title: A comparison of the biological effective dose of 50-kV electronic brachytherapy with (192)Ir high-dose-rate brachytherapy for vaginal cuff irradiation.
abstract: OBJECTIVE
  Advantages for electronic brachytherapy (EBT) of the vaginal cuff include decreased physical dose to the bladder and rectum. Here we compare (192)Ir with EBT using biological effective dose (BED) to account for the different radiobiological effectiveness (RBE) predicted for low-energy x-rays.
  
  
  METHODS
  Fifteen data sets from five consecutive postoperative endometrial cancer patients treated with EBT were analyzed. Treatment planning was performed using PLATO software. The dose was prescribed as 21Gy in three fractions to a depth of 0.5cm. Physical dose, BED(3), and BED(10) were evaluated for the mucosa, bladder, and rectum. An RBE value of 1.5 was used for BED calculations.
  
  
  RESULTS
  Mucosal physical dose is 28.4% greater with EBT (36.6 vs. 28.5Gy, p<0.05). However, the BED(10) is increased by 79.1% (55.6 vs. 99.6Gy, p<0.05) and the BED(3) by 71.5% (118.8 vs. 203.7Gy, p<0.05). The physical dose (dose to 50% volume of the organ) to the bladder (9.3 vs. 6.6Gy, p<0.05) and rectum (7.2 vs. 4.2Gy, p<0.05) are reduced with EBT. BED(3) to the rectum and bladder are also reduced but to a lesser extent (13 vs. 8.3Gy, p<0.05; 18.9 vs. 14.7Gy, p=0.06, respectively).
  
  
  CONCLUSIONS
  BED takes into account the higher RBE of low-energy photons generated with EBT and provides a more accurate estimate of the biological effect. When using EBT, physical dose may underestimate the biological effect on the vaginal mucosa and overestimate the benefit for the bladder and rectum. Dose adjustment for EBT based on BED should be considered.
authors: Department of Radiation Oncology, Tufts Medical Center, Boston, MA 02111, USA. prava@tuftsmedicalcenter.org
authors: Paul
authors: P
authors: Rava
authors: Tomas
authors: T
authors: Dvorak
authors: Robert J
authors: RJ
authors: Markelewicz
authors: Jessica R
authors: JR
authors: Hiatt
authors: Edward S
authors: ES
authors: Sternick
authors: Stephanie G
authors: SG
authors: MacAusland
authors: Kathryn
authors: K
authors: Huber
authors: David E
authors: DE
authors: Wazer
authors: Jaroslaw T
authors: JT
authors: Hepel
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007495:Iridium / Q000627:therapeutic use*; D011829:Radiation Dosage; D011868:Radioisotopes / Q000627:therapeutic use*; D012007:Rectum / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology; D014621:Vagina / Q000473:pathology*
chemical_list: D011868:Radioisotopes; D007495:Iridium