METHODOLOGY OF 3D GRAPHIC BRACHYTHERAPY FOR CERVICAL CANCER
Relevance. Effective treatment of cervical cancer is one of the most important medical and social tasks of modern gynecological oncology. Despite the fact that a large number of different modes of brachytherapy are currently known and used in practice, the choice of the optimal mode is still a matter of debate. The fractionation regimen and the choice of total doses are decisive factors in reducing the incidence of complications with radiation therapy and do not worsen the results of treatment.
Aim: description of the 3D planning method for brachytherapy in the radiotherapy program for locally advanced cervical cancer.
Materials and research methods. The first stage was remote radiation therapy (2.0 Gy, 5 fractions per week, total radiation dose (TRD) was 50 Gy).In parallel the chemotherapy (Cisplatin, 40 mg / m2) was carried out. Starting from the 5th week, when the TRD was at least 40 Gy, 3D brachytherapy sessions were started (4 sessions of 6.0-7.0 Gy per week), while the TD of combined RT was 74.0-78.0 Gr. During choosing the volume and distribution of radiation doses, the recommendations of the International Commission - ICRU were applied. The treatment was carried out on a GammaMedPlus apparatus with a 192 Ir source in a high dose rate (HDR) mode. The plans were calculated using the Varian radiotherapy complex with the ECLIPSE planning system. The assessment of the quality of the exposure plan was carried out on the basis of monitoring the dose-volume histograms.
Research results. the study is methodological in nature and includes a detailed description of the conduct of 3D brachytherapy in the radiotherapy program for locally advanced cervical cancer.
Conclusion. Optimization of radiation therapy using 3D brachytherapy creates clinically favorable conditions for effective therapy: it reduces the risk of displacement of the applicators, reduces the load by reducing the total radiation doses, the frequency of severe early and late toxic effects, providing good local control indicators regardless of tumor size and clinical stage. The choice of rational fractionation schemes and the methodology for accounting for the dose load made it possible to optimize the irradiation programs taking into account the individual parameters of the tumor process, the spatial relationship of the tumor and risk organs, as well as the constitutional characteristics of the patient, thereby ensuring a higher level of quality of life.
Dilyara R. Kaidarova1, https://orcid.org/0000-0002-0969-5983
Olga B. Andreyeva2, http://orcid.org/0000-0002-2802-9441
Tasbolat A. Adylkhanov2, http://orcid.org/0000-0002-9092-5060
Tolegen S. Kurmangaliyev 3, http://orcid.org/0000-0003-2464-7581
Gaukhar S. Kamzina 2, https://orcid.org/0000-0002-4246-9961
Anar A. Bokembayeva 2, http://orcid.org/0000-0002-6948-4176
1 Kazakh Institute of Oncology and Radiology, Almaty, Republic of Kazakhstan;
2 Semey Medical University, Semey, Republic of Kazakhstan;
3 Center of Nuclear Medicine and Oncology, Semey, Republic of Kazakhstan.
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4. Aaronson N.K., Ahmedzai S., Bergman B. et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality of life instrument for use in international clinical trilas in oncology // J. Nat. Cancer lnst. 1993. Vol.85. P.365-375.
5. Adylkhanov T.A., Rakhimbekov A.V., Sandybayev M.N., Belikhina T.I., Lepikhina A.V., Zhabagina A.S., Andreyeva O.B., Karnakova N.Yu., Omarbayeva A.S., Kamzina G.S., Zhumakanova N.S. The role of computed tomography imaging in the training program and monitoring the effectiveness of radiation therapy for cervical neoplasms // Nauka i Zdravookhranenie. 2020. №. 1. Vol.22. pp.72-79. doi:10.34689/SH.2020.22.1.008
6. Charra-Brunaud C. et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study // Radiotherapy and Oncology. 2012. Vol. 103. №.3. pp. 305-313.
7. Chen S.W. et al. Comparative study of reference points by dosimetric analyses for late complications after uniform external radiotherapy and high-dose-rate brachytherapy for cervical cancer // International Journal of Radiation Oncology Biology Physics. 2004. Vol. 60. №.2. pp. 663-671.
8. Chong-Jong Wang, Eng -Yen Huang, Li-Min Sun et al. Clinical comparison of two linear-quadratic model-based isoeffect fractionation schemes of high-dose-rate intracavitary brachytherapy for cervical cancer // Int. J. Radiation Oncology Biol. Phys., 2004, V.59 (1), p.179-18.
9. Dyk P. et al. Cervical gross tumor volume dose predicts local control using magnetic resonance imaging/diffusion-weighted imaging—guided high-dose-rate and positron emission tomography/computed tomography—guided intensity modulated radiation therapy // International Journal of Radiation Oncology* Biology* Physics. 2014. Vol. 90. №.4. pp. 794-801.
