Configuration analysis of the injection position and shape of the gel spacer in gynecologic brachytherapy

PURPOSE: In this single-institution retrospective study, configuration analysis was performed to determine the optimal location and volume of hyaluronic acid gel spacer injection into the recto vaginal or vesicovaginal septum for effective dose reduction (DR) to the organs at risk (OARs), the rectum and bladder. METHODS AND MATERIALS: 70 and 50 intracavitary brachytherapy treatment plans used only vaginal cylinders with gel spacers for the rectal and bladder sides, respectively, whereas 28 did not use spacers. Correlation analysis was performed between the geometrical parameters and injection position of the gel spacers and the 2-cm(3) covering doses of the OARs for each treatment. RESULTS: A higher DR was predicted for hyaluronic acid gel spacer injection within +/- 5 mm and +/- 2.5 mm in the lateral-medial direction from the midpoint on the rectal and bladder sides, and +/- 10 mm in the cranial-caudal direction from the midpoint on the rectal side. There were correlations between 2-cm(3) covering doses and the gel spacer parameters: the volume on the rectal (p = 0.02) and bladder (p = 0.04) sides; the craniocaudal length on the rectal side (p << 0.05); and ventrodorsad thickness on each OAR (p << 0.05) sides. There was no significant difference in the DR between a volume of similar to 10 cm(3) and that of a higher volume (p >> 0.05). CONCLUSIONS: A gel spacer volume of similar to 10 cm(3) provides sufficient OAR DR if its gravity point is on the midpoint between the cylinder applicator and OAR, and its craniocaudal length covers the active length of the cylinder applicator. (c) 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Automated summary

This study conducted configuration analysis to determine the optimal location and volume of hyaluronic acid gel spacer injection into the rectovaginal or vesicovaginal septum for effective dose reduction to the rectum and bladder. The results showed that injection of the gel spacer within specific distances and directions predicted a higher dose reduction, with correlations between covering doses and gel spacer parameters. A gel spacer volume of approximately 10 cm³ provides sufficient organ at risk dose reduction if positioned properly.