eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2013
vol. 5
 
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abstract:

Original paper
The dosimetric impact of vaginal balloon-packing on intracavitary high-dose-rate brachytherapy for gynecological cancer

William M. Rockey
,
Sudershan K. Bhatia
,
Geraldine M. Jacobson
,
Yusung Kim

J Contemp Brachytherapy 2013; 5, 1: 17–22
Online publish date: 2013/04/05
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Purpose: We perform a clinical retrospective study to determine whether a vaginal balloon-packing system provides a dosimetric reduction to organs at risk (OARs) versus traditional gauze packing for gynecological high-dose-rate brachytherapy (HDR-BT). We also test various balloon filling materials for optimizing imaging quality.

Material and methods: Filling materials for balloon-packing were evaluated based on imaging quality with X-ray, computerized tomography, and magnetic resonance imaging modalities. We then retrospectively reviewed 45 HDR-BT plans of 18 patients performed with gauze packing and 39 plans of 16 patients performed with balloon-packing. Twelve patients received both gauze and balloon-packing. HDR-BT was delivered with an iridium-192 afterloader and a Fletcher-Suit-Declos-style T&O applicator. At each fraction, 3D imaging was obtained. The D2cc values of OARs were calculated, as well as ICRU-defined point doses.

Results: In the 84 HDR fractions reviewed, vaginal balloon-packing provides statistically equivalent doses to rectum, bladder, and sigmoid compared to gauze packing. On average balloon-packing produced average reductions of 3.3% and 6.9% in the rectal and sigmoid D2cc doses and an increase of 3.2% to the bladder D2cc dose (normalized to prescription dose), although none of these values were statistically significant for the twelve patients who received both gauze and balloon-packing (32 and 40 total fractions, respectively).

Conclusions: In the 84 HDR fractions analyzed, vaginal balloon-packing is as effective as gauze packing for dose sparing to the rectum, bladder, and sigmoid. A 1 : 1 solution of saline and contrast for filling material enables easy contouring for image-guided HDR with minimal artefacts.
keywords:

brachytherapy, gynecological cancer, high-dose-rate brachytherapy, vaginal balloon packing

 
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