title: Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy.
abstract: OBJECTIVE
  To determine the utility of ureteral stents in interstitial gynecological brachytherapy.
  
  
  METHODS
  We reviewed 289 patients with cervix cancer treated with high-dose-rate interstitial brachytherapy who did not have pretreatment hydronephrosis to determine the relative incidence of benign ureteral strictures after treatment. We also did comparative dosimetry analysis in five cases of high-dose-rate brachytherapy. Bilateral ureteral stents were placed during the procedure. Three dosimetry plans were created to determine the impact of modifying clinical target volume (CTV) and applying ureteral dose constraints. In Plan 1, the ureters were contoured and excluded from the CTV and 120% dose constraints were applied. In Plan 2, the ureters were contoured and excluded, but no dose constraints were applied to the ureter. In Plan 3, the CTV was created as if the location of the ureters was unknown and then ureteral dose was determined.
  
  
  RESULTS
  There were 11 ureteral strictures observed in 255 nonstented cases and 0 ureteral strictures in 34 stented cases. Plan 1 reduced the ureter dose (D(0.1cc)) by a median 22% (7.0-53.8%) compared with Plan 2 and by a median of 30.9% (12.3-65%). compared with Plan 3.
  
  
  CONCLUSIONS
  Placement of stents and ureteral dose constraints facilitates dosimetry and reduces the dose to ureters. Temporary ureteral stents prevent obstruction during interstitial gynecologic brachytherapy and allows the ureters to be addressed as an organ at risk.
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA. Electronic address: jdemanes@mednet.ucla.edu.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Banerjee
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Cahan
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Steve P
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Fallon
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Paula
authors.initials: P
authors.lastname: Reyes
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Thanh Q
authors.initials: TQ
authors.lastname: Van
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steinberg
authors.affiliation: Division of Brachytherapy, Department of Radiation Oncology, David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Kamrava
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000532:radiotherapy*
keywords: Brachytherapy; Cervix cancer; Endometrial cancer; Gynecologic malignancy; HDR; High-dose-rate; Interstitial; Stricture; Ureter; Ureteral stent