A Dosimetric Study of Optimised and Non-Optimised Plans in Intracavitary Brachytherapy (ICBT) Using International Commission on Radiation Units and Measurement (ICRU) 89

Document Type : Original Paper


1 Department of Radiation Oncology,Max Superspeciality Hospital , Shalimar Bagh , Delhi

2 Department of Radiation Oncology,Max Superspeciality Hospital , Saket , Delhi

3 Amity Institute of Applied Sciences, Amity University, Noida


Introduction: The study aimed to assess the effectiveness of the dosimetric parameters of organs-at-risks (OARs) and target coverage in optimized plans compared to non-optimised plans normalized at point A.
Material and Methods:This retrospective study examined 21 patients with cervical cancer in stages II and III, who had undergone a high dose rate (HDR) ICBT following external beam radiotherapy(EBRT).In this study, two treatment plans were created for each case using computed tomography (CT) images. Normalization at point A was performed in the non-optimised plans, and 90% of the high-risk clinical target volume (HR-CTV) was to receive the prescribed dose in the optimised plans. Dose-volume histograms (DVH) were used to compare D5cc, D2cc, D1cc, and D0.1cc (minimum doses received by the most irradiated volumes of5cc, 2cc, 1cc and 0.1cc, respectively) for OARs as well as the D90%, D50%, D98%, D100%, and D95% coverage of HR-CTV between the non-optimised and optimised plans. Statistical analysis was performed using Wilcoxon signed rank test.
Results: The HR-CTV coverage improved in 80% of the patients. In the optimised plans, the rectum and bladder doses decreased by 8.75% and 9.85%, as compared to the non-optimised plans normalized at point A, respectively. In the sigmoid and bowel cases, there were dose drops by 8.95% and 9.75%, in the optimised plans, respectively.
Conclusion: Target coverage and OAR sparing were more satisfactory in the optimised plans than the non-optimised plans normalized at point A.


