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Volumetric evaluation of an alternative bladder point in brachytherapy for locally advanced cervical cancer

Volumetrische Auswertung eines alternativen Harnblasen-Referenzpunkts in der Brachytherapie bei lokal fortgeschrittenem Zervixkarzinom

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Abstract

Purpose

To evaluate an alternative dose point, so-called ALG (for Alain Gerbaulet), for the bladder in comparison to the International Commission on Radiation Units and Measurements (ICRU) point and D2cm3 (minimal dose to maximally exposed 2 cm3) in a large cohort of patients with locally advanced cervical cancer treated with external beam radiotherapy followed by image-guided pulsed dose rate brachytherapy.

Methods and materials

For each patient, the ALG point was constructed 1.5 cm above the ICRU bladder, parallel to the tandem (coronal and sagittal planes). The dosimetric data from 162 patients were reviewed.

Results

Average doses to ALG and bladder points were 19.40 Gy ± 7.93 and 17.14 ± 8.70, respectively (p = 0.01). The 2 cm3 bladder dose averaged 24.40 ± 6.77 Gy. Ratios between D2cm3 and dose points were 1.37 ± 0.46 and 1.68 ± 0.74 (p < 0.001) for ALG and ICRU points, respectively. Both dose points appeared correlated with D2cm3 (p < 0.001) with coefficients of determination (R2) of 0.331 and 0.399 respectively. The estimated dose to the ICRU point of the rectum was 12.77 ± 4.21 and 15.76 ± 5.94 for D2cm3 (p < 0.0001). Both values were significantly correlated (p < 0.0001, R2 = 0.485).

Conclusion

The ALG point underestimates the D2cm3, but its mean on a large cohort is closer to D2cm3 than the dose to ICRU point. However, it shows great variability between cases and the weak strength of its correlation to D2cm3 indicates that it is not a good surrogate for individual volumetric evaluation of the dose D2cm3.

Zusammenfassung

Zielsetzung

Auswertung eines Dosiswerts für einen alternativen Harnblasen-Referenzpunkt, genannt ALG (für Alain Gerbaulet), im Vergleich mit dem Referenzpunkt der internationalen Kommission für Messung von Strahleneinheiten (ICRU) und der D2cm3-Dosis (minimale Dosis auf maximal ausgesetzter Fläche 2cm3) anhand einer großen Patientengruppe mit lokal fortgeschrittenem Zervixkarzinom. Das Zervixkarzinom wurde zunächst extern bestrahlt und anschließend mit einer „Pulsed-dose-rate“-(PDR)-Brachytherapie behandelt.

Material und Methode

Für jede Patientin wurde die ALG 1,5 cm oberhalb des Referenzpunkts der ICRU im Bereich der Harnblase festgelegt, parallel zum Tandem (im Koronal- und Sagitalschnitt). Es wurden dosimetrische Daten von insgesamt 162 Patientinnen untersucht.

Ergebnisse

Der Mittelwert der Dosiswerte der ALG und des Referenzpunkts der Harnblase betrugen jeweils 19,40 Gy ± 7,93 und 17,14 ± 8,70 (p = 0,01). Die D2cm3-Dosis der Blase erreichte durchschnittlich 24,40 ± 6,77 Gy. Das Verhältnis zwischen D2cm3 und den Referenzwerten war jeweils 1,37 ± 0,46 für ALG und 1,68 ± 0,74 (p < 0,001) für ICRU. Beide Dosiswerte schienen mit der D2cm3-Dosis zu korrelieren (p < 0,001): der jeweilige Determinierungskoeffizient (R2) betrug 0,331 bzw. 0,339. Die geschätzte Dosis des ICRU-Referenzpunkts vom Rektum betrug 12,77 ± 4,21 und 15,76 ± 5,94 für D2cm3 (p < 0,0001). Beide Werte korrelierten signifikant (p < 0,0001; R2 = 0,485).

Schlussfolgerung

Der ALG-Punkt unterschätzt die D2cm3-Dosis, aber seine Bedeutung für eine große Kohorte ist näher dem D2cm3-Wert als dem des ICRU-Referenzwerts. Dennoch zeigt sich eine große Variabilität zwischen den einzelnen Fällen und die schwache Korrelation zu D2cm3 weist darauf hin, dass diese Methode kein geeigneter Ersatz für eine individuelle Auswertung der D2cm3-Dosis ist.

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Acknowledgments

We thank Laëtitia-Marie Petit (HUG, Geneva) for editing.

Compliance with ethical considerations

Conflict of interest. R. Mazeron, J. Gilmore, J. Champoudry, I. Dumas, J. Helou, P. Maroun, F. Martinetti, A. Gerbaulet, and C. Haie-Meder state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiation Oncology, Gustave Roussy, 114, rue Edouard Vaillant, 94805, Villejuif Cedex, France

    R. Mazeron MD, J. Gilmore MD, J. Helou MD, P. Maroun MD, A. Gerbaulet MD & C. Haie-Meder MD

  2. Department of Radiotherapy, Cork University Hospital, Wilton, Cork, Ireland

    J. Gilmore MD

  3. Department of Medical Physics, Gustave Roussy, Villejuif, France

    J. Champoudry, I. Dumas & F. Martinetti PhD

Authors
  1. R. Mazeron MD
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  2. J. Gilmore MD
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  3. J. Champoudry
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  4. I. Dumas
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  5. J. Helou MD
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  6. P. Maroun MD
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  7. F. Martinetti PhD
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  8. A. Gerbaulet MD
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  9. C. Haie-Meder MD
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Corresponding author

Correspondence to R. Mazeron MD.

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Mazeron, R., Gilmore, J., Champoudry, J. et al. Volumetric evaluation of an alternative bladder point in brachytherapy for locally advanced cervical cancer. Strahlenther Onkol 190, 41–47 (2014). https://doi.org/10.1007/s00066-013-0463-6

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  • DOI: https://doi.org/10.1007/s00066-013-0463-6

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