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11. Murakami N. et al. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer // BMC cancer. 2014. Vol. 14. №.1. pp. 447.
12. Skowronek J., Malicki J. Comparison of value of biologically equivalent dose (BED) in clinical target volume (CTV) and surrounding healthy organs after PDR and HDR brachytherapy //Brachytherapy. 2007. Vol. 6. №. 2. pp. 112-113.
13. Yoshio K. et al. Inverse planning for combination of intracavitary and interstitial brachytherapy for locally advanced cervical cancer // Journal of radiation research. 2013. Vol. 54. №.6. pp. 1146-1152.
Reference:
1. Andreeva O.B., Adylhanov T.A., ZHabagina A.S., Raisov D.T., Urazalina N.M. Rol' 3D-vizualizacii v programme luchevoj terapii raka shejki matki. Obzor literatury [The role of 3D imaging in the cervical cancer radiotherapy program. Literature review]. Nauka i zdravoohranenie [Science and health]. 2019 №4. Vol.21. pp. 5-19 [in Russian].
2. Kachestvo zhizni Vsemirnoi organizatsii zdravookhraneniya [World Health Organization quality of life (WHOQOL)] Electronic resource: http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/ (date of the application 15.11.2020).
3. Naznachenie, registratsiya i otchet o brakhiterapii pri rake sheiki matki. [Appointment, registration and report on brachytherapy for cervical cancer. ] Electronic resource: https://icru.org/content/reports/prescribing-recording-and-reporting-brachytherapy-for-cancer-of-the-cervix-report-no-89 (date of the application 15.11.2020).
4. Aaronson N.K., Ahmedzai S., Bergman B. et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality of life instrument for use in international clinical trilas in oncology. J. Nat. Cancer lnst. 1993. Vol.85. P.365-375.
5. Adylkhanov T.A., Rakhimbekov A.V., Sandybayev M.N., Belikhina T.I., Lepikhina A.V., Zhabagina A.S., Andreyeva O.B., Karnakova N.Yu., Omarbayeva A.S., Kamzina G.S., Zhumakanova N.S.. The role of computed tomography imaging in the training program and monitoring the effectiveness of radiation therapy for cervical neoplasms. Nauka i Zdravookhranenie [Science & Healthcare. 2020. №.1. Vol.22. pp.72-79.
6. Charra-Brunaud C. et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiotherapy and Oncology. 2012. Vol. 103. №. 3. pp. 305-313.
7. Chen S.W. et al. Comparative study of reference points by dosimetric analyses for late complications after uniform external radiotherapy and high-dose-rate brachytherapy for cervical cancer. International Journal of Radiation Oncology Biology Physics. 2004. Vol. 60. №. 2. pp. 663-671.
8. Chong-Jong Wang, Eng -Yen Huang, Li-Min Sun et al. Clinical comparison of two linear-quadratic model-based isoeffect fractionation schemes of high-dose-rate intracavitary brachytherapy for cervical cancer. Int. J. Radiation Oncology Biol. Phys., 2004, V.59 (1), p.179-18.
9. Dyk P. et al. Cervical gross tumor volume dose predicts local control using magnetic resonance imaging/diffusion-weighted imaging—guided high-dose-rate and positron emission tomography/computed tomography - guided intensity modulated radiation therapy. International Journal of Radiation Oncology* Biology* Physics. 2014. Vol. 90. №. 4. pp. 794-801.
10. Herrmann T., Knorr A., Dorner K. The RTOG/EORTC classification criteria for early and late radiation reactions. Radiobiologia, radiotherapia. 1987. Vol. 28. №. 4. pp. 519-528.
11. Murakami N. et al. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer. BMC cancer. 2014. Vol. 14. №.1. pp. 447.
12. Skowronek J., Malicki J. Comparison of value of biologically equivalent dose (BED) in clinical target volume (CTV) and surrounding healthy organs after PDR and HDR brachytherapy. Brachytherapy. 2007. Vol. 6. №. 2. pp. 112-113.
13. Yoshio K. et al. Inverse planning for combination of intracavitary and interstitial brachytherapy for locally advanced cervical cancer. Journal of radiation research. 2013. Vol. 54. №. 6. pp. 1146-1152.
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Kaidarova D.R., Andreyeva O.B., Adylkhanov T.A., Kurmangaliyev T.S., Kamzina G.S., Bokembayeva A.A. Methodology of 3D graphic brachytherapy for cervical cancer // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 6, pp. 63-70. doi 10.34689/SH.2020.22.6.009Related publications:
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