title: Uncertainties when using only one MRI-based treatment plan for subsequent high-dose-rate tandem and ring applications in brachytherapy of cervix cancer.
abstract: OBJECTIVE
  This retrospective study compares individual MRI based 3D treatment planning for each intracavitary applicator insertion and the use of only one MRI treatment plan for cervical cancer brachytherapy.
  
  
  METHODS
  GTV, high risk (HR) CTV and OAR were delineated and analysed for 14 patients. Data using the individual approach were taken from the actual irradiated plans. The "single plan procedure" was simulated by matching the dose distribution of the first plan to the MRI datasets of each subsequent implantation. Total doses from brachytherapy were added up and normalized to 2Gy fractionation (EQD2).
  
  
  RESULTS
  The mean D90 for HR CTV was 6Gy higher when using one plan than when using individual treatment plans. The D(2cc) increased 3.5Gy for the bladder, 4.2Gy for the rectum and 5.8Gy for the sigmoid. The use of only one treatment plan would have resulted in 2, 1 and 5 extra cases exceeding total D(2cc) constraints for bladder (90Gy), rectum (75Gy) and sigmoid (75Gy), respectively.
  
  
  CONCLUSIONS
  The use of only one treatment plan for several applications results in higher dose to target and OAR structures. CT, clinical examination and X-ray findings can help to reduce certain situations of overdosage, when individual MRI based treatment planning is not available for each fraction.
authors.affiliation: Department of Radiotherapy and Radiobiology, Medical University of Vienna, Vienna, Austria. Christian.Kirisits@meduniwien.ac.at
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
authors.forename: Stefan
authors.initials: S
authors.lastname: Lang
authors.forename: Johannes
authors.initials: J
authors.lastname: Dimopoulos
authors.forename: Karin
authors.initials: K
authors.lastname: Oechs
authors.forename: Dietmar
authors.initials: D
authors.lastname: Georg
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
mesh_terms: D001918:Brachytherapy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D012007:Rectum / Q000528:radiation effects; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000532:radiotherapy / Q000601:surgery; D035501:Uncertainty; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000601:surgery