Advantages of 3D-CT Based Conformal Radiotherapy Treatment Planning Over 2D Conventional Tera Six Planning for Cervical Cancer Treatment at Ocean Road Cancer Institute

Khamis Amour; Dr. Khamza Maunda; Dr. Mohamed  Mazunga; Dr. Peane Maleka; Professor Peter Msaki

doi:10.31686/ijier.vol8.iss1.2075

Authors

Khamis Amour

The state University of Zanzibar
Dr. Khamza Maunda

Ocean Road Cancer Institute
Dr. Mohamed Mazunga

University of Dar es Salaam
Dr. Peane Maleka

Department of Subatomic Physics, iTHEMBA LAB
Professor Peter Msaki

University of Dar es Salaam

DOI:

https://doi.org/10.31686/ijier.vol8.iss1.2075

Keywords:

3D-Conformal radiation planning, cervical cancer, organ at risk, conventional simulator, planned target volume, ocean road

Abstract

Although External Beam Radiation Therapy (EBRT) is essential tool for the radiation therapy of cervical cancer; only one cancer institute in Tanzania performs 3-Dimensional Conformal Radiation Therapy (3DCRT) Computed Tomography (CT)-based planning. To identify benefits and advantages of 3D-CRT over 2D- conventional radiation therapy (2D-CRT), dosimetric parameters for tumor targets and organs at risk (OARs) were compared between these modalities for 23 cervical cancer patients. 11 cervical cancer patients were CT scanned after proper positioning and immobilization and transferred to Eclipse Treatment Planning System (TPS) for dose planning. The remaining 12 curative intent patients were planned using 2D-CRT system and treatment times were calculated for each patient. From the CT based planning, the minimum dose (D _min), maximum dose (D _max) and mean dose (D _mean) to Planning Target Volume (PTV) and organs at risk (OAR), were compared for each plan. On average, the optimized maximum doses for bladder, rectum, femoral heads, PTV and Gross Tumor Volume (GTV) were 46.56 Gy, 42.65 Gy, 28.76 Gy, 48.56 Gy and 48.53 Gy. For 2D-concentional planning, the dose rate was 75.75 cGy/min and the average treatment time was 1.6075 minutes. This study confirms that 3D CT-based planning is a good choice in the treatment protocol for carcinoma cervix as it delivered a highly homogeneous and conformal plan with superior dose coverage to PTV and better OARs sparing.

References

[1]. Buzdar SA, Afzal M, Nazir A and Gadhi MA, “Accuracy Requirements in Radiotherapy Treatment Planning” (2013), Journal of the College of Physicians and Surgeons, 23(6): 418-423.
[2]. Yin G, Wang P, Lang J, Tian Y, Luo Y, Fan Z, Tam KY, “Dosimetric study for cervix carcinoma treatment using intensity modulated radiation therapy (IMRT) compensation based on 3D intracavitary brachytherapy technique”, (2016), J Contemp. Brachytherapy, 8(3):221-232.
[3]. Kisling K, Zhang L, Simonds H, N, Yang J McCarroll R, Balter P, Burger H, Bogler O, Howell R, Schmeler K, Mejia M, Beadle B, Jhingran A, Court L “Fully Automatic Treatment Planning for External-Beam Radiation Therapy of Locally Advanced Cervical Cancer: A Tool for Low-Resource Clinics”, (2019), Journal of Global Oncology, 5:1-9.
[4]. ICRU Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). ICRU Report 62, (1999), Bethesda, Maryland USA: International Commission on Radiation Units and Measurements.
[5]. Torre LA, Siegel RL, Islami F, Rebeca L, Ward EM and Jemal A, “Global Cancer in women, burden and Trends” (2017), Cancer Epidemiol. Biomarkers Prev., 26(4): 444–457.
[6]. George X, Bednarz B and Paganetti H, “A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction, (2008), Phys. Med. Biol. 53:193-241.
[7]. Amaury P, Cécile LP, Anne B, Laura N, Ivaldo F, Elena R, Jane B, Dimitri L, Nicolas DS, Jean B and Sylvie B, “IMRT or conformal radiotherapy for adjuvant treatment of retroperitoneal sarcoma?”, (2011), Radiotherapy and Oncology, 99: 73-78.
[8]. Barrett A, Dobbs J, Morris S and Roque T, “Practical Radiotherapy Planning 4 th Edn”, (2009), Hodder Education UK 338 Euston Road, London NW1 3BH.
[9]. Awad S, Aida S, Dawod T and Alia Azam A, “Comparing Study between Conventional and Conformal Planning Radiotherapy”, (2016), Middle East J. App. Sci., 6(4): CC-CC.
[10]. Pendlebury SC, Cahill S, Crandon AJ, Bull CA, “Role of bipedal lymphangiogram in radiation treatment planning for cervix cancer”, (1993), Int J Radiat Oncol Biol Phys, 27 (4):959- 962.
[11]. Bonini A, Fiorino C, Corletto D, Mangili P, Broggi S, Cattaneo GM, Parisi R, Signorotto P, Villa E, Calandrino R, “Quality assurance by systematic in vivo dosimetry: results on a large cohort of patients”, (2000), Radiother Oncol, 56:85-95.
[12]. Finlay M, Ackerman I, Tirona R, Hamilton P, Barbera L, Thomas G, “Use of CT simulation for treatment of cervical cancer to assess the adequacy of lymph node coverage of conventional pelvic fields based on bony landmarks”, (2006), International Journal of Radiation Oncology Biology Physics, 64 (1): 205–209.
[13]. Atiq M, Atiq A, Iqbal K and Andleeb F, “Evaluation of dose conformity and coverage of target volume for intensity- modulated radiotherapy of pelvic cancer treatment Evaluation of dose conformity and coverage of target volume for intensity-modulated radiotherapy of pelvic cancer treatment”, (2017), Indian J. of cancer, 54:379-384.
[14]. Shahram A, Kashi Y, Khaledi S, Houshyari M, “CT Simulation to Evaluate of Pelvic Lymph Node Coverage in Conventional Radiotherapy Fields Based on Bone and Vessels Landmarks in Prostate Cancer Patients” (2016), Iran J. Cancer Prev., 9(3):1-4.
[15]. Ong AK Ang KW, Master Z, Wong SM, Tuan, JK, “Intensity-modulated radiotherapy for whole pelvis irradiation in prostate cancer: A dosimetric and plan robustness study between photons and protons” (2018), Technical Innovations & Patient Support in Radiation Oncology, 6:11-19.
[16]. Onal, CA, Gungor T, Erkan P, Berrin Y, Melek O, Ezgi Y, Onal A, “Comparison of conventional and CT-based planning for intracavitary brachytherapy for cervical cancer: target volume coverage and organs”, (2009), Journal of Experimental and Clinical Cancer Research, 8:1-10.