Factors for predicting rectal dose of high-dose-rate intracavitary brachytherapy after pelvic irradiation in patients with cervical cancer: a retrospective study with radiography-based dosimetry.
OBJECTIVE
To evaluate the predictive factors for rectal dose of the first fraction of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer.


METHODS
From March 1993 through February 2008, 946 patients undergoing pelvic irradiation and HDR-ICBT were analyzed. Examination under anesthesia (EUA) at the first implantation of the applicator was usually performed in the early period. Rectal point was determined radiographically according to the 38th Report of the International Commission of Radiation Units and Measurements (ICRU). The ICRU rectal dose (PRD) as a percentage of point A dose was calculated; multiple linear regression models were used to predict PRD.


RESULTS
Factors influencing successful rectal dose calculation were EUA (p < 0.001) and absence of diabetes (p = 0.047). Age (p < 0.001), body weight (p = 0.002), diabetes (p = 0.020), and EUA (p < 0.001) were independent factors for the PRD. The predictive equation derived from the regression model was PRD (%) = 57.002 + 0.443 x age (years) - 0.257 x body weight (kg) + 6.028 x diabetes (no: 0; yes: 1) - 8.325 x EUA (no: 0; yes: 1)


CONCLUSIONS
Rectal dose at the first fraction of HDR-ICBT is positively influenced by age and diabetes, and negatively correlated with EUA and body weight. A small fraction size at point A may be considered in patients with a potentially high rectal dose to reduce the biologically effective dose if the ICRU rectal dose has not been immediately obtained in the first fraction of HDR-ICBT.
Huang
Eng-Yen
EY
Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan. huangengyen@giga.net.tw
Wang
Chong-Jong
CJ
Lan
Jen-Hong
JH
Chen
Hui-Chun
HC
Fang
Fu-Min
FM
Hsu
Hsuan-Chih
HC
Huang
Yu-Jie
YJ
Wang
Chang-Yu
CY
Wang
Yu-Ming
YM
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000532:radiotherapy; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000532:radiotherapy; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D011349:Proctitis / Q000209:etiology / Q000517:prevention & control; D011832:Radiation Injuries / Q000517:prevention & control; D011859:Radiography; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012007:Rectum / Q000528:radiation effects*; D012044:Regression Analysis; D012062:Relative Biological Effectiveness; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*
D007496:Iridium Radioisotopes