Positional Variability of a Tandem Applicator System in HDR Brachytherapy for Primary Treatment of Cervix Cancer
2004
Evaluation of the inter- and intraindividual applicator
variability of multiple high-dose-rate (HDR) brachytherapy
applications for primary treatment of cancer of the uterine
cervix. Retrospective analysis of 460 pairs of orthogonal X-ray
films for conventional treatment in 92 patients with five
intrauterine applications using an HDR tandem applicator.
Measurement of the position of the applicator origin relative to
a bony reference system in three dimensions. Evaluation of the
differences of the applicator position in all 460 applications
(interindividual variability), of the five applications in a
single patient (intraindividual variability) and of the
intraindividual variability relative to the applicator position
at the first application. The position of the applicator origin in the pelvis ranged
from 23 mm cranial and 55 mm caudal to the top of femoral heads,
23 mm right and 27 mm left to the pelvic midline, and 6–53 mm
dorsal to the mid of the femoral heads. Standard deviation (SD)
of interindividual applicator variability was 12.9 mm
(minimum/maximum –55/+23 mm, mean –13.6 mm) in longitudinal, 5.1
mm (–27/+23 mm, mean 1.6 mm) in lateral, and 7.6 mm (6/53 mm,
mean 26 mm) in anterior-posterior [AP] direction. SD of
intraindividual variability was 5.5 mm (–21/+23 mm, mean 0 mm)
in longitudinal, 2.5 mm (–17/+19 mm, mean 0 mm) in lateral, and
4.2 mm (–15/+18 mm, mean 0 mm) in AP direction compared to
intraindividual variability relative to the first insertion with
an SD of 8.9 mm (–23/+36 mm, mean 2.8 mm) in longitudinal, 4.0
mm (–11/+23 mm, mean 0 mm) in lateral, and 6.8 mm (–27/+17 mm,
mean –0.8 mm) in AP direction. Intraindividual applicator variability is significantly
smaller than interindividual variability. Applicator-related
procedures such as midline shielding or dose matching of tele-
and brachytherapy should be performed with information on at
least one individual applicator position.
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