title: Single line source with and without vaginal loading and the impact on target coverage and organ at risk doses for cervix cancer Stages IB, II, and IIIB: treatment planning simulation in patients treated with MRI-guided adaptive brachytherapy in a multicentre study (EMBRACE).
abstract: OBJECTIVE
  Three-dimensional evaluation and comparison of target and organs at risk (OARs) doses from two traditional standard source loading patterns in the frame of MRI-guided cervical cancer brachytherapy for various clinical scenarios based on patient data collected in a multicenter trial setting.
  
  
  METHODS
  Two nonoptimized three-dimensional MRI-based treatment plans, Plan 1 (tandem and vaginal loading) and Plan 2 (tandem loading only), were generated for 134 patients from seven centers participating in the EMBRACE study. Both plans were normalized to point A (Pt. A). Target and OAR doses were evaluated in terms of minimum dose to 90% of the high-risk clinical target volume (HRCTV D90) grouped by tumor stage and minimum dose to the most exposed 2cm³ of the OARs volume.
  
  
  RESULTS
  An HRCTV D90 ≥ Pt. A was achieved in 82% and 44% of the patients with Plans 1 and 2, respectively. Median HRCTV D90 with Plans 1 and 2 was 120% and 90% of Pt. A dose, respectively. Both plans had optimal dose coverage in 88% of Stage IB tumors; however, the tandem-only plan resulted in about 50% of dose reduction to the vagina and rectum. For Stages IIB and IIIB, Plan 1 had on average 35% better target coverage but with significant doses to OARs.
  
  
  CONCLUSIONS
  Standard tandem loading alone results in good target coverage in most Stage IB tumors without violating OAR dose constraints. For Stage IIB tumors, standard vaginal loading improves the therapeutic window, however needs optimization to fulfill the dose prescription for target and OAR. In Stage IIIB, even optimized vaginal loading often does not fulfill the needs for dose prescription. The significant dose variation across various clinical scenarios for both target and OARs indicates the need for image-guided brachytherapy for optimal dose adaptation both for limited and advanced diseases.
authors.affiliation: Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. karen.nkiwane@akhwien.at
authors.forename: Karen S
authors.initials: KS
authors.lastname: Nkiwane
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Kari
authors.initials: K
authors.lastname: Tanderup
authors.forename: Mario
authors.initials: M
authors.lastname: Federico
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Lindegaard
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging; D058958:Organs at Risk; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D014621:Vagina / Q000473:pathology