Main Subjects

  1. Haie-Meder C, Pötter 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. 2005 Mar 1;74(3):235-45.
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018 Nov;68(6):394-424.
  3. Weiner AA, Schwarz JK. Intracavitary brachytherapy for gynecologic malignancies: applications and innovations. Missouri medicine. 2015 Sep;112(5):366.
  4. Kim YJ, Kang HC, Kim YS. Impact of intracavitary brachytherapy technique (2D versus 3D) on outcomes of cervical cancer: a systematic review and meta-analysis. Strahlentherapie und Onkologie. 2020 Nov;196(11):973-82.
  5. Chassagne D, Dutreix A, Almond P, Burgers JMV, Busch M, Joslin CA.ICRU report 38: dose and volumespecification for reporting intracavitary therapy in gynecology. Journal ofInternational Commission on Radiation Units and Measurements.1985; 20(1).
  6. Jamalludin Z, Min UN, Ishak WW, Malik RA. Preliminary experience on the implementation of computed tomography (CT)-based image guided brachytherapy (IGBT) of cervical cancer using high-dose-rate (HDR) Cobalt-60 source in University of Malaya Medical Centre (UMMC). InJournal of Physics: Conference Series. 2016; 694(1): 012016.
  7. Radhika Rani, R. Srikanth. Comparative study of conventional and CT based planning of target volumes organs at risk in intracavitary brachytherapy for carcinoma of cervix. IAIM 2016;3(9):200-9.
  8. Tann YI,Choo BA, Lee KM. 2D to 3D evaluation of organ at risk doses in ICRT for cervical cancers. Journal of Contemporary Brachytherapy.2010 Mar;2(1):37–
  9. Kim RY, Shen S, Duan J. Image based three-dimensional planning of intracavitary brachytherapy for cancer of the cervix: Dose-volume histograms of the bladder, rectum, sigmoid colon and small bowel. Brachytherapy. 2007. Jul-Sep;6(3):187-94.
  10. Imanoa N, Wadasakib K, Nishibuchia I, Nagataa Y. Comparison of clinical outcome between computed tomography-based image-guided brachytherapy and two dimensional-based brachytherapy for cervical cancer. Gynaecology Oncology Reports. 2019; 29:79-82.
  11. Derks K, Steenhuijsen JL, van den Berg HA, Houterman S, Cnossen J, van Haaren P, De Jaeger K. Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer. Journal of contemporary brachytherapy. 2018 Feb;10(1):17.
  12. Wanderas AD, Sundset M, Langdal I, Danielsen S, Frykholm G, Marthinsen AB. Adaptive brachytherapy of cervical cancer, comparison of conventional point A CT based individual treatment planning. ActaOncologica. 2012 Mar;51(3):345-54.
  13. Viswanathan AN, Erickson B, Gaffney DK, Beriwal S, Bhatia SK, Burnett III OL, et al. Comparison and consensus guidelines for delineation of clinical target volume for CT-and MR-based brachytherapy in locally advanced cervical cancer. International Journal of Radiation Oncology* Biology* Physics. 2014 Oct 1;90(2):320-8.
  14. Potter R, Kirisits C, Erickson B,Haie-Meder C, Van Limbergen E,Lindegaard J. C, et al.ICRU report 89: prescribing, recording and reporting brachytherapy for cancer of the cervix. International Commission on Radiation Units and Measurements. 2016 July;13(1-2).
  15. Pötter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, et al. GEC ESTRO Working Group: Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. RadiotherOncol. 2006;78(1):67-77.
  16. Datta NR, Srivastava A, Das KJ, Gupta A, Rastogi N. Comparative assessment of doses to tumor, rectum, and bladder as evaluated by orthogonal radiographs vs. computer enhanced computed tomography-based intracavitary brachytherapy in cervical cancer. Brachytherapy. 2006 Oct 1;5(4):223-9.
  17. Wang B, Kwon A, Zhu Y, Yeo I, Henson CF. Image-guided intracavitary high-dose-rate brachytherapy for cervix cancer: A single institutional experience with three-dimensional CT-based planning. Brachytherapy. 2009 Apr 1;8(2):240-7.
  18. Tan LT, Coles CE, Hart C, Tait E. Clinical impact of computed tomography-based image-guided brachytherapy for cervix cancer using the tandem-ring applicator—the Addenbrooke's experience. Clinical Oncology. 2009 Apr 1;21(3):175-82.
  19. Shin KH, Kim TH, Cho JK, Kim JY, Park SY, Park SY, et al. CT-guided intracavitary radiotherapy for cervical cancer: comparison of conventional point A plan with clinical target volume-based three-dimensional plan using dose–volume parameters. International Journal of Radiation Oncology* Biology* Physics. 2006 Jan 1;64(1):197-204.
  20. Wachter-Gerstner N, Wachter S, Reinstadler E, Fellner C, Knocke TH, Pötter R. The impact of sectional imaging on dose escalation in endocavitary HDR-brachytherapy of cervical cancer: results of a prospective comparative trial. Radiotherapy and oncology. 2003 Jul 1;68(1):51-9.
  21. Pötter R, Knocke TH, Fellner C, Baldass M, Reinthaller A, Kucera H. Definitive radiotherapy based on HDR brachytherapy with iridium 192 in uterine cervix carcinoma: report on the Vienna University Hospital findings (1993–1997) compared to the preceding period in the context of ICRU 38 recommendations. Cancer/Radiothérapie. 2000 Mar 1;4(2):159-72.
  22. Viswanathan AN, Dimopoulos J, Kirisits C, Berger D, Pötter R. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. International Journal of Radiation Oncology* Biology* Physics. 2007 Jun 1;68(2):491-8.
Volume 18, Issue 5
September and October 2021
Pages 314-320
  • Receive Date: 09 April 2020
  • Revise Date: 28 September 2020
  • Accept Date: 12 October 2020