eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2020
vol. 12
 
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abstract:
Original paper

The value of hybrid interstitial tandem and ring applicators for organ at risk dose reduction in small volume cervical cancer

Najeeb Crossley
,
Camrin Tipton
,
Teresa Meier
,
Mickaela Sudhoff
,
Jordan Kharofa

J Contemp Brachytherapy 2020; 12, 1: 12–16
Online publish date: 2020/02/28
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Purpose
Magnetic resonance imaging (MRI)-guided adaptive brachytherapy is the standard of care for cervical cancer. Hybrid intracavitary/interstitial applicators for bulky tumor (high-risk clinical target volume [HR-CTV] > 30 cc) dose escalation is recommended in the EMBRACE II trial. The value of hybrid applicators for smaller HR-CTV (< 30 cc) in organ at risk (OAR) sparing is less certain.

Material and methods
Twenty-seven patients with FIGO stage I-IVA cervical cancer treated with definitive chemoradiation and MRI-based brachytherapy using conventional tandem and ring (TR) applicators were re-planned using virtual needles. They were then summed with the external beam dose to evaluate target coverage and OAR dose using EQD2 summation. Target and OAR dose with/without hybrid applicator use were compared.

Results
Eighty-one percent had HR-CTV volumes < 30 cc, for which, hybrid TR applicators had significantly lower mean D2cc to all OARs without differences in target coverage. For HR-CTV < 30 cc, the bladder and rectal OAR goals per EMBRACE II were exceeded in significantly fewer patients with the hybrid TR applicators. No significant difference was found in the sigmoid D2cc dose goal.

Conclusions
In small volume tumors (< 30 cc), hybrid applicators may offer improved OAR sparing compared with conventional tandem and ring applicators, and may increase the proportion of patients meeting EMBRACE II OAR goals.

keywords:

cervical cancer, brachytherapy, hybrid applicator

 
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