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A Dosimetric evaluation of a high dose rate cobalt-60 brachytherapy source using shielded, single and multi-channel cylinder applicators for gynecological cancers

      ABSTRACT

      Vaginal brachytherapy is a standard method for preventing the recurrences of malignancies in the treatment of gynecological cancers. Cylindrical applicators are usually employed in high dose rate cobalt-60 source brachytherapy after abdominal hysterectomy or bilateral salpingo-oophorectomy treatment. The aim of this study is to conduct an assessment of dosimetric properties of single channel, multichannel, and shielded cylinder applicators. This study utilizes a pelvis phantom with three different volumes of bladder and rectum to perform dose measurement around the cylindrical applicators. GAFCHROMIC EBT3 model film was used to measure dose distributions in water phantom around the bladder, rectum, applicator, and CTV. In order to properly compare the performance of the shielded applicator with multichannel and single channel applicators, we consider the both cases of a one-sided CTV and two CTVs placed on both sides of the vagina. Dose-volume histograms analysis shows no statistically significant difference in tumoral region for the two types of CTV between cylindrical applicators. The V120%, V100% and D95% values of target volume were 47.36%. 91.46%, and 3.99Gy for multi-channel cylinder applicator, 60.2%, 95.02%, and 3.99Gy for single channel cylinder applicator, respectively. Statistical analysis reports D0.1cc, D1cc, and D2cc for the multichannel applicator demonstrates a significant dose reduction in bladder compared with single channel. The V120%, V100%, and D95% values of target volume were 55.50%. 97.90%, and 3.91Gy for multi-channel cylinder applicator with four active channels (MCC-4), 41.56%, 92.10%. and 4.13Gy for shielded cylinder applicator, respectively. Statistical analysis reports D0.1cc, D1cc and D2cc for the MCC-4 demonstrates a noticeable dose reduction in bladder and rectum compared with Shielded channel. The results indicate that employing multichannel applicator in vaginal high dose rate cobalt-60 source brachytherapy can reduce the received dose to organs at risk without any significant loss of received dose in CTV, which is contributed to its asymmetric or symmetric dose distribution that depend on which channels are activated.

