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Erschienen in: Strahlentherapie und Onkologie 6/2014

01.06.2014 | Original article

Robotic radiosurgery as an alternative to brachytherapy for cervical cancer patients

verfasst von: Oliver Neumann, Anne Kluge, Ph. D., Olga Lyubina, M. D., Waldemar Wlodarczyk, Ph. D., Ulrich Jahn, Ph. D., Christhardt Köhler, M. D., Volker Budach, M. D., Markus Kufeld, M. D., Simone Marnitz, M. D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 6/2014

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Abstract

Background and purpose

To compare MRI-guided brachytherapy (BT) and two different dose prescriptions for robotic radiosurgery (RRS) in locally advanced cervical cancer.

Methods and materials

Eleven patients with FIGO stage IIB–IIIB cervical cancer underwent RRS instead of BT for various reasons. A total dose of 30 Gy was administered in five fractions. The maximum dose was chosen such that the prescribed dose was 70 % of the maximum dose (RRS70). To simulate BT more closely, additional plan calculations were carried out for a higher maximum dose with the same enclosing dose of 30 Gy being now 25 % of the maximum dose (RRS25). BT plans were calculated for the same patients (BTRRS). Finally, the resulting three sets of treatment plans were compared with 38 other patients treated with MRI-guided BT and the same dose prescription (BTref). Plan comparisons were performed based on DVH parameters with regard to target coverage (V100), conformation number (CN), and sparing of the organs at risk (OARs).

Results

The best coverage of V100 = 100 ± 0 % was obtained with RRS25, followed by RRS70 with 97.1 ± 2.7 %, BTref with 90.9 ± 8.9 %, and the intraindividual BTRRS with 80.6 ± 6.4 %. The sparing of OARs was associated with D0.1 cc, D2 cc, and D5 cc to the rectum, sigmoid, and bladder walls. OAR doses were compliant with the GEC-ESTRO guidelines and comparable among RRS70, RRS25, BTRRS, and BTref. By contrast, RRS25 could not fulfill these guidelines, exceeding considerably the tolerable dose constraints for the walls of the critical OARs.

Conclusion

Despite of the excellent coverage and higher maximum dose, the unacceptably high exposure to the OARs disqualified RRS25 as an alternative for BT in cervical cancer patients. By contrast, RRS70 offered the best protection for the OARs, comparable to BT, and even better target coverage and conformity than BT.
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Metadaten
Titel
Robotic radiosurgery as an alternative to brachytherapy for cervical cancer patients
verfasst von
Oliver Neumann
Anne Kluge, Ph. D.
Olga Lyubina, M. D.
Waldemar Wlodarczyk, Ph. D.
Ulrich Jahn, Ph. D.
Christhardt Köhler, M. D.
Volker Budach, M. D.
Markus Kufeld, M. D.
Simone Marnitz, M. D.
Publikationsdatum
01.06.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 6/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-014-0614-4

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