A Dosimetric evaluation of a high dose rate cobalt-60 brachytherapy source using shielded, single and multi-channel cylinder applicators for gynecological cancers.

Abstract

Vaginal brachytherapy is a standard method for preventing the recurrences of malignancies in the treatment of gynecological cancers. Cylindrical applicators are usually employed in high dose rate cobalt-60 source brachytherapy after abdominal hysterectomy or bilateral salpingo-oophorectomy treatment. The aim of this study is to conduct an assessment of dosimetric properties of single channel, multichannel, and shielded cylinder applicators. This study utilizes a pelvis phantom with three different volumes of bladder and rectum to perform dose measurement around the cylindrical applicators. GAFCHROMIC EBT3 model film was used to measure dose distributions in water phantom around the bladder, rectum, applicator, and CTV. In order to properly compare the performance of the shielded applicator with multichannel and single channel applicators, we consider the both cases of a one-sided CTV and two CTVs placed on both sides of the vagina. Dose-volume histograms analysis shows no statistically significant difference in tumoral region for the two types of CTV between cylindrical applicators. The V120%, V100% and D95% values of target volume were 47.36%. 91.46%, and 3.99Gy for multi-channel cylinder applicator, 60.2%, 95.02%, and 3.99Gy for single channel cylinder applicator, respectively. Statistical analysis reports D0.1cc, D1cc, and D2cc for the multichannel applicator demonstrates a significant dose reduction in bladder compared with single channel. The V120%, V100%, and D95% values of target volume were 55.50%. 97.90%, and 3.91Gy for multi-channel cylinder applicator with four active channels (MCC-4), 41.56%, 92.10%. and 4.13Gy for shielded cylinder applicator, respectively. Statistical analysis reports D0.1cc, D1cc and D2cc for the MCC-4 demonstrates a noticeable dose reduction in bladder and rectum compared with Shielded channel. The results indicate that employing multichannel applicator in vaginal high dose rate cobalt-60 source brachytherapy can reduce the received dose to organs at risk without any significant loss of received dose in CTV, which is contributed to its asymmetric or symmetric dose distribution that depend on which channels are activated.