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Dosimetric comparison of two-dimensional versus three-dimensional intracavitary brachytherapy in locally advanced cervical cancer

Klisarovska Violeta (University Clinic of Radiotherapy and Oncology, Department of Gynecologic Oncology and Brachytherapy, Skopje, FYR Macedonia)
Smichkoska Snezhana (University Clinic of Radiotherapy and Oncology, Department of Breast Cancer, Skopje, FYR Macedonia)
Chakalaroski Petar (University Clinic of Radiotherapy and Oncology, Department of Gynecologic Oncology and Brachytherapy, Skopje, FYR Macedonia)
Krstevska Valentina (University Clinic of Radiotherapy and Oncology, Department of Head and Neck Cancer, Skopje, FYR Macedonia)
Dimitrovska Nadica (University Clinic of Radiotherapy and Oncology, