Abstract
The aim of the study was to compare the dose distributions of combined intracavitary and interstitial (IC/IS) brachytherapy with 3-catheter IC brachytherapy in treating locally advanced (stage IIB) cervical cancer. In total, 46 patients were included, each with stage IIB cervical cancer, local lesion sizes ≥5cm, and tumors that had not regressed after 45Gy/25F external intensity-modulated radiotherapy. To identify the dosimetric advantage of delivering a local boost to high-risk (HR)-cervix in IC/IS, patients were divided into two groups: IC/IS and IC/IS+HR-cervix. The differences in dosimetric parameters were compared between the two groups. Comparisons were then made between the parameters of the four planning methods: IC (Point A), IC (three dimensional [3D]), IC/IS, and IC/IS+HR-cervix. In patients with IC/IS implants, the relative uterine tandem dwell time was significantly extended in the IC/IS+HR-cervix group, and the V150 and V200 volumes of HR-cervix were increased (all p<0.001), whereas the D90 and D100 values of the IC/IS+HR-cervix group were lower than those in the IC/IS group. In pairwise comparisons, HR-cervix V150 and V200 values were lowest in the IC/IS group, followed by the IC (3D), IC/IS+HR-cervix, and IC (Point A) groups. All differences were statistically significant (p<0.05), with the exception of IC/IS vs. IC (3D). When treating locally advanced cervical cancer (stage IIB, local residual volume ≥5cm after external radiotherapy), the IC/IS+HR-cervix optimization method can meet the HR clinical target volume D90 dose requirement, normal tissue dose limits, and can escalate doses to local areas of the cervix.
Published Version
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