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Inter-fraction variation in interstitial high-dose-rate brachytherapy

Published online by Cambridge University Press:  04 February 2015

Saravanan Kandasamy ,
K. S. Reddy ,
Vivekanandan Nagarajan ,
Parthasarathy Vedasoundaram  and
Gunaseelan Karunanidhi
Saravanan Kandasamy*
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
K. S. Reddy
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Vivekanandan Nagarajan
Affiliation:
Medical Physics Department, Cancer Institute (WIA), Adyar, Chennai, India
Parthasarathy Vedasoundaram
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
Gunaseelan Karunanidhi
Affiliation:
Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India
*
Correspondence to: Saravanan Kandasamy, Department of Radiotherapy, Regional Cancer Centre, JIPMER, Puducherry, India. Tel/Fax: +919442030963; E-mail: kandasamysaravanan@yahoo.com
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Abstract

Aim

To evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.

Background

Although brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.

Materials and methods

A total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.

Results

For all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.

Conclusion

Inter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

Keywords

catheterhigh-dose brachytherapyinterfraction in HDRinterstitial implantpositional variation in HDR
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 2 , June 2015 , pp. 143 - 151
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Copyright
© Cambridge University Press 2015 

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