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Cervical cancer brachytherapy

Manjunath Gudibande Narasappa, Janaki Manur Gururajachar, Vasudha Kambam Chokkanna, Mohankumar Somashekar
BACKGROUND: Wide variations are seen in clinical practice with respect to response to concurrent chemo radiation among cervical cancer patients. Fall in serum glutathione (GSH) level directly correlates with early response to treatment. Whether this early response translates to a better long term outcome is the subject of this prospective study. MATERIALS AND METHODS: Thirty eight women with cervical cancer were treated with concurrent chemo radiation followed by brachytherapy...
July 2016: Journal of Cancer Research and Therapeutics
T Sullivan, A Diak, M Surucu, J Yacoub, M Harkenrider, S Shea
PURPOSE: The use of MR to plan and evaluate brachytherapy treatment for cervical cancer is increasing given the availability of MR conditional or safe applicators and MRI's proven superiority to CT for characterizing soft tissue lesions. The titanium applicators, however, cause geometric distortions or imaging artifacts, which reduce the utility of MRI for dosimetry. We sought to quantify the observed volume of the same applicator on a previously optimized T2 sequence in comparison to the conventional T2 sequence and CT obtained for brachytherapy planning...
June 2016: Medical Physics
Y Yang, J Cai, S Meltsner, Z Chang, O Craciunescu
PURPOSE: The Varian tandem and ring applicators are used to deliver HDR Ir-192 brachytherapy for cervical cancer. The source path within the ring is hard to predict due to the larger interior ring lumen. Some studies showed the source could be several millimeters different from planned positions, while other studies demonstrated minimal dosimetric impact. A global shift can be applied to limit the effect of positioning offsets. The purpose of this study was to assess the necessities of implementing a global source shift using Monte Carlo (MC) simulations...
June 2016: Medical Physics
Tran Thi Thao Nguyen, Hidetaka Arimura, Yoshifumi Oku, Takahiro Nakamoto, Yusuke Shibayama, Takashi Yoshiura
PURPOSE: The aim of this study was to investigate the impacts of tissue inhomogeneity on dose distributions using a three-dimensional (3D) gamma analysis in cervical intracavitary brachytherapy using Monte Carlo (MC) simulations. METHODS: MC simulations for comparison of dose calculations were performed in a water phantom and a series of CT images of a cervical cancer patient (stage: Ib; age: 27) by employing a MC code, Particle and Heavy Ion Transport Code System (PHIT) version 2...
June 2016: Medical Physics
B Lee, Z Grelewicz, Z Kang, D Cutright, M Gopalakrishnan, V Sathiaseelan, H Zhang
PURPOSE: The feasibility of dose measurement using new generation EBT3 film was explored in a water phantom for a ring and tandem HDR applicator for measurements tracking mucosal dose during cervical brachytherapy. METHODS: An experimental fixture was assembled to position the applicator in a water phantom. Prior to measurement, calibration curves for EBT3 film in water and in solidwater were verified. EBT3 film was placed at different known locations around the applicator in the water tank...
June 2016: Medical Physics
M Ashenafi, D McDonald, J Peng, C Mart, N Koch, L Cooper, K Vanek
PURPOSE: Improved patient imaging used for planning the treatment of cervical cancer with Tandem and Ovoid (T&O) Intracavitary high-dose-rate brachytherapy (HDR) now allows for 3D delineation of target volumes and organs-at-risk. However, historical data relies on the conventional point A-based planning technique. A comparative dosimetric study was performed by generating both target-based (TBP) and point-based (PBP) plans for ten clinical patients. METHODS: Treatment plans created using Elekta Oncentra v...
June 2016: Medical Physics
J Bogue, E Parsai
PURPOSE: The current generation of inflatable multichannel brachytherapy applicators, such as the Varian Capri, have limited implementation to only vaginal and rectal cancers. While there are similar designs utilizing rigid, non-inflatable applicators, these alternatives could cause increased dose to surrounding tissue due to air gaps. Modification of the Capri could allow for easier treatment planning by reducing the number of channels and increased versatility by modifying the applicator to include an attachable single tandem for cervical or multiple tandems for endometrial applications...
