinical plans were converted into a structure set (S6) using MIMvista. Inverse plans were then generated in Oncentra using the inverse planning simulated annealing (IPSA) with S6 as the optimization target. The dose to 0.1cm3, 1cm3, 5cm3 of bladder (DB0.1, DB1, and DB5) and rectum (DR0.1, DR1, DR5) were determined from the dose volume histogram (DVH). Percentage of physician drawn clinical target volume (CTV) and S6 coverage (V100CTV, V100S6) were also recorded.
Results:The mean V100%CTV of the original clinical plans and the inverse plans were 88.14% and 87.57%. The mean V100%S6 of the original clinical plans and the inverse plans was 98.68% and 97.00%. The mean dose reduction for DB0.1, DB1 and DB5 were 5.4%, 5.4%, and 4.7%, respectively. The mean dose reduction for DR0.1, DR1 and DR5 were 6.4%, 5.5%, and 4.8%.
Conclusions:This work demonstrated the feasibility of this structure-based inverse planning. It can achieve comparable CTV coverage while reducing dose to critical structures. Once template structure set is constructed, this procedure can not only reduce planning time, but improve quality assurance by standardizing the procedure. This approach can be directly extended to other applicator-based brachytherapy procedures.
Marsiglia H, Haie-Meder C, Sasso G, et al. Brachytherapy for T1-T2 floor-of-the-mouth cancers: The Gustave-Roussy Institute experience. Int J Radiat Oncol Biol Phys 2002; 52: 1257-63. http://dx.doi.org/10.1016/S0360-3016(01)02761-4
Leborgne F, Leborgne JH, Zubizarreta E, et al. Cesium-137 needle brachytherapy boosts after external beam irradiation for locally advanced carcinoma of the tongue and floor of the mouth. Brachytherapy 2002; 1: 126-30. http://dx.doi.org/10.1016/S1538-4721(02)00052-1
Geiger M, Strnad V, Lotter M, et al. Pulsed-dose rate brachytherapy with concomitant chemotherapy and interstitial hyperthermia in patients with recurrent head and neck cancer. Brachytherapy 2002; 1: 149-53. http://dx.doi.org/10.1016/S1538-4721(02)00056-9
Kestin LL, Martinez AA, Stromberg JS, et al. Matched-pair analysis of conformal high–dose-rate brachytherapy boost versus external beam radiation therapy alone for locally advanced prostate cancer. J Clin Oncol 2000; 18: 2869-80.
Zietman AL. Localized prostate cancer: Brachytherapy. Curr Treat Options Oncol 2002; 3: 429-36. http://dx.doi.org/10.1007/s11864-002-0007-2
Harms W, Krempien R, Hensley FW, et al. Five-year results of pulseddose-rate Brachytherapy applied as a boost after breast-conserving therapy in patients at high risk for local recurrence from breast cancer. Strahlenther Onkol 2002; 178: 607-14. http://dx.doi.org/10.1007/s00066-002-0977-9
Hsu IC, Speight J, Hai J, et al. A comparison between tandem and ovoids and interstitial gynecologic template brachytherapy dosimetry using a hypothetical computer model. Int J Radiat Oncol Biol Phys 2002; 52: 538-43. http://dx.doi.org/10.1016/S0360-3016(01)02691-8
Lanciano RM, Won M, Coia LR, et al. Pretreatment and treatment factors associated with improved outcome in squamous cell carcinoma of the uterine cervix: A final report of the 1973 and 1978 patterns of care studies. Int J Radiat Oncol Biol Phys 1991; 20: 667-76. http://dx.doi.org/10.1016/0360-3016(91)90007-Q
Montana GS, Fowler WC, Varra MA, et al. Carcinoma of the cervix, stage III: Results of radiation therapy. Cancer 1986; 57: 148-54. http://dx.doi.org/10.1002/1097-0142(19860101)57:1<148::AID-CNCR2820570130>3.0.CO;2-7
Perez CA, Breaux S, Madoc-Jones H, et al. Radiation therapy alone in the treatment of carcinoma of the uterine cervix: I. Analysis of tumor recurrence. Cancer 1983; 51: 1393-402. http://dx.doi.org/10.1002/1097-0142(19830415)51:8<1393::AID-CNCR2820510812>3.0.CO;2-M
Eifel PJ, Morris M, Oswald MJ. The influence of tumor size and growth habit on outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1993; 27(1): 127-28.
