Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski
{"title":"对基于妇科模板的五分段间质近距离放射治疗的自适应规划进行剂量学评估。","authors":"Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski","doi":"10.1016/j.brachy.2024.07.007","DOIUrl":null,"url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.</div></div><div><h3>METHODS AND MATERIALS</h3><div>This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.</div></div><div><h3>RESULTS</h3><div>The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D<sub>90%</sub>: −6.5 (−0.6, −15.1), HR-CTV D<sub>98%</sub>: −6.5 (−0.4, −12.6), Bladder D<sub>2cc</sub>: −0.5 (0.0, −2.8), Bowel D<sub>2cc</sub>: −0.8 (0.0, −3.2), Rectum D<sub>2cc</sub>: −1.1 (0.0, −11.5), Sigmoid D<sub>2cc</sub>: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (<em>p</em> > 0.05). Fraction 3 was the most common fraction indicated for replanning.</div></div><div><h3>CONCLUSIONS</h3><div>Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 668-675"},"PeriodicalIF":1.7000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dosimetric evaluation of adaptive planning for five-fraction gynecologic template-based interstitial brachytherapy\",\"authors\":\"Steven Blum , Jessica R. Miller , Kristin A. Bradley , Bethany Anderson , Hari Menon , Bradley Eckelmann , Charles Wallace , Abby Besemer , Michael Lawless , Jordan M. Slagowski\",\"doi\":\"10.1016/j.brachy.2024.07.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>PURPOSE</h3><div>The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.</div></div><div><h3>METHODS AND MATERIALS</h3><div>This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.</div></div><div><h3>RESULTS</h3><div>The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D<sub>90%</sub>: −6.5 (−0.6, −15.1), HR-CTV D<sub>98%</sub>: −6.5 (−0.4, −12.6), Bladder D<sub>2cc</sub>: −0.5 (0.0, −2.8), Bowel D<sub>2cc</sub>: −0.8 (0.0, −3.2), Rectum D<sub>2cc</sub>: −1.1 (0.0, −11.5), Sigmoid D<sub>2cc</sub>: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (<em>p</em> > 0.05). Fraction 3 was the most common fraction indicated for replanning.</div></div><div><h3>CONCLUSIONS</h3><div>Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.</div></div>\",\"PeriodicalId\":55334,\"journal\":{\"name\":\"Brachytherapy\",\"volume\":\"23 6\",\"pages\":\"Pages 668-675\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brachytherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1538472124001181\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1538472124001181","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Dosimetric evaluation of adaptive planning for five-fraction gynecologic template-based interstitial brachytherapy
PURPOSE
The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.
METHODS AND MATERIALS
This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.
RESULTS
The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D90%: −6.5 (−0.6, −15.1), HR-CTV D98%: −6.5 (−0.4, −12.6), Bladder D2cc: −0.5 (0.0, −2.8), Bowel D2cc: −0.8 (0.0, −3.2), Rectum D2cc: −1.1 (0.0, −11.5), Sigmoid D2cc: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (p > 0.05). Fraction 3 was the most common fraction indicated for replanning.
CONCLUSIONS
Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.
期刊介绍：
Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.
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