dc.contributor.author | Serban, Monica | |
dc.contributor.author | Kirisits, Christian | |
dc.contributor.author | de Leeuw, Astrid | |
dc.contributor.author | Pötter, Richard | |
dc.contributor.author | Jürgenliemk-Schulz, Ina | |
dc.contributor.author | Nesvacil, Nicole | |
dc.contributor.author | Swamidas, Jamema | |
dc.contributor.author | Hudej, Robert | |
dc.contributor.author | Lowe, Gerry | |
dc.contributor.author | Hellebust, Taran Paulsen | |
dc.contributor.author | Menon, Geetha | |
dc.contributor.author | Oinam, Arun | |
dc.contributor.author | Bownes, Peter | |
dc.contributor.author | Oosterveld, Bernard | |
dc.contributor.author | De Brabandere, Marisol | |
dc.contributor.author | Koedooder, Kees | |
dc.contributor.author | Marthinsen, Anne Beate Langeland | |
dc.contributor.author | Whitney, Diane | |
dc.contributor.author | Lindegaard, Jacob C. | |
dc.contributor.author | Tanderup, Kari | |
dc.date.accessioned | 2021-10-28T06:40:48Z | |
dc.date.available | 2021-10-28T06:40:48Z | |
dc.date.created | 2021-01-13T14:35:46Z | |
dc.date.issued | 2020 | |
dc.identifier.citation | International Journal of Radiation Oncology, Biology, Physics. 2020, 106 (5), 1052-1062. | en_US |
dc.identifier.issn | 0360-3016 | |
dc.identifier.uri | https://hdl.handle.net/11250/2826114 | |
dc.description.abstract | Purpose
The aim of this study was to investigate the influence of brachytherapy technique and applicator type on target dose, isodose surface volumes, and organ-at-risk (OAR) dose.
Methods and Materials
Nine hundred two patients treated with tandem/ovoids (T&O) (n = 299) and tandem/ring (T&R) (n = 603) applicators from 16 EMBRACE centers were analyzed. Patients received external beam radiation therapy and magnetic resonance imaging guided brachytherapy with dose prescription according to departmental practice. Centers were divided into 4 groups, according to applicator/technique: Ovoids and ring centers treating mainly with the intracavitary (IC) technique and ovoids and ring centers treating routinely with the intracavitary/interstitial (IC/IS) technique. V85Gy EQD210, CTVHR D90% (EQD210), and bladder, rectum, sigmoid, and vaginal 5-mm lateral-point doses (EQD23) were evaluated among center groups. Differences between T&O and T&R were tested with multivariable analysis.
Results
For similar point A doses, mean CTVHR D90% was 3.3 Gy higher and V85Gy was 23% lower for ring-IC compared with ovoids-IC centers (at median target volumes). Mean bladder/rectum doses (D2cm3 and ICRU-point) were 3.2 to 7.7 Gy smaller and vaginal 5-mm lateral-point was 19.6 Gy higher for ring-IC centers. Routine use of IC/IS technique resulted in increased target dose, whereas V85Gy was stable (T&R) or decreased (T&O); reduced bladder and rectum D2cm3 and bladder ICRU-point by 3.5 to 5.0 Gy for ovoids centers; and similar OAR doses for ring centers. CTVHR D90% was 2.8 Gy higher, bladder D2cm3 4.3 Gy lower, rectovaginal ICRU-point 4.8 Gy lower, and vagina 5-mm lateral-point 22.4 Gy higher for ring-IC/IS versus ovoids-IC/IS centers. The P values were <.002 for all comparisons. Equivalently, significant differences were derived from the multivariable analysis.
Conclusions
T&R-IC applicators have better target dose and dose conformity than T&O-IC in this representative patient cohort. IC applicators fail to cover large target volumes, whereas routine application of IC/IS improves target and OAR dose considerably. Patients treated with T&R show a more favorable therapeutic ratio when evaluating target, bladder/rectum doses, and V85Gy. A comprehensive view on technique/applicators should furthermore include practical considerations and clinical outcome. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | Elsevier | en_US |
dc.title | Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study | en_US |
dc.type | Peer reviewed | en_US |
dc.type | Journal article | en_US |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | The published version of the article will not be available due to copyright restrictions by Elsevier | en_US |
dc.source.pagenumber | 1052-1062 | en_US |
dc.source.volume | 106 | en_US |
dc.source.journal | International Journal of Radiation Oncology, Biology, Physics | en_US |
dc.source.issue | 5 | en_US |
dc.identifier.doi | 10.1016/j.ijrobp.2019.12.019 | |
dc.identifier.cristin | 1870738 | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |