title: The dosimetric impact of vaginal balloon-packing on intracavitary high-dose-rate brachytherapy for gynecological cancer.
abstract: OBJECTIVE
  We perform a clinical retrospective study to determine whether a vaginal balloon-packing system provides a dosimetric reduction to organs at risk (OARs) versus traditional gauze packing for gynecological high-dose-rate brachytherapy (HDR-BT). We also test various balloon filling materials for optimizing imaging quality.
  
  
  METHODS
  Filling materials for balloon-packing were evaluated based on imaging quality with X-ray, computerized tomography, and magnetic resonance imaging modalities. We then retrospectively reviewed 45 HDR-BT plans of 18 patients performed with gauze packing and 39 plans of 16 patients performed with balloon-packing. Twelve patients received both gauze and balloon-packing. HDR-BT was delivered with an iridium-192 afterloader and a Fletcher-Suit-Declos-style T&O applicator. At each fraction, 3D imaging was obtained. The D2cc values of OARs were calculated, as well as ICRU-defined point doses.
  
  
  RESULTS
  In the 84 HDR fractions reviewed, vaginal balloon-packing provides statistically equivalent doses to rectum, bladder, and sigmoid compared to gauze packing. On average balloon-packing produced average reductions of 3.3% and 6.9% in the rectal and sigmoid D2cc doses and an increase of 3.2% to the bladder D2cc dose (normalized to prescription dose), although none of these values were statistically significant for the twelve patients who received both gauze and balloon-packing (32 and 40 total fractions, respectively).
  
  
  CONCLUSIONS
  In the 84 HDR fractions analyzed, vaginal balloon-packing is as effective as gauze packing for dose sparing to the rectum, bladder, and sigmoid. A 1: 1 solution of saline and contrast for filling material enables easy contouring for image-guided HDR with minimal artefacts.
authors: Radiation Oncology Department, The University of Iowa.
authors: William M
authors: WM
authors: Rockey
authors: Sudershan K
authors: SK
authors: Bhatia
authors: Geraldine M
authors: GM
authors: Jacobson
authors: Yusung
authors: Y
authors: Kim
keywords: brachytherapy; gynecological cancer; high-dose-rate brachytherapy; vaginal balloon packing
references: Radiother Oncol. 2006 Jan;78(1):67-77
references: 16403584
references: Cancer. 1983 Mar 1;51(5):959-67
references: 6821861
references: J Contemp Brachytherapy. 2012 Dec;4(4):241-6
references: 23378854
references: J Contemp Brachytherapy. 2009 Mar;1(1):38-44
references: 27799952
references: Radiother Oncol. 2005 Mar;74(3):235-45
references: 15763303
references: J Contemp Brachytherapy. 2012 Mar;4(1):52-9
references: 23346140
references: Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):947-55
references: 20934275
references: Radiother Oncol. 2009 May;91(2):173-80
references: 19243846
references: Br J Radiol. 2011 May;84(1001):441-8
references: 21511749
references: Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):1263-7
references: 20950949
references: Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):201-11
references: 10924990