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首页> 外文期刊>Journal of Contemporary Brachytherapy >Clinical analysis of speculum-based vaginal packing for high-dose-rate intracavitary tandem and ovoid brachytherapy in cervical cancer
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Clinical analysis of speculum-based vaginal packing for high-dose-rate intracavitary tandem and ovoid brachytherapy in cervical cancer

机译：高剂量率腔内串联和卵形近距离放射治疗的基于阴道镜的阴道包装临床分析

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Purpose Intra-vaginal packing is used to fix the applicator and displace organs at risk (OAR) during high-dose-rate intracavitary tandem and ovoid brachytherapy (HDR-ICB). We retain the speculum from applicator placement as a dual-function bladder and rectum retractor during treatment. Our objective is to review salient techniques for OAR displacement, share our packing technique, and determine the reduction in dose to OAR and inter-fraction variability of dose to OAR, associated with speculum-based vaginal packing (SBVP) in comparison to conventional gauze packing during HDR-ICB. Material and methods We reviewed HDR-ICB treatment plans for 45 patients, including 10 who underwent both conventional gauze packing and SBVP. Due to institutional inter-provider practice differences, patients non-selectively received either packing procedure. Packing was performed under conscious sedation, followed by cone beam computed tomography used for dosimetric planning. Maximum absolute and percent-of-prescription dose to the International Commission of Radiation Units bladder and rectal points in addition to D0.1cc, D1.0cc, and D2.0cc volumes of the bladder and rectum were analyzed and compared for each packing method using an independent sample t-test. Results Of the 179 fractions included, 73% and 27% used SBVP and gauze packing, respectively. For patients prescribed 6 Gy to point A, SBVP was associated with reduced mean D0.1cc bladder dose, inter-fraction variability in D0.1cc bladder dose by 9.3% (p = 0.026) and 9.0%, respectively, and statistically equivalent rectal D0.1cc, D1.0cc, and D2.0cc. Patients prescribed 5.5 Gy or 5 Gy to point A after dose optimization, were less likely to benefit from SBVP. In the intra-patient comparison, 80% of patients had reduction in at least one rectum or bladder parameter. Conclusions In patients with conducive anatomy, SBVP is a cost-efficient packing method that is associated with improved bladder sparing and comparable rectal sparing relative to gauze packing during HDR-ICB without general anesthesia.
机译：目的阴道内填充物用于固定施药器，并在高剂量率腔内串联和卵形近距离放疗（HDR-ICB）期间置换有风险的器官（OAR）。在治疗过程中，我们保留了从涂药器放置的窥器，作为双功能膀胱和直肠牵开器。我们的目标是复查OAR移位的主要技术，分享我们的包装技术，并确定与传统的纱布包装相比，与基于窥镜的阴道包装（SBVP）相关的OAR剂量的减少和OAR剂量的分数间变异性在HDR-ICB期间。材料和方法我们审查了45例HDR-ICB的治疗计划，其中包括10例同时行常规纱布包装和SBVP的患者。由于提供者之间机构之间的惯例差异，患者非选择性地接受了两种包装程序。包装在有意识的镇静下进行，然后使用锥束计算机断层摄影进行剂量规划。除D 0.1cc ，D 1.0cc 和D 之外，国际放射单位委员会膀胱和直肠点的最大绝对剂量和处方剂量使用独立的样本t检验分析并比较每种包装方法的2.0cc 膀胱和直肠体积。结果包括的179个馏分中，分别使用SBVP和纱布填充的占73％和27％。对于A点指定为6 Gy的患者，SBVP与平均D 0.1cc 膀胱剂量减少，D 0.1cc 膀胱剂量的部分间变异性降低9.3％（p分别为0.026）和9.0％，并在统计学上等效于直肠D 0.1cc ，D 1.0cc 和D 2.0cc 。在剂量优化后开出A点的5.5 Gy或5 Gy的患者较难从SBVP中获益。在患者内比较中，80％的患者至少有一个直肠或膀胱参数降低。结论在具有有益解剖结构的患者中，SBVP是一种经济高效的填充方法，与HDR-ICB无需全麻时的纱布填充相比，可改善膀胱保留和可比的直肠保留。

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