Positional stability of sources during low dose rate brachytherapy for cervical carcinoma

Abstract Purpose: A presumed advantage of high dose rate gynecologic applicators is the fixed relationship maintained between applicator and anatomic structures during the brief exposure. However, it has never been demonstrated that movement of applicators during low dose rate procedures is significant. Therefore, we assessed the magnitude of changes in positioning and attendant alterations in dosimetry which occur during LDR applications. Methods and Materials: Fifteen consecutive cervix cancer patients who were treated with combined external beam and brachytherapy (Fletcher-Suit-Delclos applicator), agreed to have orthogonal pelvic radiographs prior to after-loading and following removal of Cesium-137 sources. Results: The median duration of the insertion was 56.5 hours. The average shift was 3.0 mm. Detailed analysis of source movement showed the following changes in median dose (external plus implant): point A, 1.4%; point B, 1.7%; point P, 0.9%; bladder point, 1.9%; rectal point, 2.6%. Conclusion: The geometric relationships between the intracavitary gynecologic applicator and the target tissue as well as the critical structures can be adequately maintained throughout the course of a low dose rate implant. Source movement does not result in significant dose changes in terms of decreased cure rates or added complications. Thus, while rationale for high dose rate applicators continues to be proposed, maintenance of a fixed geometric relationship should not be an impetus for the selection of high dose rate intracavitary applicators when treating cervical tumors.