A dosimetric comparison of two high-dose-rate brachytherapy planning systems in cervix cancer: Standardized template planning vs. computerized treatment planning

Abstract 

Purpose

High-dose-rate brachytherapy is an important component of the curative treatment for cervical cancer. Some institutions use standardized template planning (STP), based on a precalculated table of dose rates, instead of computerized treatment planning (CTP), based on digitized orthogonal X-ray films. STP can be used as a backup check in case of computer hardware malfunction, and/or as a way to minimize treatment planning time. We performed a dosimetric comparison of STP and CTP to determine dose differences at point A and the International Commission on Radiation Units and Measurements Report 38 bladder and rectal reference points.

Methods and materials

We retrospectively reviewed the treatment plans of 62 patients (135 applications) treated with a tandem and two ovoids using the CTP method. For each of these plans, we calculated the dwell times required to deliver the same prescription dose had STP been used. We also used the planning computer to vary tandem and ovoid geometry and develop a table of dose rates based on geometric parameters.

Results

The mean dose at point A was 7.6Gy using CTP, increasing to 8.4Gy when the STP approach was used (p<0.05). The mean doses at the International Commission on Radiation Units and Measurements Report 38 bladder and rectal points were both 4.5Gy with CTP and increased to 4.9 and 5.0Gy, respectively using STP (p<0.05). Our table of dose rates showed significant dose rate dependency on the applicators geometry.

Conclusions

Our study shows that if the STP approach had been used, a significantly higher dose would have been delivered, and that STP tables accounting for differences in implant geometry should be carefully considered.

Keywords: Cervical cancer, Brachytherapy, Template, Treatment planning, Dosimetry