      Keywords

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      References

        • Karlsson J.
        • Dreifaldt A.C.
        • Mordhorst L.B.
        • Sorbe B.
        Differences in outcome for cervical cancer patients treated with or without brachytherapy.
        Brachytherapy. 2017; 16: 133-140
        • Nout R.A.
        • Smit V.T.
        • Putter H.
        • et al.
        Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial.
        The Lancet. 2010; 375: 816-823
        • Yau I.
        • Vuong T.
        • Garant A.
        • et al.
        Risk of hypogonadism from scatter radiation during pelvic radiation in male patients with rectal cancer.
        Int. J. Radiat. Oncol. Biol. Phys. 2009; 74: 1481-1486
        • Bajwa H.K.
        • Singareddy R.
        • Talluri A.K.
        • et al.
        Development of an indigenous low-cost multichannel cylinder applicator for vaginal tumors.
        Brachytherapy. 2020; 19: 674-678
        • Li D.
        • Wen E.
        • Zhang Y.
        • et al.
        Preliminary report of a single-channel applicator in high dose rate afterloading brachytherapy for cervical cancer.
        Cancer science. 2018; 109: 3953-3961
        • Hou X.
        • Liu A.
        • Zhang F.
        • Wong J.
        • Chen Y.J.
        Dosimetric advantages of using multichannel balloons compared to single-channel cylinders for high-dose-rate vaginal cuff brachytherapy.
        Brachytherapy. 2016; 15: 471-476
        • Kim Y.
        • Cabel K.
        • Sun W.
        Does the apex optimization line matter for single-channel vaginal cylinder brachytherapy planning?.
        J. Appl. Clin. Med. Phys. 2018; 19: 307-312
        • Bahadur Y.A.
        • Constantinescu C.
        • Hassouna A.H.
        • et al.
        Single versus multichannel applicator in high-dose-rate vaginal brachytherapy optimized by inverse treatment planning.
        J. Contemp. Brachytherapy. 2015; 6: 362
        • Carrara M.
        • Cusumano D.
        • Giandini T.
        • et al.
        Comparison of different treatment planning optimization methods for vaginal HDR brachytherapy with multichannel applicators: A reduction of the high doses to the vaginal mucosa is possible.
        Physica Medica. 2017; 44: 58-65
        • Shin S.M.
        • Duckworth T.L.
        • Cooper B.T.
        • et al.
        Use of a flexible inflatable multi-channel applicator for vaginal brachytherapy in the management of gynecologic cancer.
        Frontiers in oncology. 2015; 5: 201
        • Sureka C.S.
        • Aruna P.
        • Ganesan S.
        • Sunny C.S.
        • Subbaiah K.V.
        Computation of relative dose distribution and effective transmission around a shielded vaginal cylinder with HDR source using MCNP4B.
        Medical physics. 2006; 33: 1552-1561
        • Shukla A.K.
        • Jangid P.K.
        • Rajpurohit V.S.
        • et al.
        Dosimetric comparison of 60Co and 192Ir high dose rate source used in brachytherapy treatment of cervical cancer.
        J. Cancer Res. Ther. 2019; 15: 1212
        • Shukla A.K.
        • Rana B.S.
        • Singh N.P.
        • Kumar S.
        Dosimetric study of CO-60 source step size in uterine cervix intracavitary HDR brachytherapy.
        Brachytherapy. 2019; 18: 180-185
        • Abtahi M.
        • Gholami S.
        • Nashi H.
        High dose rate192Ir versus high dose rate60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020.
        Biomed Phys Eng Express. 2021; 7 (PMID: 34375964)https://doi.org/10.1088/2057-1976/ac1c52
        • Andrássy M.
        • Niatsetsky Y.
        • Pérez-Calatayud J.
        Co-60 versus Ir-192 in HDR brachytherapy: scientific and technological comparison.
        Rev Fis Med. 2012; 13: 125-130
        • Kim H.
        • Rajagopalan M.S.
        • Houser C.
        • Beriwal S.
        Dosimetric comparison of multichannel with one single-channel vaginal cylinder for vaginal cancer treatments with high-dose-rate brachytherapy.
        Brachytherapy. 2014; 13: 263-267
        • Malik U.
        • Meigooni A.S.
        • Yoneda J.
        • Payne T.
        Comparison of standard single-channel vaginal cylinder to the multi-channel wright applicator for HDR vaginal brachytherapy in endometrial carcinoma.
        Int. J. Radiat. Oncol. Biol. Phys. 2004; 60: S480
        • Abacioglu M.
        • Ozen Z.
        • Hancilar N.
        • et al.
        Comparison of target volume and organ at risk doses with multi-channel versus single channel cylinder for vaginal brachytherapy.
        Int. J. Radiat. Oncol. Biol. Phys. 2014; 90: S496
        • Waterman F.M.
        • Holcomb D.E.
        Dose distributions produced by a shielded vaginal cylinder using a high-activity iridium-192 source.
        Medical physics. 1994; 21: 101-106
        • Van Elburg D.J.
        • Roumeliotis M.
        • Morrison H.
        • Rodgers J.R.
        • Fenster A.
        • Meyer T.
        Dosimetry of a sonolucent material for an ultrasound-compatible gynecologic high-dose-rate brachytherapy cylinder using Monte Carlo simulation and radiochromic film.
        Brachytherapy. 2021; 20: 265-271
        • Massillon-JL G.
        • Chiu-Tsao S.
        • Domingo-Munoz I.
        • Chan M.
        Energy Dependence of the New Gafchromic EBT3 Film:Dose Response Curves for 50 KV, 6 and 15 MV X-Ray Beams.
        Int J Med Phys Clin Eng Radiat Oncol. 2012; 1: 60-65https://doi.org/10.4236/ijmpcero.2012.12008
        • Mozaffari A.
        • Ghorbani M.
        Determination of TG-43 dosimetric parameters for photon emitting brachytherapy sources.
        JBPE. 2019; 9: 425
        • Ballester F.
        • Meigooni A.
        • Wright C.
        • et al.
        TG-43U1 BASED DOSIMETRIC CHARACTERIZATION OF MODEL 67-6520 CS-137 BRACHYTHERAPY SOURCE.
        Radiother. Oncol. 2009; (SUPPLEMENT 1, S222)https://doi.org/10.1016/S0167-8140(12)7318
        • Perez-Calatayud J.
        • Ballester F.
        • Das R.K.
        • et al.
        Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: report of the AAPM and ESTRO.
        Medical physics. 2012; 39: 2904-2929
        • Devic S.
        • Seuntjens J.
        • Hegyi G.
        • et al.
        Dosimetric properties of improved GafChromic films for seven different digitizers.
        Medical physics. 2004; 31: 2392-2401
        • Gholami S.
        • Mirzaei H.R.
        • Arfaee A.J.
        • et al.
        Dose distribution verification for GYN brachytherapy using EBT Gafchromic film and TG-43 calculation.
        Rep. Pract. Oncol. Radiother. 2016; 21: 480-486