Henrike Westerveld1, Astrid de Leeuw2, Kathrin Kirchheiner3, Pittaya Dankulchai4, Bernard Oosterveld5, Arun Oinam6, Robert Hudej7, Jamema Swamidas8, Jacob Lindegaard9, Kari Tanderup9, Richard Pötter10, Christian Kirisits10. 1. Department of Radiotherapy, Academic Medical Centre, University of Amsterdam, The Netherlands; Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria. Electronic address: g.h.westerveld@amc.uva.nl. 2. Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands. 3. Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria. 4. Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5. Department of Radiation Oncology, Radiotherapiegroep, Arnhem, The Netherlands. 6. Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 7. Department of Radiotherapy, Institute of Oncology Ljubljana, Slovenia. 8. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. 9. Department of Oncology, Aarhus University Hospital, Denmark. 10. Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria.
Abstract
BACKGROUND AND PURPOSE: Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. MATERIAL AND METHODS: In a subset of patients from the EMBRACE study, vaginal doses were evaluated. Doses at the applicator surface left/right and anterior/posterior and at 5mm depth were measured. In addition, the dose at the Posterior-Inferior Border of Symphysis (PIBS) vaginal dose point and PIBS±2cm, corresponding to the mid and lower vagina, was measured. RESULTS: 153 patients from seven institutions were included. Large dose variations expressed in EQD2 with α/β=3Gy were seen between patients, in particular at the top left and right vaginal wall (median 195 (range 61-947)Gy/178 (61-980)Gy, respectively). At 5mm depth, doses were 98 (55-212)Gy/91 (54-227)Gy left/right, and 71 (51-145)Gy/67 (49-189)Gy anterior/posterior, respectively. The dose at PIBS and PIBS±2cm was 41 (3-81)Gy, 54 (32-109)Gy and 5 (1-51)Gy, respectively. At PIBS+2cm (mid vagina) dose variation was coming from BT. The variation at PIBS-2cm (lower vagina) was mainly dependent on EBRT field border location. CONCLUSIONS: This novel method for reporting vaginal doses coming from EBRT and BT through well-defined dose points gives a robust representation of the dose along the vaginal axis. In addition, it allows comparison of vaginal dose between patients from different centres. The doses at the PIBS points represent the doses at the mid and lower parts of the vagina. Large variations in dose throughout the vagina were observed between patients and centres.
BACKGROUND AND PURPOSE: Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancerpatients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. MATERIAL AND METHODS: In a subset of patients from the EMBRACE study, vaginal doses were evaluated. Doses at the applicator surface left/right and anterior/posterior and at 5mm depth were measured. In addition, the dose at the Posterior-Inferior Border of Symphysis (PIBS) vaginal dose point and PIBS±2cm, corresponding to the mid and lower vagina, was measured. RESULTS: 153 patients from seven institutions were included. Large dose variations expressed in EQD2 with α/β=3Gy were seen between patients, in particular at the top left and right vaginal wall (median 195 (range 61-947)Gy/178 (61-980)Gy, respectively). At 5mm depth, doses were 98 (55-212)Gy/91 (54-227)Gy left/right, and 71 (51-145)Gy/67 (49-189)Gy anterior/posterior, respectively. The dose at PIBS and PIBS±2cm was 41 (3-81)Gy, 54 (32-109)Gy and 5 (1-51)Gy, respectively. At PIBS+2cm (mid vagina) dose variation was coming from BT. The variation at PIBS-2cm (lower vagina) was mainly dependent on EBRT field border location. CONCLUSIONS: This novel method for reporting vaginal doses coming from EBRT and BT through well-defined dose points gives a robust representation of the dose along the vaginal axis. In addition, it allows comparison of vaginal dose between patients from different centres. The doses at the PIBS points represent the doses at the mid and lower parts of the vagina. Large variations in dose throughout the vagina were observed between patients and centres.
Authors: Richard Pötter; Kari Tanderup; Christian Kirisits; Astrid de Leeuw; Kathrin Kirchheiner; Remi Nout; Li Tee Tan; Christine Haie-Meder; Umesh Mahantshetty; Barbara Segedin; Peter Hoskin; Kjersti Bruheim; Bhavana Rai; Fleur Huang; Erik Van Limbergen; Max Schmid; Nicole Nesvacil; Alina Sturdza; Lars Fokdal; Nina Boje Kibsgaard Jensen; Dietmar Georg; Marianne Assenholt; Yvette Seppenwoolde; Christel Nomden; Israel Fortin; Supriya Chopra; Uulke van der Heide; Tamara Rumpold; Jacob Christian Lindegaard; Ina Jürgenliemk-Schulz Journal: Clin Transl Radiat Oncol Date: 2018-01-11
Authors: María Del Valle Aguilera; Ángeles Rovirosa; Carlos Ascaso; Antonio Herreros; Joan Sánchez; Julia Garcia-Migue; Stephanía Cortes; Eduardo Agusti; Cristina Camacho; Yaowen Zhang; Yan Li; Sebastià Sabater; Aureli Torne; Meritxell Arenas Journal: J Contemp Brachytherapy Date: 2018-02-28
Authors: Nuria Carrasco; Jose Chimeno; Mar Adrià-Mora; María José Pérez-Calatayud; Blanca Ibáñez; Vicente Carmona; Francisco Celada; Jose Gimeno; Françoise Lliso; José Pérez-Calatayud Journal: J Contemp Brachytherapy Date: 2020-04-17