eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 15
Original paper

Are active dwell positions always necessary in the ring/ovoids channel of the cervical applicator in the intracavitary-interstitial brachytherapy of cervical cancer?

Georgina Fröhlich
1, 2
Júlia Vízkeleti
Anhhong Nhung Nguyen
Csaba Polgár
1, 3
Zoltán Takácsi-Nagy
1, 3
Tibor Major
1, 3

National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
Department of Biophysics, Faculty of Natural Sciences, Eötvös Loránd University, Budapest, Hungary
Semmelweis University, Faculty of Medicine, Department of Oncology, Budapest, Hungary
J Contemp Brachytherapy 2023; 15, 1: 48–56
Online publish date: 2023/01/20
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To compare dosimetric parameters of brachytherapy (BT) treatment plans made with or without active source positions of the ring/ovoid (R/O) applicator in locally advanced cervical cancer patients.

Material and methods
Sixty patients with cervical cancer without vaginal involvement were selected for the study, who received intra-cavitary/interstitial BT. For each patient, two plans with and without active source dwell positions in R/O were created, using the same dose-volume constraints. EQD2 total doses from external beam and BT of target volumes and organs at risk (OARs) between the competing plans were compared.

There was no significant difference in the dose of high-risk clinical target volume (HR-CTV) and gross tumor volume (GTV) between the plans with inactive vs. active R/O. The mean D98 of intermediate-risk clinical target volume (IR-CTV) was significantly lower with inactive R/O; however, the GEC-ESTRO (EMBRACE II study) and ABS criteria were fulfilled in 96% in both plans. There was no difference in dose homogeneity, but conformity of the plans with inactive R/O was higher. Doses to all OARs were significantly lower in plans without R/O activation. While all the plans without R/O activation fulfilled the recommended dose criteria for OARs, it was less achievable with R/O activation.

Inactivation of R/O applicator results in similar dose coverage of the target volumes with lower doses to all OARs, as activation of R/O in cervix cancer patients when HR-CTV does not extend to R/O applicator. The use of active source positions in R/O shows worse performance regarding the fulfilment of the recommended criteria for OARs.


cervical cancer, ring activation, ring applicator, Venezia applicator, interstitial brachytherapy

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