title: Patient-related factors determining geometry of intracavitary applicators and pelvic dose distribution during cervical cancer brachytherapy.
abstract: OBJECTIVE
  The aim of this study was to assess retrospectively the influence of the size of cervical cancer brachytherapy applicators (ovoids and uterine tandems) on pelvic dose distribution and to analyze the impact of various patient- and disease-related factors on applicators' geometry and on dose distribution in particular applications.
  
  
  METHODS
  The subject of this study were 356 cervical cancer patients treated with Selectron LDR as a part of their radical radiotherapy. Analyzed factors included patient age, weight, number of vaginal deliveries, and disease stage.
  
  
  RESULTS
  The use of larger vaginal applicators resulted in lower bladder and rectum doses and in higher point B doses (all p < 0.0001); longer uterine tandems produced lower rectum doses and higher point B doses (both p < 0.0001). Increasing patient age and disease stage resulted in a decreased frequency of use of large ovoids (both p < 0.0001) and of long tandems (age: p = 0.0069, stage: p = 0.004). As a result, higher doses to bladder (age: p < 0.0001, stage: p = 0.017) and rectum (age: p = 0.037, stage: p = 0.011) were observed. Increasing age also resulted in lower point B doses (p < 0.0001). Increasing patient weight correlated with less frequent use of long tandems (p = 0.0015) and with higher bladder doses (p = 0.04). Higher number of vaginal deliveries was related to the increase in the use of long tandems (p = 0.002); in patients who had had at least one vaginal delivery, point B doses were significantly higher (p = 0.0059). In multivariate analysis ovoid size and uterine tandem length were dependent on patient age (respectively: p < 0.001 and p = 0.001), disease stage (respectively: p = 0.003 and p = 0.008) and on the number of vaginal deliveries (respectively: p = 0.07 and p = 0.008). Doses to critical organs and to points B were dependent on patient age (respectively: p < 0.001, p = 0.011, and p < 0.001) and on disease stage (respectively: p < 0.001, p = 0.004, and p = 0.048).
  
  
  CONCLUSIONS
  The results of this study allow for identification of some patient- and disease-related factors influencing pelvic dose distribution in cervical cancer brachytherapy. This potentially may enable optimization of the dose distribution in particular clinical situations.
authors.affiliation: Department of Oncology and Radiotherapy, Medical University of Gdańsk,Poland.
authors.forename: E
authors.initials: E
authors.lastname: Senkus-Konefka
authors.forename: A
authors.initials: A
authors.lastname: Kobierska
authors.forename: J
authors.initials: J
authors.lastname: Jassem
authors.forename: A
authors.initials: A
authors.lastname: Badzio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D036861:Delivery, Obstetric; D004867:Equipment Design; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010388:Pelvis; D011247:Pregnancy; D011879:Radiotherapy Dosage; D012007:Rectum; D012189:Retrospective Studies; D001743:Urinary Bladder; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*