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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Critical structure movement in cervix brachytherapy.

Clare Anderson1, Gerry Lowe, Rachel Wills

  • 1Mount Vernon Cancer Centre, Northwood, UK. clare.anderson@nhs.net

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|March 7, 2013
PubMed
Summary

Organ movement during MR-guided cervix brachytherapy can significantly alter radiation doses to organs at risk (OARs). Pre-treatment imaging is crucial for adjusting dosimetry to minimize these dose changes and improve treatment accuracy.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Gynecologic Oncology

Background:

  • Cervix brachytherapy utilizes Magnetic Resonance (MR) imaging for precise tumor targeting.
  • Conformal radiotherapy aims to deliver accurate radiation doses while sparing organs at risk (OARs).
  • Organ movement between planning and treatment can lead to dose discrepancies.

Purpose of the Study:

  • To assess critical structure movement and its impact on radiation dose delivery in MR-guided cervix brachytherapy.
  • To evaluate dose variations in organs at risk (OARs) due to anatomical changes.

Main Methods:

  • 21 patients with cervical cancer undergoing high-dose-rate (HDR) brachytherapy were studied.
  • Planning and pre-treatment MR scans were acquired for each patient.
  • Organs at risk (bowel, bladder, rectum) were contoured, and dosimetry was compared between scans.

Main Results:

  • Significant inter-patient variations in OAR doses were observed, with differences up to 3.3 Gy.
  • In 61.1% (bladder), 41.7% (rectum), and 47.2% (bowel) of fractions, the D2cc dose varied by at least 10% from the planned dose.
  • No correlation was found between the time interval (average 4.75 hours) and OAR movement.

Conclusions:

  • Organ movement is unpredictable but can cause substantial dose changes in individual patients.
  • A significant proportion of fractions experienced at least a 10% change in OAR D2cc dose.
  • Pre-treatment imaging and dosimetry adjustment are recommended to mitigate the impact of organ movement.