Reporting of dose–volume specifications for “Martinez Universal Perineal Interstitial Template–based interstitial high-dose-rate brachytherapy for gynecological cancers” according to International Commission on Radiation Units and Measurements 58 with early clinical outcomes

Published:February 26, 2021DOI:



      The study is an audit of reporting dose and volume specifications as per the ICRU 58 for MUPIT-based interstitial brachytherapy in gynecological cancers. Correlation between total reference air kerma (TRAK) and isodose surface was also evaluated to understand the intensity of treatment in interstitial brachytherapy.

      Methods and Materials

      Forty-two patients underwent HDR MUPIT-based interstitial brachytherapy 20 Gy in five fractions after EBRT during 2017–2019. Treated volume, high and low-dose regions, mean central dose, Dose Homogeneity Index (DHI), organ at risk doses, and TRAK values were computed.


      High-dose regions V150 mean was 12.4 cc and V200 was 4.58 cc; and low-dose region was 75.92 cc. The mean treated volume was 59.8 cc. The mean central dose was 3.7 Gy. DHI was 79%. The mean D2cm3 bladder and rectum were 2.9 Gy and 2.8 Gy. The mean TRAK was 0.16 cGy per fraction per hour at 1 m. TRAK values showed significant correlation with various isodose volumes (TRAK and V100: r = 0.943 p < 0.0005; and TRAK and V50: r = 0.953; p < 0.0005). A positive correlation was observed between TRAK and the number of needles (r = 0.746; p < 0.0005). At a median followup of 16 months, 4 of 42 patients (9.5%) had local recurrences.


      Our study shows compliance with ICRU 58 recommendations along with certain deviations. Local recurrence rate is acceptable. TRAK shows correlation with surface isodose in MUPIT-based brachytherapy and should to be evaluated in future studies.


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        • Agrawal P.P.
        • Singhal S.S.
        • Neema J.P.
        • et al.
        The role of interstitial brachytherapy using template in locally advanced gynecological malignancies.
        Gynecol Oncol. 2005; 99: 169-175
      1. Dose and Volume Specification for Reporting Interstitial Therapy - ICRU Report 58, 1997.

        • Serban M.
        • Kirisits C.
        • Pötter R.
        • et al.
        Isodose surface volumes in cervix cancer brachytherapy: Change of practice from standard (point A) to individualized image guided adaptive (EMBRACE I) brachytherapy.
        Radiother Oncol. 2018; 129: 567-574
        • Datta N.R.
        • Das K.J.M.
        • Basu R.
        • et al.
        Total reference air kerma: To what extent can it predict intracavitary volume enclosed by isodose surfaces during multiple high-dose rate brachytherapy?.
        Brachytherapy. 2003; 2: 91-97
        • Nkiwane K.S.
        • Andersen E.
        • Champoudry J.
        • et al.
        Total reference air kerma can accurately predict isodose surface volumes in cervix cancer brachytherapy. A multicenter study.
        Brachytherapy. 2017; 16: 1184-1191
        • Garsa A.A.
        • Ferraro D.J.
        • DeWees T.
        • et al.
        Analysis of fat necrosis after adjuvant high-dose-rate interstitial brachytherapy for early stage breast cancer.
        Brachytherapy. 2013; 12: 99-106
        • Wazer D.E.
        • Lowther D.
        • Boyle T.
        • et al.
        Clinically evident fat necrosis in women treated with high-dose-rate brachytherapy alone for early-stage breast cancer.
        Int J Radiat Oncol. 2001; 50: 107-111
        • Chopra S.
        • Shukla P.
        • Paul S.N.
        • et al.
        Evaluation of quality indices during multifractionated pelvic interstitial brachytherapy for cervical cancer.
        Brachytherapy. 2013; 12: 156-161
        • Yaparpalvi R.
        • Kuo H.-C.
        • Hsu S.-H.
        • et al.
        TRAK relates to prescription isodose surface volume and treatment time in vaginal cylinder HDR brachytherapy.
        Brachytherapy. 2019; 18: S113
        • Deshpande D.D.
        • Shrivastava S.K.
        • Nehru R.M.
        • et al.
        Treatment volume from Total Reference Air Kerma (TRAK) in intracavitory applications and its comparison with ICRU reference volume.
        Int J Radiat Oncol. 1994; 28: 499-504
        • Eisbruch A.
        • Williamson J.F.
        • Ross Dickson D.
        • et al.
        Estimation of tissue volume irradiated by intracavitary implants.
        Int J Radiat Oncol. 1993; 25: 733-744
        • Stanton C.
        • Bockelmann F.
        • Ko F.
        • et al.
        TRAK as a patient-specific QA tool in gynaecological cancer brachytherapy.
        (Available at:)
      2. 142 Oral Volume in intracavitary therapy; the first proof that it is clinically significant.
        Radiother Oncol. 2002; 64: S47-S48
        • Bockel S.
        • Escande A.
        • Dumas I.
        • et al.
        Total reference air kerma is associated with late bowel morbidity in locally advanced cervical cancer patients treated with image-guided adaptive brachytherapy.
        J Clin Med. 2019; 8: 125
        • Chopra S.
        • Engineer R.
        • Shah S.
        • et al.
        MRI- and PET-guided interstitial brachytherapy for postsurgical vaginal recurrences of cervical cancer: Results of phase II study.
        Int J Radiat Oncol. 2020; 106: 310-319