Brachytherapy dose changes: comparing in-room and out-room image-guided brachytherapy. A randomized study

Pooriwat Muangwong; Ekkasit Tharavichitkul; Patumrat Sripan; Somvilai Chakrabandhu; Pitchayaponne Klunklin; Wimrak Onchan; Bongkot Jia-Mahasap; Razvan Galalae; Imjai Chitapanarux

doi:10.5114/jcb.2022.118940

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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4/2022
vol. 14

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abstract:

Original paper

Brachytherapy dose changes: comparing in-room and out-room image-guided brachytherapy. A randomized study

Pooriwat Muangwong

^{1, 2}

,

Ekkasit Tharavichitkul

^{1, 2}

,

Patumrat Sripan

³

,

Somvilai Chakrabandhu

^{1, 2}

,

Pitchayaponne Klunklin

^{1, 2}

,

Wimrak Onchan

^{1, 2}

,

Bongkot Jia-Mahasap

^{1, 2}

,

Razvan Galalae

^{4, 5}

,

Imjai Chitapanarux

^{1, 2}

Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
Department of Radiotherapy, Faculty of Medicine, Christian-Albrecht’s University, Kiel, Germany
MedAustron, Center for Carbon ion Therapy and Research, Wiener Neustadt, Vienna, Austria

J Contemp Brachytherapy 2022; 14, 4: 347–353

DOI: https://doi.org/10.5114/jcb.2022.118940

Online publish date: 2022/08/19

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Introduction
Image-based brachytherapy, involving an image machine and a brachytherapy unit in the same room (in-room brachytherapy [IRBT]), limits patient movements; however, this technique may not be feasible in high workload centers. In this study, we compared changes in the dose and volume of organs at risk (OARs) with out-room brachytherapy (ORBT) technique, in which patients musted be transferred to a waiting room and then transferred back for brachytherapy delivery.

Material and methods
This was a randomized prospective study comparing changes in D2cc doses and volume of OARs during IRBT and ORBT. Patients underwent CT for treatment planning (CT1) installed in brachytherapy loading room, and another CT immediately before brachytherapy (CT2) during each fraction. While patients remained on CT table after CT1 during treatment planning and delivery in IRBT arm, they were transferred out to waiting room and back to CT table in ORBT arm. CT2 was analyzed with CT1 to evaluate any changes in volumes and doses.

Results
A total of 294 fractions of brachytherapy were considered. The findings indicated no significant differences in the mean D2cc changes (Gy) (CT2 minus CT1) to the bladder, rectum, and sigmoid between IRBT and ORBT (mean ±SD: –0.07 ±0.36 vs. –0.01 ±0.39, p = 0.1426; –0.15 ±0.32 vs. –0.14 ±0.29, p = 0.8898; –0.17 ±0.38 vs. –0.19 ±0.31, p = 0.5221, respectively). Moreover, significant correlations were observed between D2cc changes and volume changes to each of OARs, p < 0.001.

Conclusions
IRBT does not result in differences in dose changes between planning and pre-treatment imaging when compared with ORBT. Consequently, ORBT can be considered for routine practice in high workload centers. Correlations in volume change and dose change to OARs were also observed.

keywords:

Brachytherapy dose changes: comparing in-room and out-room image-guided brachytherapy. A randomized study

Pooriwat Muangwong 1, 2 , Ekkasit Tharavichitkul 1, 2 , Patumrat Sripan 3 , Somvilai Chakrabandhu 1, 2 , Pitchayaponne Klunklin 1, 2 , Wimrak Onchan 1, 2 , Bongkot Jia-Mahasap 1, 2 , Razvan Galalae 4, 5 , Imjai Chitapanarux 1, 2

HDR brachytherapy, brachytherapy, image-guided brachytherapy, dose change, cervical cancer

Pooriwat Muangwong

^{1, 2}

,

Ekkasit Tharavichitkul

^{1, 2}

,

Patumrat Sripan

³

,

Somvilai Chakrabandhu

^{1, 2}

,

Pitchayaponne Klunklin

^{1, 2}

,

Wimrak Onchan

^{1, 2}

,

Bongkot Jia-Mahasap

^{1, 2}

,

Razvan Galalae

^{4, 5}

,

Imjai Chitapanarux

^{1, 2}