Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study
Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study
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DOI：
10.1016/j.ijrobp.2019.12.019
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发表时间：
2020-04-01
影响因子：
7
通讯作者：
Tanderup, Kari
中科院分区：
文献类型：
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作者：
Serban, Monica;Kirisits, Christian;Tanderup, Kari
用途：本研究的目的是探讨近距离放射治疗技术和喷头类型的影响，靶向剂量，等剂量表面体积，和器官的危险（OAR）dose.Methods和材料：九百两个串联/卵形（T&O）（n = 299）和串联/环（T&R）（n = 603）喷头从16个EMBRACE中心进行了分析。患者接受外照射放射治疗和磁共振成像引导的近距离放射治疗，剂量处方根据部门实践。根据施源器/技术将中心分为4组：卵形和环形中心主要采用腔内（IC）技术治疗，卵形和环形中心常规采用腔内/间质（IC/IS）技术治疗。在中心组中评价了V85 Gy EQD 2（10）、CTVHR D-90%（EQD 2（10））和膀胱、直肠、乙状结肠和阴道5 mm侧点剂量（EQD 2（3））。T&O和T&R之间的差异进行了测试与多变量analysis.Results：对于类似的A点剂量，平均CTVHR D-90%是3.3戈伊高，V85戈伊是23%，环IC相比，卵圆形IC中心（中位靶体积）。环IC中心的平均膀胱/直肠剂量（D-2 cm 3和ICRU点）小3.2至7.7戈伊，阴道5 mm外侧点高19.6戈伊。常规使用IC/IS技术导致靶剂量增加，而V85戈伊稳定（T&R）或降低（T & O）;卵形中心的膀胱和直肠D-2 cm 3和膀胱ICRU点减少3.5至5.0戈伊;环形中心的OAR剂量相似。环状IC/IS中心与卵圆形IC/IS中心相比，CTVHR D-90%高2.8戈伊，膀胱D-2cm 3低4.3戈伊，直肠阴道ICRU点低4.8戈伊，阴道5 mm外侧点高22.4戈伊。P值为
Purpose: The aim of this study was to investigate the influence of brachytherapy technique and applicator type on target dose, isodose surface volumes, and organ-at-risk (OAR) dose.Methods and Materials: Nine hundred two patients treated with tandem/ovoids (T&O) (n = 299) and tandem/ring (T&R) (n = 603) applicators from 16 EMBRACE centers were analyzed. Patients received external beam radiation therapy and magnetic resonance imaging guided brachytherapy with dose prescription according to departmental practice. Centers were divided into 4 groups, according to applicator/technique: Ovoids and ring centers treating mainly with the intracavitary (IC) technique and ovoids and ring centers treating routinely with the intracavitary/interstitial (IC/IS) technique. V85Gy EQD2(10), CTVHR D-90% (EQD2(10)), and bladder, rectum, sigmoid, and vaginal 5-mm lateral-point doses (EQD2(3)) were evaluated among center groups. Differences between T&O and T&R were tested with multivariable analysis.Results: For similar point A doses, mean CTVHR D-90% was 3.3 Gy higher and V85Gy was 23% lower for ring-IC compared with ovoids-IC centers (at median target volumes). Mean bladder/rectum doses (D-2cm3 and ICRU-point) were 3.2 to 7.7 Gy smaller and vaginal 5-mm lateral-point was 19.6 Gy higher for ring-IC centers. Routine use of IC/IS technique resulted in increased target dose, whereas V85Gy was stable (T&R) or decreased (T & O); reduced bladder and rectum D-2cm3 and bladder ICRU-point by 3.5 to 5.0 Gy for ovoids centers; and similar OAR doses for ring centers. CTVHR D-90% was 2.8 Gy higher, bladder D-2cm3 4.3 Gy lower, rectovaginal ICRU-point 4.8 Gy lower, and vagina 5-mm lateral-point 22.4 Gy higher for ring-IC/IS versus ovoids-IC/IS centers. The P values were