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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Uncertainty analysis for 3D image-based cervix cancer brachytherapy by repetitive MR imaging: Assessment of DVH-variations between two HDR fractions within one applicator insertion and their clinical relevance
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Uncertainty analysis for 3D image-based cervix cancer brachytherapy by repetitive MR imaging: Assessment of DVH-variations between two HDR fractions within one applicator insertion and their clinical relevance

机译：重复MR成像对基于3D图像的子宫颈癌近距离放射治疗的不确定性分析：评估一个涂药器内两个HDR组分之间的DVH变异及其临床相关性

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AbstractPurpose To investigate dosimetric uncertainties of MRI-based cervix cancer brachytherapy, when applying two HDR fractions for each applicator insertion and their clinical relevance. Methods 21 patients with 84 MRI-examinations and fractions were investigated. After insertion of the MRI compatible tandem-ring applicator, an MRI-set was recorded and the treatment plan optimised for the first fraction. Prior to the second fraction 16-20 h later a second MRI-set was recorded, and the dose distribution from the plan of the previous day superimposed and analysed. The same procedure was repeated for fractions 3 and 4. Dose from EBRT and brachytherapy was normalised to 2 Gy-fractionation (EQD2), added up to a total dose, and compared to a calculated total dose if only 1 MRI-examination per insertion is available. Results The total D90 for High risk (HR) CTV was 1.2 ± 2.7 Gy αβ10 (1 ± 3%) (mean ± 1SD) lower by individual MRI-evaluation of each fraction compared to 1 MRI per insertion. The D2cm 3 increased by 0.7 ± 4.7 Gy αβ3 (1 ± 6%) for bladder, 1.1 ± 2.4 Gy αβ3 (2 ± 4%) for rectum and decreased by 0.8 ± 3.4 Gyαβ3 (1 ± 5%) for sigmoid. For HR CTV the individual approach did not identify any case with a decrease of D 90 5 Gyαβ10. For the bladder 3 cases, for the rectum no case and for the sigmoid 1 case was identified with an increase of D2cm 3 5 Gyαβ3. For the bladder all dose variations of more than 5 Gyαβ3 could have been avoided by ensuring a constant bladder filling. Individual MRI-evaluation did not determine any case where dose constraints were not fulfilled. Conclusions For the treatment schedule as applied in this study, geometric differences between applicator, target and OAR result in overall dosimetric changes, which seem to be of minor relevance in regard to clinical dose volume constraints applied at present.
机译：摘要目的探讨以MRI为基础的子宫颈癌近距离放射治疗在剂量上的不确定性，即在每个施药器插入处使用两个HDR分数时及其临床相关性。方法对21例患者进行84例MRI检查和分数的检查。插入MRI兼容的串联环涂药器后，记录MRI装置并针对第一部分优化治疗计划。在第二部分16-20 h之后，记录第二组MRI，并叠加和分析前一天计划的剂量分布。对于第3部分和第4部分重复相同的步骤。将来自EBRT和近距离放射治疗的剂量标准化为2 Gy-分离（EQD2），加总到总剂量，如果每次插入仅进行MRI检查1次，则与计算出的总剂量进行比较。可用。结果通过每个部分的单独MRI评估，高风险（HR）CTV的总D90为1.2±2.7 Gyαβ10（1±3％）（平均值±1SD），而每次插入1 MRI更低。膀胱的D2cm 3增加0.7±4.7 Gyαβ3（1±6％），直肠的D2cm 3增加1.1±2.4 Gyαβ3（2±4％），乙状结肠的D2cm 3减少0.8±3.4Gyαβ3（1±5％）。对于HR CTV，单独的方法没有发现D 90降低> 5Gyαβ10降低的任何情况。对于膀胱3例，对于直肠无1例，对于乙状结肠1例，D2cm 3> 5Gyαβ3增加。对于膀胱，通过确保恒定的膀胱充盈可以避免超过5Gyαβ3的所有剂量变化。单独的MRI评估无法确定未满足剂量限制的任何情况。结论对于本研究中应用的治疗方案，施药器，靶标和OAR之间的几何差异导致总体剂量学变化，这与目前应用的临床剂量限制似乎没有太大关系。

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