title: Image-based 3D treatment planning for vaginal cylinder brachytherapy: dosimetric effects of bladder filling on organs at risk.
abstract: OBJECTIVE
  To investigate the dosimetric effects of bladder filling on organs at risk (OARs) using three-dimensional image-based treatment planning for vaginal cylinder brachytherapy.
  
  
  METHODS
  Twelve patients with endometrial or cervical cancer underwent postoperative high-dose rate vaginal cylinder brachytherapy. For three-dimensional planning, patients were simulated by computed tomography with an indwelling catheter in place (empty bladder) and with 180 mL of sterile water instilled into the bladder (full bladder). The bladder, rectum, sigmoid, and small bowel (OARs) were contoured, and a prescription dose was generated for 10 to 35 Gy in 2 to 5 fractions at the surface or at 5 mm depth. For each OAR, the volume dose was defined by use of two different criteria: the minimum dose value in a 2.0-cc volume receiving the highest dose (D(2cc)) and the dose received by 50% of the OAR volume (D(50%)). International Commission on Radiation Units & Measurements (ICRU) bladder and rectum point doses were calculated for comparison. The cylinder-to-bowel distance was measured using the shortest distance from the cylinder apex to the contoured sigmoid or small bowel. Statistical analyses were performed with paired t tests.
  
  
  RESULTS
  Mean bladder and rectum D(2cc) values were lower than their respective ICRU doses. However, differences between D(2cc) and ICRU doses were small. Empty vs. full bladder did not significantly affect the mean cylinder-to-bowel distance (0.72 vs. 0.92 cm, p = 0.08). In contrast, bladder distention had appreciable effects on bladder and small bowel volume dosimetry. With a full bladder, the mean small bowel D(2cc) significantly decreased from 677 to 408 cGy (p = 0.004); the mean bladder D(2cc) did not increase significantly (1,179 cGy vs. 1,246 cGy, p = 0.11). Bladder distention decreased the mean D(50%) for both the bladder (441 vs. 279 cGy, p = 0.001) and the small bowel (168 vs. 132 cGy, p = 0.001). Rectum and sigmoid volume doses were not affected by bladder filling.
  
  
  CONCLUSIONS
  In high-dose rate vaginal cylinder brachytherapy, treatment with a distended bladder preferentially reduces high dose to the small bowel around the vaginal cuff without a significant change in dose to the bladder, rectum, or sigmoid.
authors.affiliation: Department of Radiation Oncology, University of Alabama Medical Center, Birmingham, AL 35249-6832, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hung
authors.forename: Sui
authors.initials: S
authors.lastname: Shen
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: De Los Santos
authors.forename: Robert Y
authors.initials: RY
authors.lastname: Kim
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D012809:Colon, Sigmoid / Q000000981:diagnostic imaging / Q000528:radiation effects; D004106:Dilatation; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000528:radiation effects; D009068:Movement; D009929:Organ Size; D058958:Organs at Risk / Q000000981:diagnostic imaging / Q000528:radiation effects*; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging / Q000528:radiation effects; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000528:radiation effects*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*