Comparison of DVH parameters and loading patterns of standard loading, manual and inverse optimization for intracavitary brachytherapy on a subset of tandem/ovoid cases

Purpose: Comparison of inverse planning with the standard clinical plan and with the manually optimized plan based on dose-volume parameters and loading patterns. Materials and methods: Twenty-eight patients who underwent MRI based HDR brachytherapy for cervix cancer were selected for this study. Three plans were calculated for each patient: (1) standard loading, (2) manual optimized, and (3) inverse optimized. Dosimetric outcomes from these plans were compared based on dose-volume parameters. The ratio of Total Reference Air Kerma of ovoid to tandem (TRAK(O/T)) was used to compare the loading patterns. Results: The volume of HR CTV ranged from 9-68 cc with a mean of 41(+/- 16.2)cc. Mean V100 for standard, manual optimized and inverse plans was found to be not significant (p = 0.35, 0.38, 0.4). Dose to bladder (7.8 +/- 1.6 Gy) and sigmoid (5.6 +/- 1.4 Gy) was high for standard plans: Manual optimization reduced the dose to bladder (7.1 +/- 1.7 Gy p = 0.006) and sigmoid (4.5 +/- 1.0 Gy p = 0.005) without compromising the HR CTV coverage. The inverse plan resulted in a significant reduction to bladder dose (6.5 +/- 1.4 Gy, p = 0.002). TRAK was found to be 0.49(+/- 0.02), 0.44(+/- 0.04) and 0.40(+/- 0.04)cGy M-2 for the standard loading, manual optimized and inverse plans, respectively. It was observed that TRAK(O/T) was 0.82(+/- 0.05), 1.7(+/- 1.04) and 1.41(+/- 0.93) for standard loading, manual optimized and inverse plans, respectively, while this ratio was 1 for the traditional loading pattern. Conclusions: Inverse planning offers good sparing of critical structures without compromising the target coverage. The average loading pattern of the whole patient cohort deviates from the standard Fletcher loading pattern. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 97 (2010) 501-506