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Comparing organ-at-risk doses for high-dose-rate vaginal brachytherapy between three different planning workflows
J D Gruhl1, D Zheng1, J L Longo2
1Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
Brachytherapy
|January 1, 2017
Summary
Standardized treatment planning for high-dose-rate vaginal brachytherapy (HDR-VB) in endometrial cancer patients may save time and costs. Minimal differences in organ-at-risk doses to the rectum and bladder were observed compared to individualized planning.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- High-dose-rate vaginal brachytherapy (HDR-VB) is a crucial treatment modality for postoperative endometrial cancer.
- Accurate dose delivery and minimizing radiation exposure to organs at risk (OARs), specifically the rectum and bladder, are paramount in HDR-VB planning.
- Current treatment planning workflows vary, impacting efficiency and potentially OAR doses.
Purpose of the Study:
- To compare organ-at-risk (rectum and bladder) doses in postoperative endometrial cancer patients undergoing HDR-VB.
- To evaluate three distinct treatment planning workflows: fully individualized (Workflow A), first-fraction individualized (Workflow B), and standardized template (Workflow C).
- To determine the dosimetric impact of a standardized template approach versus patient-specific planning.
Main Methods:
- Retrospective analysis of 22 patients who received HDR-VB for endometrial cancer.
- Alternative plans were generated using Workflow B and C for comparison with Workflow A (pre-existing individualized plans).
- Dosimetric parameters (D50, D2cc, D1cc, D0.1cc, V100) for the rectum and bladder were compared using the Wilcoxon signed-rank test.
Main Results:
- No significant dosimetric differences were found between Workflow A and Workflow B for rectal or bladder OARs.
- Workflow C (standardized template) resulted in significantly higher median doses to the rectum compared to Workflow A.
- Workflow C also delivered significantly higher doses to the bladder than Workflow A, though the magnitude of differences was small.
Conclusions:
- Standardized template planning (Workflow C) in HDR-VB for endometrial cancer may offer substantial time and cost savings.
- The observed differences in OAR doses between standardized and individualized planning were minimal.
- Plan standardization represents a viable strategy for improving efficiency in HDR-VB without compromising OAR safety significantly.
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