Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T21:23:36.507Z Has data issue: false hasContentIssue false
  • English
  • Français

Inter-fraction variation in interstitial high-dose-rate brachytherapy

Published online by Cambridge University Press:  04 February 2015

Saravanan Kandasamy ,
K. S. Reddy ,
Vivekanandan Nagarajan ,
Parthasarathy Vedasoundaram  and
Gunaseelan Karunanidhi
Saravanan Kandasamy*
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
K. S. Reddy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Vivekanandan Nagarajan
Affiliation:
Medical Physics Department, Cancer Institute (WIA), Adyar, Chennai, India
Parthasarathy Vedasoundaram
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Gunaseelan Karunanidhi
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
*
Correspondence to: Saravanan Kandasamy, Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India. Tel/Fax: +919442030963; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

To evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.

Background

Although brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.

Materials and methods

A total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.

Results

For all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.

Conclusion

Inter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

Keywords

catheterhigh-dose brachytherapyinterfraction in HDRinterstitial implantpositional variation in HDR
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 2 , June 2015 , pp. 143 - 151
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ferlay, J, Soerjomataram, I, Ervik, Met al Cancer incidence and mortality worldwide: IARC CancerBase No. 11 GLOBOCAN 2012; V1.0.Google Scholar
2.Jemal, A, Murray, T, Samuels, A, Ghafoor, A, Ward, E, Thun, M J. Cancer statistics, 2003. Cancer J Clin 2003; 53 (1): 5–26.Google Scholar
3.Dale, R G, Jones, B. The clinical radiobiology of brachytherapy. Br J Radiol 1998; 71: 465–483.Google Scholar
4.Joslin, C A, Flynn, A, Hall, E J. Principles and Practice of Brachytherapy Using Afterloading Systems, 1st edition. London: Arnold, 2001: 1–229.Google Scholar
5.Eeva, K S, Krystyna, K, Geoffrey, S Iet al. International Conference on Advances in Radiation Oncology (ICARO): Outcomes of an IAEA Meeting. Rad Oncol 2011; doi:10.1186/1748-717X-6-11.Google Scholar
6.Martinez, A A, Pataki, I, Edmundson, G, Sebastian, E, Bradbbins, D, Gustafson, G. Phase II prospective study of the use of conformal high dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys 2001; 49: 61–69.Google Scholar
7.Hoskin, P J, Bownes, P J, Ostler, Pet al. High dose-rate afterloading brachytherapy for prostate cancer: catheter and gland movement between fractions. Radiother Oncol 2003; 68: 285–288.Google Scholar
8.Nath, R, Anderson, L L, Luxton, G, Weaver, K A, Williamson, J F, Meigooni, A S. Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys 1995; 22 (2): 209–234.Google Scholar
9.Saravanan, K, Reddy, K S, Nagarajan, V, Parthasarathy, V, Gunaseelan, K. Dosimetric impact of inter-fraction variation in interstitial HDR brachytherapy. Int J Med Phys, Clin Eng Radiat Oncol 2013; 2: 111–116.Google Scholar
10.Naiyanet, N, Oonsri, S, Lertbutsayanukul, C, Suriyapee, S. Measurement of patient’s setup variation in intensity modulated radiation therapy of head and neck cancer using electronic portal imaging device. Biomed Imaging Intervent J 2007; doi: 10.2349/biij.3.1.e30.Google Scholar
11.Velmurugan, T, Sukumar, P, Krishnappan, C, Boopathy, R. Study of dosimetric variation due to interfraction organ movement in high dose rate interstitial (MUPIT) brachytherapy for gynecologic malignancies. Pol J Med Phys Eng 2010; 16 (2): 85–95.Google Scholar
12.Narayan, K, Barkati, M, van Dyk, S, Bernshaw, D. Image-guided brachytherapy for cervix cancer: from Manchester to Melbourne. Expert Rev Anticancer Ther 2010; 10 (1): 41–46.Google Scholar
13.Nesvacil, N, Tanderup, K, Hellebust, T Pet al. A multicentre comparison of the dosimetric impact of inter- and intra-fractional anatomical variations in fractionated cervix cancer brachytherapy. Radiother Oncol 2013; 107: 20–25.Google Scholar
14.Kirisits, C, Lang, S, Dimopoulos, J, Oechs, K, Georg, C, Potter, R. Uncertainties when using only one MRI-based treatment plan for subsequent high-dose-rate tandem and ring applications in brachytherapy of cervix cancer. Radiother Oncol 2006; 81: 269–275.Google Scholar
15.Mohamed, S M I, Nielson, S K, Fokdal, L Uet al. Feasibility of applying a single treatment plan for both fractions in PDR image guided brachytherapy in cervix cancer. Radiother Oncol 2013.Google Scholar
16.Simnor, T, Li, S, Lowe, Get al. Justification for inter-fraction correction of catheter movement in fractionated high dose-rate brachytherapy treatment of prostate cancer. Radiother Oncol 2009; 93: 253–258.Google Scholar
17.Glasgow, G P, Bourland, J D, Grigsby, P W, Meli, J A, Weaver, K A. A report of AAPM Task Group No. 41 Remote Afterloading Technology, 1993; P-84.Google Scholar