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Dosimetric comparison of sequential intensity-modulated radiation therapy (IMRT) and simultaneous integrated boost IMRT for lymph node-positive cervical cancer

Published online by Cambridge University Press:  31 October 2023

Samarpita Mohanty Open the ORCID record for Samarpita Mohanty [Opens in a new window] ,
Raghavendra Hajare Open the ORCID record for Raghavendra Hajare [Opens in a new window] ,
Lavanya Gurram Open the ORCID record for Lavanya Gurram [Opens in a new window] ,
Dheera Aravindakshan ,
Vanisha Midha ,
Supriya Chopra Open the ORCID record for Supriya Chopra [Opens in a new window]  and
Umesh Mahantshetty Open the ORCID record for Umesh Mahantshetty [Opens in a new window]
Samarpita Mohanty
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Raghavendra Hajare
Affiliation:
Department of Medical Physics, Homi Bhabha Cancer Hospital, Visakhapatnam, India
Lavanya Gurram*
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Dheera Aravindakshan
Affiliation:
Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Vanisha Midha
Affiliation:
Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Supriya Chopra
Affiliation:
Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Umesh Mahantshetty
Affiliation:
Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Visakhapatnam, India
*
Corresponding author: Lavanya Gurram; Email: naidu.lavanya@gmail.com
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Abstract

Introduction:

Nodal boost is being increasingly employed to escalate the dose to involved nodes in node-positive cervical cancer. The study aimed to compare the dosimetric differences between sequential boost intensity-modulated radiation therapy (SeB-IMRT) and simultaneous integrated boost IMRT (SIB-IMRT) in terms of target coverage and organs-at-risk (OARs) with special emphasis on the effect of nodal shrinkage and anatomical change of normal tissues during radiotherapy.

Methods:

Two computed tomography (CT) datasets (of phase I and phase II) of 40 patients of node-positive cervical cancer treated with SeB-IMRT [planning target volume (PTV) 45/25] followed by SeB to residual nodes (PTV 12·6/7) were utilised. SIB-IMRT1 plan consisted of PTV pelvis and para-aortic nodal region (PTV 45/25) and SIB to gross nodes (PTV 55/25). In order to account for the change in nodal and normal tissue topography during treatment, a third plan (SIB-IMRT2) was generated by utilising the SIB-IMRT1 plan for 44 Gy in 20 fractions and reproducing the plan on the second CT dataset for 11 Gy in 5 fractions. Dosimetric parameters of the three plans were compared using the Friedman test with Bonferroni correction.

Results:

We observed that the doses to OARs (bowel, rectum and bladder) were significantly higher in SeB-IMRT plan as compared to the SIB-IMRT plans. V40 Gy of bowel for SeB-IMRT, SIB-IMRT1 and SIB-IMRT2 plans were 354·8 cc, 271 cc and 321·8 cc, respectively (p = 0·001), whereas V30 Gy were 687·8 cc, 635·5 cc and 680 cc, respectively (p = 0·001). The target coverage was marginally better in SeB-IMRT plan as compared to SIB-IMRT1 and SIB-IMRT2 plans (V95% = 99·2 versus 97·7 versus 97·9, respectively, p = 0·000)

Conclusion:

SIB-IMRT led to better sparing of OARs, especially bowel. However, the magnitude of benefit decreases if the change in nodal and normal tissue topography during radiotherapy is not considered implying the need for frequent image guidance when SIB-IMRT is planned for node-positive cervical cancer.

Keywords

nodal boostintensity-modulated radiotherapycervical cancer
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e113
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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