title: Interstitial brachytherapy using virtual planning and Doppler transrectal ultrasonography guidance for internal iliac lymph node metastasis.
abstract: To expand the indications for high-dose-rate interstitial brachytherapy (HDR-ISBT) for deep-seated pelvic tumors, we investigated the usefulness of Doppler transrectal ultrasonography (TRUS) guidance and virtual planning. The patient was a 36-year-old female. She had right internal iliac lymph node oligometastasis of vaginal cancer 12 months after radical radiotherapy. The tumor could not be found by gray-scale TRUS and physical examination. Virtual planning was performed using computed tomography with template and vaginal cylinder insertion. We uploaded the images to our treatment planning software and reconstructed the contours of the clinical target volume (CTV) and right internal iliac vessel. Virtual needle applicators were plotted using the template holes for virtual planning. At the time of implantation, Doppler TRUS was used to prevent vessel injury by needle applicators. Applicators were implanted in accordance with virtual planning and Doppler TRUS could detect the right iliac vessel. The percentage of CTV covered by the prescribed dose was 99.8%. The minimum dose received by the maximally irradiated 0.1-cc volume for the right internal iliac vessel was 95% prescribed dose. Complete response was achieved, however, radiological findings showed marginal recurrence at 15 months after HDR-ISBT. Post-radiation neuropathy occurred as a late complication four months after treatment; however, the pain was well controlled by medication. We consider that virtual planning and Doppler TRUS are effective methods in cases where it is difficult to detect the tumor by physical examination and gray-scale TRUS, thereby expanding the indications for ISBT.
authors.affiliation: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Japan. kyoshida@onh.go.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
authors.forename: Mari
authors.initials: M
authors.lastname: Ueda
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Tadashi
authors.initials: T
authors.lastname: Takenaka
authors.forename: Mineo
authors.initials: M
authors.lastname: Yoshida
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyake
authors.forename: Susumu
authors.initials: S
authors.lastname: Yoshida
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koizumi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Ban
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D003131:Combined Modality Therapy; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D009339:Needles; D009929:Organ Size; D010388:Pelvis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D018608:Ultrasonography, Doppler / Q000379:methods*; D018084:Ultrasonography, Interventional; D014584:User-Computer Interface; D014625:Vaginal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy