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Conformal brachytherapy planning for cervical cancer using transabdominal ultrasound
Sylvia Van Dyk1, Kailash Narayan, Richard Fisher
1Radiation Therapy Services, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia. sylvia.vandyk@petermac.org
Purpose:
To determine if transabdominal ultrasound (US) can be used for conformal brachytherapy in cervical cancer patients.
Materials And Methods:
Seventy-one patients with locoregionally advanced cervix cancer treated with chemoradiation and brachytherapy were included in this study. The protocol consisted of US-assisted tandem insertion and conformal US-based planning. Orthogonal films for applicator reconstruction were also taken. A standard plan was modified to suit the US-based volume and treatment was delivered. The patient then underwent a magnetic resonance imaging (MRI) scan with the applicators in situ. Retrospectively, individual standard (STD), US, and MRI plans were extrapolated for five fractions and superimposed onto the two-dimensional sagittal MRI images for comparison. Doses to Point A, target volume, International Commission on Radiation Units and Measurements (ICRU) 38 bladder and rectal points, and individualized bowel points were calculated on original implant geometry on Plato for each planning method.
Results:
STD (high-dose-rate) plans reported higher doses to Point A, target volume, ICRU 38 bladder and rectal points, and individualized bowel point compared with US and MRI plans. There was a statistically significant difference between standard plans and image-based plans-STD vs. US, STD vs. MRI, and STD vs. Final-having consistent (p
Conclusions:
Transabdominal ultrasound offers an accurate, quick, accessible, and cost-effective method of conformal brachytherapy planning.
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