title: Rectal and bladder dose reduction with the addition of intravaginal balloons to vaginal packing in intracavitary brachytherapy for cervical cancer.
abstract: The use of intravaginal Foley balloons in addition to conventional packing during high-dose-rate (HDR) tandem and ovoids intracavitary brachytherapy (ICBT) is a means to improve displacement of organs at risk, thus reducing dose-dependent complications. The goal of this project was to determine the reduction in dose achieved to the bladder and rectum with intravaginal Foley balloons with CT-based planning and to share our packing technique.
  
  
  
  One hundred and six HDR-ICBT procedures performed for 38 patients were analyzed for this report. An uninflated Foley balloon was inserted into the vagina above and below the tandem flange separately and secured in place with vaginal packing. CT images were then obtained with both inflated and deflated Foley balloons. Plan optimization occurred and dose volume histogram data were generated for the bladder and rectum. Maximum dose to 0.1, 1.0, and 2.0 cm(3) volumes for the rectum and bladder were analyzed and compared between inflated and deflated balloons using parametric statistical analysis.
  
  
  
  Inflation of intravaginal balloons allowed significant reduction of dose to the bladder and rectum. Amount of reduction was dependent on the anatomy of the patient and the placement of the balloons. Displacement of the organs at risk by the balloons allowed an average of 7.2% reduction in dose to the bladder (D0.1 cm(3)) and 9.3% to the rectum (D0.1 cm(3)) with a maximum reduction of 41% and 43%, respectively.
  
  
  
  For patients undergoing HDR-ICBT, a significant dose reduction to the bladder and rectum could be achieved with further displacement of these structures using intravaginal Foley balloons in addition to conventional vaginal packing.
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX. Electronic address: eng@uthscsa.edu.
authors.forename: T Y
authors.initials: TY
authors.lastname: Eng
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: A J
authors.initials: AJ
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: C S
authors.initials: CS
authors.lastname: Ha
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D058958:Organs at Risk; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided; D012007:Rectum; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder; D062885:Urinary Catheters; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D014621:Vagina
keywords: Bladder dose; Cervical cancer; Foley balloon catheter; High-dose-rate; Intracavitary balloon; Intracavitary brachytherapy; Rectal dose; Vaginal packing technique