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Ureter dose optimization during image guided brachytherapy for cervical cancer
Asma Sarwar1, Narinder Lalli2, Gemma Eminowicz1
1University College London Hospitals, London, United Kingdom; University College London, London, United Kingdom.
Brachytherapy
|April 15, 2022
Summary
Radiation dose to ureters during brachytherapy can cause stenosis. Re-optimizing treatment plans reduced ureter dose and toxicity risk in cervical cancer patients, while maintaining tumor coverage.
Area of Science:
- Radiation Oncology
- Medical Physics
- Gynecologic Oncology
Background:
- Image-guided radiotherapy and interstitial brachytherapy are standard for cervical cancer.
- Radiation dose to the ureters is a known cause of toxicity.
- Ureteric stenosis is a potential complication of brachytherapy for cervical cancer.
Purpose of the Study:
- To investigate ureter dose in cervical cancer brachytherapy patients.
- To evaluate the impact of re-optimizing treatment plans on ureter dose.
- To assess the feasibility of reducing ureter dose while maintaining target coverage and organ-at-risk constraints.
Main Methods:
- Retrospective analysis of 106 cervical cancer patients.
- Contouring of 212 ureters and dose recording.
- Re-optimization of brachytherapy plans for 20 MRI-planned patients to reduce ureter dose.
Main Results:
- Crude incidence of ureteric stenosis was 6.6%.
- Initial average ureter dose was 75.8 Gy (right) and 74.4 Gy (left).
- Re-optimization reduced ureter dose significantly (e.g., 91.1 Gy to 84.4 Gy on the right).
- Smaller tumors with better HRCTV coverage saw greater dose reduction (13.3%).
- Organ at risk doses to rectum, sigmoid, and bladder were also reduced.
Conclusions:
- MRI-guided brachytherapy with interstitial needles poses a risk of ureteric stenosis.
- Contouring ureters and implementing dose constraints are crucial for reducing ureter dose.
- Balancing ureter dose reduction with maintaining high-risk clinical target volume (HRCTV) coverage is essential.
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