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Short-term clinical outcome and dosimetric comparison of tandem and ring versus tandem and ovoids intracavitary applicators.

Ma JK, Mourad WF, Allbright R, Packianathan S, Harrell LM, Chinchar E, Nguyen A, Vijayakumar S - J Contemp Brachytherapy (2015)

Bottom Line: Treatment time and irradiated tissue volume were compared.No significant differences in the dose to the right and left point A, or the left point B were observed.Long-term clinical outcomes will be elucidated with longer follow up period.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To compare the short-term toxicity and dosimetry of tandem and ring (TR), and tandem and ovoid (TO) applicators in treatment of gynecologic malignancy.

Material and methods: Following pelvic external beam radiation therapy (EBRT), a total of 52 computed tomography-based plans from 13 patients with cervical cancer (FIGO IB2-IIIB) were evaluated for HDR brachytherapy. Prescription was 7 Gy to the ICRU point A for four weekly fractions. Gastrointestinal and genitourinary toxicities were evaluated. Clinical target volume (CTV) and organs at risk were delineated on CT scans. Bladder, rectum, and sigmoid mean doses and D2cc were calculated. Treatment time and irradiated tissue volume were compared. Percent of CTV receiving 100% (CTV100%) of the prescribed dose as well as the percent of the prescription dose covering 90% of the CTV (D90) were evaluated.

Results: Gastrointestinal and genitourinary toxicities were not different between TO and TR applicators. No significant differences in the dose to the right and left point A, or the left point B were observed. TO delivered a higher dose to right point B. Organs at risk doses were similar between the two applicators, except mean rectal dose was lower for TO applicator. Overall, TO treats a larger tissue volume than TR. Mean treatment time was shorter for TR. Tumor coverage (D90 and CTV100%) was equivalent between TO and TR applicators.

Conclusion: Although TO treats a larger tissue volume than TR, short-term toxicities and tumor coverage are similar. Long-term clinical outcomes will be elucidated with longer follow up period.

No MeSH data available.


Related in: MedlinePlus

A) Tandem and ovoids applicator assembled. B) Tandem and ring applicator assembled
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Figure 0001: A) Tandem and ovoids applicator assembled. B) Tandem and ring applicator assembled

Mentions: The selection of applicator was based on preference and the experience of the attending physician. One physician used TO applicators exclusively, whereas the other radiation oncologist preferred TR applicators. The first insertion of ICBT applicators was performed while patients were under anesthesia in the operating room. A Foley catheter filled with saline solution was inserted into the bladder. Sounding the uterus, cervical dilation, and Smitt sleeve placement typically took place in the OR in the presence of a gynecologic oncologist. After applicator placement was verified, vaginal packing was applied. The subsequent applicator insertions were performed in the outpatient clinic with the patient placed under conscious sedation. The TO and TR applicators are shown in Figure 1. Small ovoids were utilized in the 32 TO insertions. Vaginal packing was applied subsequently for TO insertions, both anterior and posterior to the tandem to minimize bladder and rectal doses. Rectal tube was inserted, after which rectal contrast was injected. For TR insertions, 60° ring and rectal retractor were utilized in all TR patients.


Short-term clinical outcome and dosimetric comparison of tandem and ring versus tandem and ovoids intracavitary applicators.

Ma JK, Mourad WF, Allbright R, Packianathan S, Harrell LM, Chinchar E, Nguyen A, Vijayakumar S - J Contemp Brachytherapy (2015)

A) Tandem and ovoids applicator assembled. B) Tandem and ring applicator assembled
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499513&req=5

Figure 0001: A) Tandem and ovoids applicator assembled. B) Tandem and ring applicator assembled
Mentions: The selection of applicator was based on preference and the experience of the attending physician. One physician used TO applicators exclusively, whereas the other radiation oncologist preferred TR applicators. The first insertion of ICBT applicators was performed while patients were under anesthesia in the operating room. A Foley catheter filled with saline solution was inserted into the bladder. Sounding the uterus, cervical dilation, and Smitt sleeve placement typically took place in the OR in the presence of a gynecologic oncologist. After applicator placement was verified, vaginal packing was applied. The subsequent applicator insertions were performed in the outpatient clinic with the patient placed under conscious sedation. The TO and TR applicators are shown in Figure 1. Small ovoids were utilized in the 32 TO insertions. Vaginal packing was applied subsequently for TO insertions, both anterior and posterior to the tandem to minimize bladder and rectal doses. Rectal tube was inserted, after which rectal contrast was injected. For TR insertions, 60° ring and rectal retractor were utilized in all TR patients.

Bottom Line: Treatment time and irradiated tissue volume were compared.No significant differences in the dose to the right and left point A, or the left point B were observed.Long-term clinical outcomes will be elucidated with longer follow up period.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To compare the short-term toxicity and dosimetry of tandem and ring (TR), and tandem and ovoid (TO) applicators in treatment of gynecologic malignancy.

Material and methods: Following pelvic external beam radiation therapy (EBRT), a total of 52 computed tomography-based plans from 13 patients with cervical cancer (FIGO IB2-IIIB) were evaluated for HDR brachytherapy. Prescription was 7 Gy to the ICRU point A for four weekly fractions. Gastrointestinal and genitourinary toxicities were evaluated. Clinical target volume (CTV) and organs at risk were delineated on CT scans. Bladder, rectum, and sigmoid mean doses and D2cc were calculated. Treatment time and irradiated tissue volume were compared. Percent of CTV receiving 100% (CTV100%) of the prescribed dose as well as the percent of the prescription dose covering 90% of the CTV (D90) were evaluated.

Results: Gastrointestinal and genitourinary toxicities were not different between TO and TR applicators. No significant differences in the dose to the right and left point A, or the left point B were observed. TO delivered a higher dose to right point B. Organs at risk doses were similar between the two applicators, except mean rectal dose was lower for TO applicator. Overall, TO treats a larger tissue volume than TR. Mean treatment time was shorter for TR. Tumor coverage (D90 and CTV100%) was equivalent between TO and TR applicators.

Conclusion: Although TO treats a larger tissue volume than TR, short-term toxicities and tumor coverage are similar. Long-term clinical outcomes will be elucidated with longer follow up period.

No MeSH data available.


Related in: MedlinePlus