Shwetha B, Ravikumar M, Siddanna R. Palled, et al. Dosimetric comparison of high dose rate brachytherapy and intensity-modulated radiation therapy for cervical carcinoma, J Med Phys 2011; 36(2): 111-6. http://dx.doi.org/10.4103/0971-6203.79687
Nag S, Erickson B, Thomadsen B, et al. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000; 48: 201-11. http://dx.doi.org/10.1016/S0360-3016(00)00497-1
Shin KH, Kim TH, Cho JK, et al. CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters. Int J Radiat Oncol Biol Phys 2006; 64: 197-204. http://dx.doi.org/10.1016/j.ijrobp.2005.06.015
Fellner C, Potter R, Knocke TH, et al. Comparison of radiography and computed tomography-based treatment planning in cervix cancer in brachytherapy with specific attention to some quality assurance aspects. Radiother Oncol 2001; 58: 53-62. http://dx.doi.org/10.1016/S0167-8140(00)00282-6
Kim RY, Pareek P. Radiography-based treatment planning compared with computed tomography (CT)-based treatment planning for intracavitary brachytherapy in cancer of the cervix: Analysis of dosevolume histograms. Brachytherapy 2003; 2: 200-6. http://dx.doi.org/10.1016/j.brachy.2003.06.001
Kirisits C, Potter R, Lang S, et al. Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2005; 62: 901-11. http://dx.doi.org/10.1016/j.ijrobp.2005.02.040
Nag S, Erickson B, Thomadsen B, et al. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiation Oncol Biol Phys 2000; 48(1): 201-11. http://dx.doi.org/10.1016/S0360-3016(00)00497-1
Coltart RS, Nethersell AB, Thomas S, et al. A CT based dosimetry system for intracavitary therapy in carcinoma of the cervix. Radiother Oncol 1987; 10: 295-305. http://dx.doi.org/10.1016/S0167-8140(87)80036-1
Datta NR, Srivastava A, Maria Das KJ, et al. Comparative assessment of doses to tumor, rectum, and bladder as evaluated by orthogonal radiographs vs. computer enhanced computed tomography-based intracavitary brachytherapy in cervical cancer. Brachytherapy 2006; 5: 223-9. http://dx.doi.org/10.1016/j.brachy.2006.09.001
Eisbruch A, Johnston CM, Martel MK, et al. Customized gynecologic interstitial implants: CT-based planning, dose evaluation, and optimization aided by laparotomy. Int J Radiat Oncol Biol Phys 1998; 40: 1087-93. http://dx.doi.org/10.1016/S0360-3016(98)00010-8
Lee KR, Mansfield CM, Dwyer SJ, et al. CT for intracavitary radiotherapy planning. AJR Am J Roentgenol 1980; 135: 809-13.
Erickson B, Albano K, Gillin M. CT-guided interstitial implantation of gynecologic malignancies. Int J Radiat Oncol Biol Phys 1996; 36: 699-709. http://dx.doi.org/10.1016/S0360-3016(96)00373-2
Viswanathan AN, Cormack R, Holloway CL, et al. Magnetic resonance-guided interstitial therapy for vaginal recurrence of endometrial cancer. Int J Radiat Oncol Biol Phys 2006; 66: 91-9. http://dx.doi.org/10.1016/j.ijrobp.2006.04.037
Viswanathan AN, Dimopoulos J, Kirisits C, et al. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: Results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys 2007; 68: 491-8. http://dx.doi.org/10.1016/j.ijrobp.2006.12.021