Abstract
Within a multifraction high-dose-rate vaginal cuff brachytherapy course, we determined if individual variations in organ at risk (OAR) volume and cylinder insertion geometry (CIG) impacted dose and whether planned minus fractional (P - F) differences led to a discrepancy between planned dose and delivered dose. We analyzed vaginal cuff brachytherapy applications from consecutive patients treated with three fractions of 5 Gy after each undergoing a planning CT and three repeat fractional CTs (fCTs). Rectal and bladder D2ccs and volumes were recorded in addition to the x (in relationship to midplane) and y (in relationship to the table) angles of CIG. Paired t-tests and multiple regression analyses were performed. Twenty-seven patients were identified. In comparing the planning CT vs. mean fCT rectal volumes, bladder volumes, x angles, and y angles, only bladder volume was significantly different (planned volume higher, t = 2.433, p = 0.017). The cumulative mean planned OAR D2cc vs. delivered D2cc was only significantly different for the bladder (planned dose lower, t = -2.025, p = 0.053). Regression analysis revealed planned rectal D2cc (p < 0.0003) and a positive (posterior) y insertion angle (p = 0.015) to significantly impact...Continue Reading
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