Impact of Bladder Distension on Organs at Risk in 3D Intracavitary Brachytherapy for Cervical Cancer
To determine the effects of bladder distension on organs at risk (OAR) during ICBT for cervical cancer with 3D Imaging based Planning.
MATERIALS AND METHODS:
Twenty-eight patients with cervical cancer who received high-dose radiation (HDR) brachytherapy using 7Gy x 4 fractions, were included in the study. For three-dimensional (3D) analysis, pelvic CT scans were obtained with indwelling catheters in place (defined as empty bladder) and repeated scans with 200-cc of sterile water in their bladders (defined as full bladder). To compare the International Commission on Radiation Units and Measurements (ICRU) point doses with 3D-volume doses, the volume dose was defined by using two different criteria, D2cc (the minimum dose value in a 2.0-cm3 volume receiving the highest dose) and D50% (the dose received by 50% of the volume of the OAR) for OARs.
For patients with a full bladder, the mean bladder D2cc increased from 395 to 558.4 cGy (41%, p < 0.001). However, the bowel D2cc and sigmoid colon D2cc decreased from 477.4 to 216.1 cGy (55.0%, p < 0.001) and 450.8 to 350.8 cGy (22%, p= 0.001), respectively. The mean D50% values of both the bladder and the bowel decreased from 301.6 to 227.3 cGy (25%, p < 0.001) and from 116.5 to 74.3 cGy (36%, p < 0.001) with a full bladder, respectively.
The mean D50% for sigmoid colon also decreased from 148 cGy to 119.3 cGy (19%, p< 0.001) with bladder distension. However, there was no significant difference in rectal D2cc and D50% values.
Full bladder technique reduces sigmoid colon and bowel wall radiation exposure. The bladder gets a higher point dose and rectum remains unaffected.
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