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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2021
vol. 13
 
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abstract:
Original paper

Evaluation of the impact of EMBRACE II protocol in Spanish centers, with a large cohort of patients using a ranking index

Jose Chimeno
1
,
Naiara Fuentemilla
2
,
Paula Monasor
3
,
Francisco Celada
1
,
Elena Villafranca
2
,
Sílvia Rodriguez
3
,
María José Pérez-Calatayud
1
,
Santiago Pellejero
2
,
Jose Pérez-Calatayud
1, 3

  1. Radiotherapy Department, La Fe University Hospital, Valencia, Spain
  2. Complejo Hospitalario de Navarra, Pamplona, Spain
  3. Hospital Clínica Benidorm, Benidorm, Spain
J Contemp Brachytherapy 2021; 13, 6: 680–686
DOI: https://doi.org/10.5114/jcb.2021.112119
Online publish date: 2021/12/30
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Introduction
The aim of this paper was to assess development of high-dose-rate (HDR) cervix brachytherapy (BT) implants in three Spanish institutions before and after introduction of EMBRACE II protocol.

Material and methods
392 patients from three different institutions, treated between 2009 and 2019 were analyzed. D90 of high-risk clinical target volume (HR-CTV) and D2cc of organs at risk (OARs) of all patients were collected. Statistical distribution was analyzed for two different periods of time: before and after EMBRACE II publication. Index I was applied based on collected dosimetric quantities (D90 and D2cc) to enhance equilibrium between HR-CTV coverage and doses to OARs. Variation in dosimetry and index depending on CTV and technique used (IC vs. IC/IT) were also evaluated.

Results
Adaptation of institutions to EMBRACE II protocol resulted in a statistically significant increase of D90 HR-CTV (Institution 1; p < 0.00001) or decrease of D2cc OARs (Institution 2; p < 0.04). Increase in the use of interstitial component showed higher coverage of HR-CTV for Institution 3 (p = 0.03), and lower doses to OARs for the same coverage of HR-CTV at Institution 2 (p-OARs < 0.03). Even though index I was only significantly different between periods for Institution 1 (p < 0.0000001), it was able to show a reduction of dose variability related to higher expertise and higher interstitial component.

Conclusions
Depending on local protocol before EMBRACE II, the adaptation through increasing interstitial component and physician and physicist training, resulted in a significant increase of HR-CTV doses or reduction of OARs doses. Index I was able to describe an evolution of equilibrium between CTV coverage and OARs’ sparing.

keywords:

brachytherapy, cervix, dosimetric index, EMBRACE II

  
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