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Title: CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters

Abstract

Purpose: To perform an intracavitary radiotherapy (ICR) plan comparison between the conventional point A plan (conventional plan) and computed tomography (CT)-guided clinical target volume-based plan (CTV plan) by analysis of the quantitative dose-volume parameters and irradiated volumes of organs at risk in patients with cervical cancer. Methods and Materials: Thirty plans for {sup 192}Ir high-dose-rate ICR after 30-40-Gy external beam radiotherapy were investigated. CT images were acquired at the first ICR session with artifact-free applicators in place. The gross tumor volume, clinical target volume (CTV), point A, and International Commission on Radiation Units and Measurements Report 38 rectal and bladder points were defined on reconstructed CT images. A fractional 100% dose was prescribed to point A in the conventional plan and to the outermost point to cover all CTVs in the CTV plan. The reference volume receiving 100% of the prescribed dose (V{sub ref}), and the dose-volume parameters of the coverage index, conformal index, and external volume index were calculated from the dose-volume histogram. The bladder, rectal point doses, and percentage of volumes receiving 50%, 80%, and 100% of the prescribed dose were also analyzed. Results: Conventional plans were performed, and patients were categorized on the basis of whether themore » 100% isodose line of point A prescription dose fully encompassed the CTV (Group 1, n = 20) or not (Group 2, n = 10). The mean gross tumor volume (11.6 cm{sup 3}) and CTV (24.9 cm{sup 3}) of Group 1 were smaller than the corresponding values (23.7 and 44.7 cm{sup 3}, respectively) for Group 2 (p = 0.003). The mean V{sub ref} for all patients was 129.6 cm{sup 3} for the conventional plan and 97.0 cm{sup 3} for the CTV plan (p = 0.003). The mean V{sub ref} in Group 1 decreased markedly with the CTV plan (p < 0.001). For the conventional and CTV plans in all patients, the mean coverage index, conformal index, and external volume index were 0.98 and 1.0, 0.23 and 0.34, and 3.86 and 2.15, respectively. Statistical analysis showed that the conformal index and external volume index improved significantly with the CTV plan, and this improvement was more marked in Group 1. The mean values of the bladder and rectal point doses and volume fractions receiving 50%, 80%, and 100% of the reference dose did not differ between plans for all patients. The reduction in the mean rectal and bladder point doses and irradiated volumes for the CTV plan was statistically significant in Group 1. Conclusion: Computed tomography-guided CTV planning of ICR is superior to conventional point A planning in terms of conformity of target coverage and avoidance of overdosed normal tissue volume. To ascertain the potential benefit of treatment outcome, ICR with image-guided three-dimensional plans will be pursued and correlated with the dose-volume parameters.« less

Authors:
 [1];  [2];  [1];  [1];  [1];  [1];  [1];  [1];  [1];  [1]
  1. Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi (Korea, Republic of)
  2. Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi (Korea, Republic of). E-mail: k2onco@ncc.re.kr
Publication Date:
OSTI Identifier:
20788285
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2005.06.015; PII: S0360-3016(05)01122-3; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; CARCINOMAS; CAT SCANNING; DOSE RATES; IMAGES; ION CYCLOTRON-RESONANCE; IRIDIUM 192; IRRADIATION; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Shin, Kyung Hwan, Kim, Tae Hyun, Cho, Jung Keun, Kim, Joo-Young, Park, Sung Yong, Park, Sang-Yoon, Kim, Dae Yong, Chie, Eui Kyu, Pyo, Hong Ryull, and Cho, Kwan Ho. CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Shin, Kyung Hwan, Kim, Tae Hyun, Cho, Jung Keun, Kim, Joo-Young, Park, Sung Yong, Park, Sang-Yoon, Kim, Dae Yong, Chie, Eui Kyu, Pyo, Hong Ryull, & Cho, Kwan Ho. CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters. United States. doi:10.1016/J.IJROBP.2005.0.
Shin, Kyung Hwan, Kim, Tae Hyun, Cho, Jung Keun, Kim, Joo-Young, Park, Sung Yong, Park, Sang-Yoon, Kim, Dae Yong, Chie, Eui Kyu, Pyo, Hong Ryull, and Cho, Kwan Ho. Sun . "CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788285,
title = {CT-guided intracavitary radiotherapy for cervical cancer: Comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose-volume parameters},
author = {Shin, Kyung Hwan and Kim, Tae Hyun and Cho, Jung Keun and Kim, Joo-Young and Park, Sung Yong and Park, Sang-Yoon and Kim, Dae Yong and Chie, Eui Kyu and Pyo, Hong Ryull and Cho, Kwan Ho},
abstractNote = {Purpose: To perform an intracavitary radiotherapy (ICR) plan comparison between the conventional point A plan (conventional plan) and computed tomography (CT)-guided clinical target volume-based plan (CTV plan) by analysis of the quantitative dose-volume parameters and irradiated volumes of organs at risk in patients with cervical cancer. Methods and Materials: Thirty plans for {sup 192}Ir high-dose-rate ICR after 30-40-Gy external beam radiotherapy were investigated. CT images were acquired at the first ICR session with artifact-free applicators in place. The gross tumor volume, clinical target volume (CTV), point A, and International Commission on Radiation Units and Measurements Report 38 rectal and bladder points were defined on reconstructed CT images. A fractional 100% dose was prescribed to point A in the conventional plan and to the outermost point to cover all CTVs in the CTV plan. The reference volume receiving 100% of the prescribed dose (V{sub ref}), and the dose-volume parameters of the coverage index, conformal index, and external volume index were calculated from the dose-volume histogram. The bladder, rectal point doses, and percentage of volumes receiving 50%, 80%, and 100% of the prescribed dose were also analyzed. Results: Conventional plans were performed, and patients were categorized on the basis of whether the 100% isodose line of point A prescription dose fully encompassed the CTV (Group 1, n = 20) or not (Group 2, n = 10). The mean gross tumor volume (11.6 cm{sup 3}) and CTV (24.9 cm{sup 3}) of Group 1 were smaller than the corresponding values (23.7 and 44.7 cm{sup 3}, respectively) for Group 2 (p = 0.003). The mean V{sub ref} for all patients was 129.6 cm{sup 3} for the conventional plan and 97.0 cm{sup 3} for the CTV plan (p = 0.003). The mean V{sub ref} in Group 1 decreased markedly with the CTV plan (p < 0.001). For the conventional and CTV plans in all patients, the mean coverage index, conformal index, and external volume index were 0.98 and 1.0, 0.23 and 0.34, and 3.86 and 2.15, respectively. Statistical analysis showed that the conformal index and external volume index improved significantly with the CTV plan, and this improvement was more marked in Group 1. The mean values of the bladder and rectal point doses and volume fractions receiving 50%, 80%, and 100% of the reference dose did not differ between plans for all patients. The reduction in the mean rectal and bladder point doses and irradiated volumes for the CTV plan was statistically significant in Group 1. Conclusion: Computed tomography-guided CTV planning of ICR is superior to conventional point A planning in terms of conformity of target coverage and avoidance of overdosed normal tissue volume. To ascertain the potential benefit of treatment outcome, ICR with image-guided three-dimensional plans will be pursued and correlated with the dose-volume parameters.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 64,
place = {United States},
year = {Sun Jan 01 00:00:00 EST 2006},
month = {Sun Jan 01 00:00:00 EST 2006}
}