June 2016: Medical Physics
Y Miyasaka, N Kadoya, Y Kuroda, K Ito, M Chiba, Y Nakajima, K Sato, S Dobashi, K Takeda, K Jingu
PURPOSE: Accurate deformable image registration (DIR) between external beam radiotherapy (EBRT) and HDR brachytherapy (BT) CT images in cervical cancer is challenging. DSC has been evaluated only on the basis of the consistency of the structure, and its use does not guarantee an anatomically reasonable deformation. We evaluate the DIR accuracy for cervical cancer with DSC and anatomical landmarks using a 3D-printed pelvis phantom. METHODS: A 3D-printed, deformable female pelvis phantom was created on the basis of the patient's CT image...
June 2016: Medical Physics
U Mwidu, S Devic, M Shehadeh, M AlKafi, R Mahmood, B Moftah
PURPOSE: A retrospective comparison of dose distributions achievable by High dose rate brachytherapy (HDRBT), Helical TomoTherapy (TOMO), CyberKnife (CK) and RapidArc (RA) in locally advanced inoperable cervical cancer patients is presented. METHODS: Five patients with advanced stage cervical carcinoma were selected for this study after a full course of external beam radiotherapy (EBRT), chemotherapy and HDR Brachytherapy. To highlight any significant similarities/differences in dose distributions, high-risk clinical target volume (HRCTV) coverage, organs at risk (OAR) sparing, and machine specific delivery limitations, we used D90 (dose received by 90% of the volume) as the parameter for HRCTV coverage as recommended by the GEC-ESTRO Working Group...
June 2016: Medical Physics
J Santoro, M Witten, J Haas
PURPOSE: Brachytherapy has been the standard of care for cervical cancer for 100 years. The treatment can be administered using an HDR (high dose rate) remote afterloader with a (192) Ir source in an outpatient setting, a PDR afterloader with a (192) Ir source, or with LDR manually loaded or a remote afterloader utilizing (192) Ir or (137) Cs sources in an inpatient setting. The procedure involves the placement of a tandem and ovoid, tandem and ring, or tandem and cylinder applicator in an operating room setting with the patient under general anesthesia...
June 2016: Medical Physics
H Safigholi, D Han, S Mashouf, Abraam Soliman, A Owrangi, W Y Song
PURPOSE: To characterize the dosimetric properties/distributions of the novel proposed direction modulated brachytherapy (DMBT) tandem applicator in combination with 192Ir HDR source, and compare against conventional tandem design, using Monte Carlo simulations. METHODS: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy, especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18...
June 2016: Medical Physics
X Zhen, H Chen, Y Liao, L Zhou, B Hrycushko, K Albuquerque, X Gu
PURPOSE: To study the feasibility of employing deformable registration methods for accurate rectum dose volume parameters calculation and their potentials in revealing rectum dose-toxicity between complication and non-complication cervical cancer patients with brachytherapy treatment. METHOD AND MATERIALS: Data from 60 patients treated with BT including planning images, treatment plans, and follow-up clinical exam were retrospectively collected. Among them, 12 patients complained about hematochezia were further examined with colonoscopy and scored as Grade 1-3 complication (CP)...
June 2016: Medical Physics
R Ma, X Zhu, S Li, D Zheng, Y Lei, S Wang, V Verma, N Bennion, A Wahl, S Zhou
PURPOSE: High Dose Rate (HDR) brachytherapy forward planning is principally an iterative process; hence, plan quality is affected by planners' experiences and limited planning time. Thus, this may lead to sporadic errors and inconsistencies in planning. A statistical tool based on previous approved clinical treatment plans would help to maintain the consistency of planning quality and improve the efficiency of second checking. METHODS: An independent dose calculation tool was developed from commercial software...
