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Cumulative dose assessment in combined radiotherapy for locally advanced cervical cancer using deformable image
Jiahao Wang1, Yeqiang Tu1, Yuanyuan Chen1
1Department of Radiation Oncology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China.
Background And Purpose:
Direct dose-volume histogram (DVH) parameter addition (PA) is widely used to evaluate cumulative doses in combined external beam radiation therapy (EBRT) and brachytherapy (BT) for locally advanced cervical cancer (LACC), while it shows discrepancies compared to deformable dose summation (DS). Optimizing EBRT dosimetric uniformity within the predefined BT target volume (BTV) may enhance the dosimetric consistency between PA and DS estimations. This study aims to assess the dosimetric impact of using deformable image registration (DIR) based on BTV dose uniformity to determine the cumulative EBRT and BT doses to the targets and organs at risk.
Methods And Materials:
Twenty-one LACC patients were stratified into nodal-boost EBRT+BT (n=16) and non-boost EBRT+BT (n=5) cohorts. Cumulative doses were calculated via direct DVH PA, routine deformable DS (DS_Routine), and deformable DS based on BTV dose uniformity (DS_BTV). Dosimetric differences of D90% in high- and intermediate-risk clinical target volume (HRCTV/IRCTV) and D2cc in organs at risk (bladder and rectum) were analyzed by one-way ANOVA for three methods, and dose agreement was performed by Bland-Altman test between PA and DS techniques.
Results:
Cumulative D90% doses for HRCTV and IRCTV showed significant discrepancies across three methods by one-way ANOVA (p<0.05), with no statistically significant difference between DS_BTV and PA in multiple comparisons (p>0.05). In the nodal-boost cohort, DS_BTV exhibited smaller deviations from PA than DS_Routine: 2.57% vs 6.44% for HRCTV_D90%, 3.19% vs 7.68% for IRCTV_D90%, 0.67% vs 5.01% for bladder_D2cc, and 4.29% vs 6.58% for rectum_D2cc. The non-boost cohort had comparable inter-method differences. Bland-Altman analysis confirmed superior target dose agreement between PA and DS_BTV (HRCTV_D90% CR=4.687, IRCTV_D90% CR=8.195) compared to DS_Routine (10.748/12.468).
Conclusions:
The DS method incorporating BTV dose uniformity achieves superior consistency with conventional PA. Systematic EBRT dose optimization within the BTV is clinically recommended to improve cumulative dose assessment accuracy, particularly in nodal-boost radiotherapy protocols.
