Impact of Bladder Distension on Organs at Risk in 3D Intracavitary Brachytherapy for Cervical Cancer

  • MUHAMMAD ALI Prince Sultan Military Medical City
  • Hooryia Bajwa Bajwa
  • Bilal Muhammad Muhammad
  • K Rehman Rehman
  • I Niazi Niazi
  • I Haider Haider
  • A Masood Masood
Keywords: organ at risk(OAR, HDR, D2CC, D50%

Abstract

Objectives:

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.

 RESULTS:

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.

 CONCLUSION:

Full bladder technique reduces sigmoid colon and bowel wall radiation exposure. The bladder gets a higher point dose and rectum remains unaffected.

Author Biography

MUHAMMAD ALI, Prince Sultan Military Medical City

MBBS, FCPS(Radiation Oncology)
Senior Registar
Department Of Oncology
Prince Sultan Military Medical City
Riyadh, KSA

References

1. Cervical Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. International Agency for Research on Cancer and World Health Organization; 2012. Available at: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx

2. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69-90

3. Report available at: http://www.hpvcentre.net/statistics/reports/PAK.pdf

4. NCI clinical announcement: concurrent chemoradiation for cervical cancer. Washington, DC: US Department of
Public Health, 1999
5. Vale C. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802Y5812.

6. Kirwan JM, Symonds P, Green JA, et al. A systemic review of acute and late toxicity of concomitant hemoradiation for cervical cancer. Radiother Oncol. 2003; 68: 217-226.

7. Forrest JL, Ackerman I, Barbera L, Barnes EA, Davidson M, Kiss A, et al. Patient outcome study of concurrent chemoradiation, external beam radiotherapy, and high-dose rate brachytherapy in locally advanced carcinoma of the cervix. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2010;20(6):1074-8.

8. Perez CA, Grigsby PW, Lockett MA, Chao KS, Williamson J. Radiation therapy morbidity in carcinoma of the uterine cervix: dosimetric and clinical correlation. International journal of radiation oncology, biology, physics. 1999;44(4):855-66.

9.Kottmeier HL, Gray MJ. Rectal and bladder injuries in relation to radiation dosage in carcinoma of the cervix. A 5 year follow-up. American journal of obstetrics and gynecology. 1961;82:74-82.

10. Kim RY, Shen S, Lin HY, Spencer SA, De Los Santos J. Effects of bladder distension on organs at risk in 3D image-based planning of intracavitary brachytherapy for cervical cancer. International journal of radiation oncology, biology, physics. 2010;76(2):485-9.

11. Cengiz M, Gurdalli S, Selek U, Yildiz F, Saglam Y, Ozyar E, et al. Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer: three-dimensional computed tomography plan evaluation. International journal of radiation oncology, biology, physics. 2008;70(2):464-8.

12. Haie-Meder C, Potter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2005;74(3):235-45.

13. Niladri B. Patra, , Kazi S. Manir, Swapnendu Basu. Et al; Effect of bladder distension on dosimetry of organs at risk in computer tomography based planning of high-dose-rate intracavitary brachytherapy for cervical cancer; J Contemp Brachytherapy 2013; 5, 1: 3–9

14. Cengiz M, Gurdalli S, Selek U, Yildiz F, Saglam Y, Ozyar E, et al. Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer: three-dimensional computed tomography plan evaluation. International journal of radiation oncology, biology, physics. 2008;70(2):464-8.

15. Ozan C. Guler, Cem Onal, Ibrahim Acibuci; Effects of bladder distension on dose distribution of vaginal vault brachytherapy in patients with endometrial cancer; J Contemp Brachytherapy 2014; 6, 4: 371–376

16. Yamashita H, Nakagawa K, Okuma K, Sakumi A, Haga A, Kobayashi R, et al. Correlation between bladder volume and irradiated dose of small bowel in CT-based planning of intracavitary brachytherapy for cervical cancer. Japanese journal of clinical oncology. 2012;42(4):302-8.

17. Sun LM, Huang HY, Huang EY, Wang CJ, Ko SF, Lin H, et al. A prospective study to assess the bladder distension effects on dosimetry in intracavitary brachytherapy of cervical cancer via computed tomography-assisted techniques. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2005;77(1):77-82.

18. Hall E. J, Giacia A.J. (2012). Clinical Response of Normal Tissues, Radiobiology for the Radiologist (pp. 327-355). Philadelphia, PA: Lippincott Williams & Wilkins
19. Ju SG, Huh SJ, Shin JS, Park W, Nam H, Bae S, et al. Different effects of bladder distention on point A-based and 3D-conformal intracavitary brachytherapy planning for cervical cancer. Journal of radiation research. 2013;54(2):349-56.

20. Stewart AJ, Cormack RA, Lee H, Xiong L, Hansen JL, O'Farrell DA, et al. Prospective clinical trial of bladder filling and three-dimensional dosimetry in high-dose-rate vaginal cuff brachytherapy. International journal of radiation oncology, biology, physics. 2008;72(3):843-8.
Published
2018-02-28
How to Cite
ALI, M., Bajwa, H. B., Muhammad, B. M., Rehman, K. R., Niazi, I. N., Haider, I. H., & Masood, A. M. (2018, February 28). Impact of Bladder Distension on Organs at Risk in 3D Intracavitary Brachytherapy for Cervical Cancer. EPH - International Journal of Medical and Health Science (ISSN: 2456 - 6063), 4(2), 21-31. Retrieved from https://ephjournal.com/index.php/mhs/article/view/490