June 2016: Medical Physics
A Soliman, D Han, A Elzibak, H Safigholi, S Mashouf, A Owrangi, A Ravi, W Song
PURPOSE: To assess image quality and artifact extent of a novel direction modulated brachytherapy (DMBT) tandem applicator on a 3T MRI using various clinical imaging sequences. METHODS: The tandem applicator is composed of a tungsten alloy with 6 peripheral grooves covered with a PEEK tip. An MR-compatible phantom with similar dimensions to the female pelvis was manufactured. To visually assess the spatial shift of the applicator's tip, a mountable radial-fiducial with 4 plastic rods, each of 3mm diameter, was designed to tightly fit on the applicator...
June 2016: Medical Physics
D Han, H Safigholi, A Soliman, W Song
PURPOSE: To explore and quantify the upper limits in dose sculpting capacity of the novel direction modulated brachytherapy (DMBT) tandem applicator compared with conventional tandem design for (192) Ir-based HDR planning. METHODS: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy (IGABT), especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18...
June 2016: Medical Physics
A Khan, N Yue
PURPOSE: Brachytherapy is a highly targeted from of radiotherapy. While this may lead to ideal dose distributions on the treatment planning system, a small error in source location can lead to change in the dose distribution. The purpose of this study is to quantify the impact on source position error due to curvature of the transfer tubes and the impact this may have on the dose distribution. METHODS: Since the source travels along the midline of the tube, an estimate of the positioning error for various angles of curvature was determined using geometric properties of the tube...
June 2016: Medical Physics
X Liang, D Zheng, X Zhang, G Narayanasamy, S Morrill, J Penagaricano, N Paudel, Z Li
PURPOSE: In the context of evaluating dosimetric impacts of a variety of uncertainties involved in HDR Tandem-and-Ovoid treatment, to study the correlations between conventional point doses and 3D volumetric doses. METHODS: For 5 cervical cancer patients treated with HDR T&O, 150 plans were retrospectively created to study dosimetric impacts of the following uncertainties: (1) inter-fractional applicator displacement between two treatment fractions within a single insertion by applying Fraction#1 plan to Fraction#2 CT; (2) positional dwell error simulated from -5mm to 5mm in 1mm steps; (3) simulated temporal dwell error of 0...
June 2016: Medical Physics
H Zhang
PURPOSE: To evaluate the dosimetric metrics of HDR Ring and Tandem applicator Brachytherapy for primary cervical cancers. METHODS: The dosimetric metrics of high-risk clinical target volumes (HDR-CTV) of 12 patients (in total 60 fractions/plans) treated with the HDR ring and tandem applicators were retrospectively analyzed. Ring diameter is from 2.6 to 3.4 cm, tandem length is from 4 to 6 cm, and the angle is either 45 or 60 degrees. The first fraction plan was MR guided, the MR images were then used as a reference for contouring the HR-CTV in CT images of following 4 fractions...
June 2016: Medical Physics
R Meerschaert, A Paul, W Chen, S Miller, L Zhuang
PURPOSE: To identify indicators for recurrence in cervical cancer patients treated with high-dose-rate brachytherapy (HDR-BT). METHODS: A total of 37 biopsy proven uterine cervical cancer patients of stage IB-IVA treated between 2011 and 2015 were included in this study. All patients were treated with 37.8-52.2Gy of external beam radiotherapy (EBRT) plus 5 × 5.0-6.5Gy of HDR-BT. Patient age, standard deviation of high-risk clinical tumor volume (HR-CTVSD) collected throughout HDR-BT, and D90 (EQD2, α/β=10Gy) of the HR-CTV were investigated as potential indicators for local/distant recurrence using ROC analysis...
June 2016: Medical Physics
H Safigholi, D Han, S Mashouf, A Soliman, A S Meigooni, A Owrangi, W Y Song
PURPOSE: To evaluate the improvement in plan quality when various combinations of 192Ir, 60Co, and 169Yb sources are used in combination with a novel direction modulated brachytherapy (DMBT) tandem applicator for high dose rate brachytherapy of cervical cancer. METHODS: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy (IGABT), especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18...
June 2016: Medical Physics
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