Abstract：
PURPOSE:In this planning study, we investigated the dosimetric benefit of repeat CT-based treatment planning at each fraction vs. the use of a single CT-based treatment plan for all fractions for high-dose-rate endorectal brachytherapy (HDREBT) for rectal cancer. METHODS AND MATERIALS:We included 11 patients that received a CT scan with applicator in situ for all three fractions. The treatment plan of the first fraction was projected on the repeat CT scans to simulate the use of a single treatment plan. In addition, replanning was performed on the repeat CT scans, and these were compared to the corresponding projected treatment plans. RESULTS:Repeat CT-based treatment planning resulted on average in a 21% higher (p = 0.01) conformity index compared to single CT-based treatment planning. Projecting the initial treatment plan to the repeat CT scans of fraction two and three, 12/22 fractions reached a CTV D98 of 85% of the prescribed dose of 7 Gy, which increased to 14/22 using replanning. For the remaining fractions, median CTV D98 was 4.2 Gy, and an intervention would be necessary to correct applicator balloon setup or to remove remaining air and/or feces between the CTV and the applicator. CONCLUSIONS:Using a single CT-based treatment plan for all fractions may result in a suboptimal treatment at later fractions. Therefore, repeat CT imaging should be the minimal standard practice in HDREBT for rectal cancer to determine whether an intervention would be necessary. Replanning based on repeat CT imaging resulted in more conformal treatment plans and is therefore recommended.
journal_name
Brachytherapyjournal_title
Brachytherapyauthors
van den Ende RPJ,Rijkmans EC,Kerkhof EM,Nout RA,Ketelaars M,Laman MS,Marijnen CAM,van der Heide UAdoi
10.1016/j.brachy.2017.08.011subject
Has Abstractpub_date
2018-01-01 00:00:00pages
78-85issue
1eissn
1538-4721issn
1873-1449pii
S1538-4721(17)30452-Xjournal_volume
17pub_type
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