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Volume 13, Number 1, 2008

Optimization in high dose rate vaginal cylinder for vaginal cuff irradiation

Somangili Sathyamoorthy Sivakumar, Johnson Gilbert Roy Solomon, Sanjay Sudhakar Supe, Bejadi Manjunath Vadhiraja, Kilari Koteshwer Rao, Mamidipudi Srinivasa Vidyasagar


Aim The aim of this study is to evaluate the infl uence of high dose rate (HDR) brachytherapy
source step size, source dwell position, dose prescription depth, dose specification points and optimization technique on dose distribution around Microselectron HDR brachytherapy vaginal cylinders and to evaluate the influence of distal dwell position and optimization technique on rectal and bladder dose of patients treated for vaginal cuff irradiation.
Materials/Methods Orthogonal radiographs of vaginal cylinders of diameter 2.0, 2.5, 3.0 and 3.5cm form the basis of the study. Dose distribution using the PLATO brachytherapy
treatment planning system (version 14.1) was generated. Two different HDR cylinder
models, namely the non-curved dome model (NCDM) and curved dome
model (CDM), were studied. To evaluate bladder and rectum dose in the patients
NCDM was used.
Results CDM gives more uniform dose distribution around the cylinder than NCDM. Dose
prescription at 5mm depth from the surface results in very high dose to apex and
dome as compared with the surface dose prescription. Dose prescription depth and
dwell positions infl uence the length of prescription isodose. Optimization method
and dwell positions affect the bladder and rectal dose of the studied patients.
Conclusions Uniform dose distribution can be obtained for HDR vaginal cylinders by appropriately selecting dose specifi cation points and optimization method. Dose distribution
can be confi gured to provide a uniform dose on the surface, if the apex
and curved surface of the cylinder are considered for dose specifi cation and optimization.
Appropriate HDR parameters are identifi ed to minimize the dose to
the apex of the vaginal cylinder, essential to reduce the dose to overlying small
bowel and reduce the dose to rectum and bladder.

Signature: Rep Pract Oncol Radiother, 2008; 13(1) : 35-48


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