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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 10
Original paper

Dosimetric evaluation of Point A and volume-based high-dose-rate plans: a single institution study on adaptive brachytherapy planning for cervical cancer

Arun George Paul, Adrian Nalichowski, Judith Abrams, Peter Paximadis, Ling Zhuang, Steven Miller

J Contemp Brachytherapy 2018; 10, 3: 202–210
Online publish date: 2018/06/28
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External beam radiation therapy (EBRT) and brachytherapy (BT) with concurrent cisplatin is the standard of care for locally advanced cervical cancer. The applicability of image-guided adaptive volume-based high-dose-rate (HDR) intracavitary brachytherapy planning is an active area of investigation. In this study, we examined whether volume-based HDR-BT (HDRVOL) plans leads to more conformal plans compared to Point A (HDRPointA)-based plans.

Material and methods
Two hundred and forty HDRPointA plans from 48 cervical cancer patients treated with chemoradiotherapy were retrospectively collected. Point A plans were renormalized with respect to the high-risk clinical target volume (HR-CTV) for the HDRVOL plans. The doses to organs at risk (OAR; rectum, sigmoid, and bladder), and HR-CTV and the conformal index were compared between HDRPointA and HDRVOL plans.

HDRVOL plans resulted in a 6-12% reduction in the total dose (EBRT + HDR-BT) to 0.1 cc, 1.0 cc, and 2.0 cc of the OAR as well as an 8-37% reduction in the dose to 2 cc of OAR per HDR-BT fraction compared to HDRPointA plans. Differences in the conformal indexes between the two groups of plans showed an 18-31% relative increase per HDR-BT fraction for HDRVOL plans. The D90 of the HR-CTV was reduced by 11% by HDRVOL planning and had a median dose of 86 Gy.

Our study reports the relative improvement in OAR doses per HDR-BT fraction by HDRVOL planning compared to HDRPointA planning and demonstrates the dosimetric advantages of volume-based HDR-BT planning in creating more conformal plans.


brachytherapy, cervical cancer, HDR, image-guided, Point A, radiation-planning

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