Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer

Tanvir Pasha; Hanan Naniparuthayil Hassann; Nikhila Radhakrishna; Muhammed Shafeeque N; Ajin Shaji Varghese; Lokesh Viswanath; Nithin Bhaskar Valuvil; Sathiyan S; Govardhan H B; Ibrahim Khaleel; Siddanna Rudrappa Palled; Naveen Thimmaiah

doi:10.5114/jcb.2021.112113

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy of cervical cancer

Tanvir Pasha

¹

,

Hanan Naniparuthayil Hassann

²

,

Nikhila Radhakrishna

¹

,

Muhammed Shafeeque N

³

,

Ajin Shaji Varghese

⁴

,

Lokesh Viswanath

¹

,

Nithin Bhaskar Valuvil

¹

,

Sathiyan S

^{1, 2}

,

Govardhan H B

¹

,

Ibrahim Khaleel

¹

,

Siddanna Rudrappa Palled

¹

,

Naveen Thimmaiah

¹

Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Department of Radiation Oncology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Yenepoya Medical College Hospital, Deralakatte, Mangalore, Karnataka, India
Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

J Contemp Brachytherapy 2021; 13, 6: 627–632

DOI: https://doi.org/10.5114/jcb.2021.112113

Online publish date: 2021/12/30

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AMA

Pasha T, Naniparuthayil Hassann H, Radhakrishna N, et al. Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer. Journal of Contemporary Brachytherapy. 2021;13(6):627-632. doi:10.5114/jcb.2021.112113.

APA

Pasha, T., Naniparuthayil Hassann, H., Radhakrishna, N., Shafeeque N, M., Shaji Varghese, A.,  & Viswanath, L. et al. (2021). Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer. Journal of Contemporary Brachytherapy, 13(6), 627-632. https://doi.org/10.5114/jcb.2021.112113

Chicago

Pasha, Tanvir, Hanan Naniparuthayil Hassann, Nikhila Radhakrishna, Muhammed Shafeeque N, Ajin Shaji Varghese, Lokesh Viswanath,  and Nithin Bhaskar Valuvil et al. 2021. "Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer". Journal of Contemporary Brachytherapy 13 (6): 627-632. doi:10.5114/jcb.2021.112113.

Harvard

Pasha, T., Naniparuthayil Hassann, H., Radhakrishna, N., Shafeeque N, M., Shaji Varghese, A., Viswanath, L., Bhaskar Valuvil, N., S, S., H B, G., Khaleel, I., Rudrappa Palled, S.,  and Thimmaiah, N. (2021). Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer. Journal of Contemporary Brachytherapy, 13(6), pp.627-632. https://doi.org/10.5114/jcb.2021.112113

MLA

Pasha, Tanvir et al. "Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer." Journal of Contemporary Brachytherapy, vol. 13, no. 6, 2021, pp. 627-632. doi:10.5114/jcb.2021.112113.

Vancouver

Pasha T, Naniparuthayil Hassann H, Radhakrishna N, Shafeeque N M, Shaji Varghese A, Viswanath L et al. Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy 
of cervical cancer. Journal of Contemporary Brachytherapy. 2021;13(6):627-632. doi:10.5114/jcb.2021.112113.

Introduction
To evaluate feasibility and safety of execution of optimized intra-cavitary brachytherapy (ICBT) plan of first fraction in subsequent fractions in high-volume, low-resource centers.

Material and methods
This non-randomized prospective study included 30 cervical cancer patients, who underwent 4 fractions of high-dose-rate (HDR)-ICBT in 2 applications, one week apart, 2 fractions per application delivered on two consecutive days. Computed tomography (CT) simulation was done before each fraction, organs at risk (OARs) were contoured on all sets of CT images. Optimized plans were generated for each set of CT images and executed for the treatment. Test treatment plans were retrospectively generated by applying first treatment fraction’s dwell times adjusted for decay, and dwell positions of the applicator for subsequent treatment fractions paired t-test was performed to analyze D2cc dose variations of OARs among the paired sets of plans.

Results
Comparison between the plans showed daily plans provided lower D2cc to OARs than test plans. In intra-application plan comparison, there was a significant dose reduction to 2 cc sigmoid (p = 0.021) and bladder (p = 0.007) in daily plan. Mean D2cc of optimized and unoptimized plans were 361.35 ±114.01 and 411.70 ±152.73 for sigmoid, and 511.23 ±85.47 cGy and 553.57 ±111.23 cGy for bladder, respectively. In inter-application, D2cc rectum and sigmoid demonstrated a statistically significant dose variation (p = 0.002) and (p = 0.007), with mean D2cc rectum of optimized and unoptimized plans being 401.06 ±83.53 cGy and 452.46 ±123.97 cGy, and of 2 cc sigmoid 340.84 ±117.90 cGy and 387.79 ±141.36 cGy, respectively.

Conclusions
Fractionated HDR brachytherapy amounts to significant variation in OAR doses if re-simulation and re-plan is not performed for every fraction and ICBT application. Therefore, plan of the day with optimization of the doses to target and OARs must be followed for each fraction.

keywords:

Evaluation of dosimetric impact of inter-application and intra-application variations in fractionated high-dose-rate intra-cavitary brachytherapy of cervical cancer

Tanvir Pasha 1 , Hanan Naniparuthayil Hassann 2 , Nikhila Radhakrishna 1 , Muhammed Shafeeque N 3 , Ajin Shaji Varghese 4 , Lokesh Viswanath 1 , Nithin Bhaskar Valuvil 1 , Sathiyan S 1, 2 , Govardhan H B 1 , Ibrahim Khaleel 1 , Siddanna Rudrappa Palled 1 , Naveen Thimmaiah 1

cervical cancer, organ at risk, anatomical variation, intracavitary brachytherapy