The Netherlands: University Medical Center, Utrecht

Abstract

In Utrecht brachytherapy for cervical cancer is delivered using tandem ovoid applicators. Point based treatment planning has traditionally been performed according to ICRU 38 guidelines. Until 2005, treatment plans were generated using standard loading patterns with adaptation if dose to ICRU bladder and/or rectum point exceeded our institutional constraints. The dilemma of this strategy is that the OAR related dose reduction decreases the tumour dose and probably diminishes the chance of tumour control. Since 2006, dosimetric improvement in these situations was gained by MRI guided treatment planning according to GEC ESTRO recommendations, which allows individual dose modulation to end up with an optimised dose volume relationship between tumour and OAR. In 2007, we developed a new applicator, the “Utrecht Interstitial Fletcher Applicator” (Nucletron, Veenendaal) for patients with large tumour remnants at time of brachytherapy in order to increase the target dose and to spare the OAR.