Table of Contents
ISRN Oncology
Volume 2014, Article ID 687365, 7 pages
Clinical Study

Magnitude and Implications of Interfraction Variations in Organ Doses during High Dose Rate Brachytherapy of Cervix Cancer: A CT Based Planning Study

Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Received 6 November 2013; Accepted 26 November 2013; Published 3 February 2014

Academic Editors: G. E. Kim and L.-M. Sun

Copyright © 2014 Santam Chakraborty et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Quantifying the interfraction dose variations in the organs at risk (OAR) in HDR intracavitary brachytherapy (HDR ICBT). Methods. Rectum and bladder were contoured in 44 patients of cervical carcinoma on CT after each fraction of HDR ICBT (9 Gy/2 fractions). Interfraction dose variations (VARact) were calculated. Rigid image registration of consecutive fraction images allowed quantification of the hypothetical variation in dose (VARhypo) arising exclusively due to changes in applicator placement and geometry. VARhypo was regressed against the VARact to find out to what extent the applicator variation could explain the VARact in the OAR. The rest of the variation was assumed to be due to organ deformation. Results. The VARact in the dose to 2 cc of bladder and rectum were 1.46 and 1.16 Gy, respectively. Increased dose was seen in 16 and 23 patients in the subsequent fraction for bladder and rectum, respectively. Doses to OAR would have exceeded constraints in 16% patients if second fraction was not imaged. VARhypo explained 19% and 47% of the VARact observed for the bladder and rectum respectively. Conclusions. Significant interfraction variations in OAR doses can occur in HDR ICBT. Organ deformations are mostly responsible for this variation.