Abstract
Purpose:To evaluate the improvement in plan quality when various combinations of 192Ir, 60Co, and 169Yb sources are used in combination with a novel direction modulated brachytherapy (DMBT) tandem applicator for high dose rate brachytherapy of cervical cancer.Methods:The proposed DMBT tandem applicator is designed for image‐guided adaptive brachytherapy (IGABT), especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3‐mm width, grooved along a 5.4‐mm diameter nonmagnetic tungsten alloy rod of density 18.0 g/cc, capable of generating directional dose profiles ‐ leading to enhanced dose sculpting capacity through inverse planning. Monte Carlo simulations of the three HDR sources individually inside the DMBT applicator were performed and imported into an in‐house developed inverse optimization code. We then performed inverse planning with 14 cervical cancer patients enrolled in EMBRACE study. In all patients, 3D MRI‐based planning was performed while utilizing 1) tandem‐ring and needles attached‐to‐ring (7 patients) and 2) tandem‐ring and needles both attached‐to‐ring and free‐hand‐loaded (7 patients), in accordance with the GEC‐ESTRO recommendations. All plans were normalized to receive the same HRCTV D90 and DVH parameters were evaluated.Results:The DMBT tandem was used in all cases. Overall, the combined use of two sources (192Ir‐60Co and 192Ir‐169Yb, but not 60Co‐169Yb) generally produced better quality plans than with the 192Ir source alone in terms of sparing OARs. For example, up to 3.5, 4.4, and 3.9% individual reductions in D2cc were observed for the bladder, rectum, and sigmoid, respectively, between 192Ir‐60Co and 192Ir‐only plans for patient cases in #1. While up to 5.5, 2.0, and 5.7% individual reductions were observed for patient cases in #2.Conclusion:We have demonstrated that, in addition to “directional modulation” of DMBT, use of multiple sources with sufficient differences in energy can be utilized to achieve additional improvement in plan quality for IGABT of cervical cancer.
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