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Authors: Violeta Klisarovska 
Petar Chakalaroski 
Snezana Smickoska 
Igor Stojkovski 
Nadica Dimitrovska
Zoran Stefanovski
Jasmina Djundeva
Keywords: cervical carcinoma
intracavitary brachytherapy
Issue Date: 23-May-2016
Publisher: University of Nis, Faculty of Electronic Engineering
Conference: Fourth International Conference on Radiation and Applications in Various Fields of Research
Abstract: Introduction Cervical carcinoma is the third most present malignancy at women worldwide. Beside the screening program for early cancer detection, locally advanced disease is still present, thus requiring specific therapeutic approach. Intracavitary high dose rate (HDR) brachytherapy is one of the most efficient radiotherapy techniques in cervical cancer treatment which builds up upon the external beam radiation (EBRT) dose. Limited two-dimensional (2D) planning in ICRU points is moreover replaced by more sophisticated tridimensional (3D) volumetric planning. Materials and methods 22 patients with diagnosed inoperable locally advanced cervical carcinoma were treated in 5 month period. Median age was 51 years, planocellular carcinoma was dominant histological type with 81% (18) and according to the clinical stage of disease 77% (17 ) were in IIB stage. EBRT chemo-radiation was applied to all patients, followed by 3D HDR intracavitary brachytherapy given in 3 applications (one/weekly), with prescribed dose of 7Gy to point A. Brachytherapy planning was made in 2D and 3D setting for dosimetric comparison purpose. 2D planning utilized 2D radiography with C-arm or 2D simulator, while 3D used CT scans. For 2D plans there were used ICRU 38 defined reference points, while 3D plans were calculated upon delineated volumes of interest and organs of risk. Doses were calculated and reported according to ICRU 38. Brachytherapy itself was performed on GammaМed Plus apparatus, using Ir-192 source. Total treatment time was evaluated which encompassed the period from the first external beam fraction till the last brachytherapy application. Results 2D vs 3D dosimetric comparison showed no significant difference in point A (2D) vs reconstructed point A (3D). However, 3D planning showed the isodose coverage of the whole target volume with average value of 56.9% covered with 100%, while 63.3% received 90% of the prescribed dose. Generally organs of risk (OR) in 2D planning had significantly lower ICRU dose values compared to 3D planning where maximal dose points and absorbed dose in volume of 2ccm were higher than ICRU points. Volumetric doses showed more realistic view of isodose projection in surrounding tissues and organs, thus reducing the adverse events rate and potential later complications such as fistulae and strictures. However, OR related results were not the main aim of this study. Total Treatment time averaged 69 days (57 to 89) showing a 23.2% deviation (extending) of the treatment optimum of 56 days. 12 (55%) patients finished their treatment in 57-70 days range, 7 (31%) in 71-80 days, while 3 (14%) finished in timeframe of 81-89 days. Conclusion 3D planning offers the option for treatment individualization and volumetric dose presentation which results in better local disease control and surrounding tissues preservation. In our clinic 2D planning was a decades-long tradition, but now planning is being shifted towards the 3D approach.
Appears in Collections:Faculty of Medicine: Conference papers

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