title: The value of systematic contouring of the bowel for treatment plan optimization in image-guided cervical cancer high-dose-rate brachytherapy.
abstract: To investigate the dose-volume histogram metrics and optimization results of the contoured bowel in cervical cancer brachytherapy.
  
  
  
  Treatment plans of cervical cancer patients treated with image-guided high dose rate were retrospectively analyzed with institutional review board approval. In addition to the clinical target volume, rectum, bladder, and sigmoid, the bowel was contoured at the time of planning (Group 1) or at the time of this analysis (Group 2).
  
  
  
  Thirty-two patients treated with 145 insertions were included. Before optimization, mean ± 1 standard deviation overall bowel minimum dose to the most irradiated 2 cm3volume of an organ (D2cc) was 67.8 Gyα/β3± 13.7 Gyα/β3(Group 1: 72.6 ± 13.2 Gyα/β3; Group 2: 57.3 ± 8.0 Gyα/β3). Before optimization, one patient in Group 1 presented a bowel D2ccmetric exceeding 100 Gyα/β3. After optimization, bowel D2ccmean ± 1 standard deviation was 59.4 ± 6.7 Gyα/β3(Group 1: 61.4 ± 6.0 Gyα/β3, p < 0.001; Group 2: 55.2 ± 6.5 Gyα/β3, p = 0.026).
  
  
  
  Given the potentially high doses and the benefit of optimization in reducing dose to the organs at risk, we recommend consideration of systematic contouring of the bowel when bowel is present in the pelvis.
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: damatoa@mskcc.org.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Damato
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Buzurovic
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Mandar S
authors.initials: MS
authors.lastname: Bhagwat
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cormack
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott
authors.initials: S
authors.lastname: Friesen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Matthias M
authors.initials: MM
authors.lastname: Manuel
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Linda P
authors.initials: LP
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Farrell
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D012809:Colon, Sigmoid / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D058958:Organs at Risk; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061089:Radiotherapy, Image-Guided; D012007:Rectum / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*
keywords: Bowel; Cervical cancer; Contouring