Reduced toxicity with equivalent outcomes using three-dimensional volumetric (3DV) image-based versus nonvolumetric point-based (NV) brachytherapy in a cervical cancer population.

Authors:
Strahinja Stojadinovic, Ph.D.
Strahinja Stojadinovic, Ph.D.
UT Southwestern Medical Center
Associate Professor
Medical Physics
Dallas, TX | United States

Brachytherapy 2017 Sep - Oct;16(5):943-948. Epub 2017 Jun 8.

Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Purpose: Brachytherapy (BT) techniques have historically used a two-dimensional nonvolumetric (NV) system involving dose prescribed to a point fixed in space. We compared dosimetric, toxicity, and oncologic outcomes for volumetric planning (3DV) versus CT point-based planning.

Methods And Materials: Patients treated with external beam radiation therapy and high dose rate (HDR) intracavitary BT were included (n = 71). Patients planned with NV BT treated from 2009 to 2011 (n = 37) were compared to patients planned with 3DV BT treated from 2012 to 2014 (n = 34). Investigators delineated volumes for organs at risk clinical target volumes for the 2009-2011 NV cohort. Acute and chronic toxicity data were graded.

Results: The mean HDR clinical target volume D90 received in the NV and 3DV cohorts were significantly different (p < 0.001). The mean dose to point A was significantly higher in the NV cohort than in the 3DV cohort (p < 0.001). There were significantly more Grade 3 or higher gastrointestinal toxicities in the NV cohort (p = 0.048). There was a nonsignificant trend toward improved oncologic outcomes for patients undergoing CT-based planning.

Conclusions: 3DV BT allows for a significant reduction of dose to critical structures, resulting in decreased gastrointestinal toxicity, while delivering noninferior doses to the high-risk clinical target volume. Outcomes were improved in the 3D cohort trending toward statistical significance.

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Source
http://dx.doi.org/10.1016/j.brachy.2017.05.001DOI Listing
April 2018
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