Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer
Meeting dose prescription is critical to control tumors in radiation therapy. Interfraction dose variations (IDVs) from the prescribed dose in high dose rate brachytherapy (HDR) would cause the target dose to deviate from the prescription but their clinical effect has not been widely discussed in th...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/19/4862 |
| _version_ | 1797576135633010688 |
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| author | Brien Washington Dennis Cheek Denise Fabian Mahesh Kudrimoti Damodar Pokhrel Chi Wang Cameron Thayer-Freeman Wei Luo |
| author_facet | Brien Washington Dennis Cheek Denise Fabian Mahesh Kudrimoti Damodar Pokhrel Chi Wang Cameron Thayer-Freeman Wei Luo |
| author_sort | Brien Washington |
| collection | DOAJ |
| description | Meeting dose prescription is critical to control tumors in radiation therapy. Interfraction dose variations (IDVs) from the prescribed dose in high dose rate brachytherapy (HDR) would cause the target dose to deviate from the prescription but their clinical effect has not been widely discussed in the literature. Our previous study found that IDVs followed a left-skewed distribution. The clinical effect of the IDVs in 100 cervical cancer HDR patients will be addressed in this paper. An in-house Monte Carlo (MC) program was used to simulate clinical outcomes by convolving published tumor dose response curves with IDV distributions. The optimal dose and probability of risk-free local control (RFLC) were calculated using the utility model. The IDVs were well-fitted by the left-skewed Beta distribution, which caused a 3.99% decrease in local control probability and a 1.80% increase in treatment failure. Utility with respect to IDV uncertainty increased the RFLC probability by 6.70% and predicted an optimal dose range of 83 Gy–91 Gy EQD2. It was also found that a 10 Gy dose escalation would not affect toxicity. In conclusion, HRCTV IDV uncertainty reduced LC probabilities and increased treatment failure rates. A dose escalation may help mitigate such effects. |
| first_indexed | 2024-03-10T21:47:55Z |
| format | Article |
| id | doaj.art-bc15a612a19c459991afc8abf20f7b98 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:47:55Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-bc15a612a19c459991afc8abf20f7b982023-11-19T14:11:38ZengMDPI AGCancers2072-66942023-10-011519486210.3390/cancers15194862Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical CancerBrien Washington0Dennis Cheek1Denise Fabian2Mahesh Kudrimoti3Damodar Pokhrel4Chi Wang5Cameron Thayer-Freeman6Wei Luo7Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Internal Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USADepartment of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USAMeeting dose prescription is critical to control tumors in radiation therapy. Interfraction dose variations (IDVs) from the prescribed dose in high dose rate brachytherapy (HDR) would cause the target dose to deviate from the prescription but their clinical effect has not been widely discussed in the literature. Our previous study found that IDVs followed a left-skewed distribution. The clinical effect of the IDVs in 100 cervical cancer HDR patients will be addressed in this paper. An in-house Monte Carlo (MC) program was used to simulate clinical outcomes by convolving published tumor dose response curves with IDV distributions. The optimal dose and probability of risk-free local control (RFLC) were calculated using the utility model. The IDVs were well-fitted by the left-skewed Beta distribution, which caused a 3.99% decrease in local control probability and a 1.80% increase in treatment failure. Utility with respect to IDV uncertainty increased the RFLC probability by 6.70% and predicted an optimal dose range of 83 Gy–91 Gy EQD2. It was also found that a 10 Gy dose escalation would not affect toxicity. In conclusion, HRCTV IDV uncertainty reduced LC probabilities and increased treatment failure rates. A dose escalation may help mitigate such effects.https://www.mdpi.com/2072-6694/15/19/4862cervical cancerdose variationbeta distributionhigh dose rate brachytherapydose response modelutility |
| spellingShingle | Brien Washington Dennis Cheek Denise Fabian Mahesh Kudrimoti Damodar Pokhrel Chi Wang Cameron Thayer-Freeman Wei Luo Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer Cancers cervical cancer dose variation beta distribution high dose rate brachytherapy dose response model utility |
| title | Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer |
| title_full | Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer |
| title_fullStr | Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer |
| title_full_unstemmed | Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer |
| title_short | Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer |
| title_sort | effects of interfraction dose variations of target and organs at risk on clinical outcomes in high dose rate brachytherapy for cervical cancer |
| topic | cervical cancer dose variation beta distribution high dose rate brachytherapy dose response model utility |
| url | https://www.mdpi.com/2072-6694/15/19/4862 |
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