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Technical Aspects of the Integration of Three-Dimensional Treatment Planning Dose Parameters (GEC-ESTRO Working Group) Into Pre-implant Planning for LDR Gynecological Interstitial Brachytherapy (p. 181-186)

This study investigates the technical feasibility of pre-implant image-based treatment planning for LDR GYN interstitial brachytherapy(IB) based on the GEC-ESTRO guidelines. Initially, a virtual plan is generated based on the prescription dose and GEC-ESTRO defined OAR dose constraints with a pre-implant CT. After the actual implant, a regular diagnostic CT was obtained and fused with our pre-implant scan/initial treatment plan in our planning software. The Flexi-needle position changes, and treatment plan modifications were made if needed. Dose values were normalized to equivalent doses in 2 Gy fractions (LQED 2 Gy) derived from the linear-quadratic model with α/β of 3 for late responding tissues and α/β of 10 for early responding tissues. D90 to the CTV, which was gross tumor (GTV) at the time of brachytherapy with a margin to count for microscopic disease, was 84.7 ± 4.9% of the prescribed dose. The OAR doses were evaluated by D2cc (EBRT+IB). Mean D2cc values (LQED2Gy) for the rectum, bladder, sigmoid, and small bowel were the following: 63.7 ± 8.4 Gy, 61.2 ± 6.9 Gy, 48.0 ± 3.5 Gy, and 49.9 ± 4.2 Gy. This study confirms the feasibility of applying the GEC-ESTRO recommended dose parameters in pre-implant CT-based treatment planning in GYN IB. In the process, this pre-implant technique also demonstrates a good approximation of the target volume dose coverage, and doses to the OARs.

Key words: LDR; Gynecological interstitial brachytherapy; GEC-ESTRO; Syed-Neblett template.




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TCRT June 2009

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Volume 8
No. 3 (p 177-248)
June 2009
ISSN 1533-0338

Alexander Chi, MD1,*
Mingcheng Gao, Ph.D.1
Nam P. Nguyen, MD2
Kevin Albuquerque, MD1

1Dept of Radiation Oncology
Loyola University Medical Center
Maywood, IL 60153, USA
2Dept of Radiation Oncology
The University of Arizona
Tucson, AZ 85724-5081, USA
*achi@lumc.edu