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Clinical Trial
. 2013 Mar 1;54(2):349-56.
doi: 10.1093/jrr/rrs091. Epub 2012 Oct 26.

Different effects of bladder distention on point A-based and 3D-conformal intracavitary brachytherapy planning for cervical cancer

Sang Gyu Ju  1 , Seung Jae Huh, Jung Suk Shin, Won Park, Heerim Nam, Sunhyun Bae, Dongryul Oh, Chae-Seon Hong, Jin Sung Kim, Youngyih Han, Doo Ho Choi
Affiliations
Clinical Trial

Different effects of bladder distention on point A-based and 3D-conformal intracavitary brachytherapy planning for cervical cancer

Sang Gyu Ju et al. J Radiat Res. .

Abstract

This study sought to evaluate the differential effects of bladder distention on point A-based (AICBT) and three-dimensional conformal intracavitary brachytherapy (3D-ICBT) planning for cervical cancer. Two sets of CT scans were obtained for ten patients to evaluate the effect of bladder distention. After the first CT scan, with an empty bladder, a second set of CT scans was obtained with the bladder filled. The clinical target volume (CTV), bladder, rectum, and small bowel were delineated on each image set. The AICBT and 3D-ICBT plans were generated, and we compared the different planning techniques with respect to the dose characteristics of CTV and organs at risk. As a result of bladder distention, the mean dose (D50) was decreased significantly and geometrical variations were observed in the bladder and small bowel, with acceptable minor changes in the CTV and rectum. The average D2 cm(3)and D1 cm(3)showed a significant change in the bladder and small bowel with AICBT; however, no change was detected with the 3D-ICBT planning. No significant dose change in the CTV or rectum was observed with either the AICBT or the 3D-ICBT plan. The effect of bladder distention on dosimetrical change in 3D-ICBT planning appears to be minimal, in comparison with AICBT planning.

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Figures

Fig. 1.
Fig. 1.
Two sets of CT images for a patient [with (aand c) and without (band d) bladder distention] were registered based on the applicator position, and reconstructed in the sagittal (aand b) and coronal (cand d) plan. Figures show a significant geometrical change of the bladder and small bowel as the result of bladder distention, while clinically acceptable minor changes were detected in the CTV and rectum. The distended bladder pushed the small bowel upward (aand c).
Fig. 2.
Fig. 2.
Pictures showing an example of the difference in dose distribution between AICBT (a)and 3D-ICBT (b). The AICBT plan, which has a uniform pear-shaped dose pattern based on point A, produces a relatively large high-dose volume compared with the 3D-ICBT plan. The 3D-ICBT plan showed better dose conformity by dose optimization to the target volume.
Fig. 3.
Fig. 3.
Comparison of the dose volume histograms for bladder, rectum and bowel, and the CTV of a patient between the AICBT (a)and the 3D-ICBT (b)plan.
See this image and copyright information in PMC

References

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