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

Assessment of dose to vaginal mucosa for gynecologic template interstitial high-dose-rate brachytherapy using Monte Carlo simulation

Devin Van Elburg
1, 2
Tyler Meyer
1, 2, 3
Kevin Martell
Sarah Quirk
Michael Roumeliotis

Department of Physics & Astronomy, University of Calgary, Calgary AB, Canada
Medical Physics Department, Tom Baker Cancer Centre, Calgary AB, Canada
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary AB, Canada
Department of Radiation Oncology, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
J Contemp Brachytherapy 2023; 15, 5: 317–324
Online publish date: 2023/10/03
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This study investigated reliable vaginal mucosa dose-volume histogram (DVH) metrics in gynecologic template interstitial high-dose-rate brachytherapy (HDR-BT) for the purpose of standardized dose reporting.

Material and methods:
Gynecologic template (Syed/Neblett) interstitial HDR-BT patients treated from September 2016 to November 2022 at the study institute were included in the cohort. Each patient implant included a vaginal mucosa contour defined by a 5 mm expansion from vaginal cylinder, then another volume with clinical target volume subtracted. DVH metrics were investigated between D0.1cc to D4cc. Clinical plans were re-calculated using Monte Carlo (MC) simulations both in heterogeneous material and in water.

The patient cohort included 61 patients with clinical plans using conventional homogeneous dose calculation (TG43). Heterogeneous vs. water MC dose differences were between –1.1% and –1.4% for all metrics investigated. DVH metrics D1cc and smaller resulted in > 5% discrepancies between TG43 and MC dose (to water) calculation due to the proximity of source positions in/nearby the vaginal mucosa. Reliability improved when DVH metric volume was larger (D2cc and D4cc). Both D2cc and D4cc presented very high linear correlation between TG43 and MC reported doses for the vagina, and average ± standard deviation dose difference was 4.6 ±2.9% and –3.0 ±1.9%, respectively. Dose differences decreased when the clinical target volume was removed: –1.5 ±3.5% and –0.8 ±2.1% for D2cc and D4cc, respectively.

For perineal template gynecologic HDR-BT procedures, the 2 cc volume is the smallest representative volume that reliably reports vaginal dose and at minimum should be reported to establish dose and outcome evaluation.


brachytherapy, interstitial radiotherapy, gynecologic cancers, dosimetry calculations

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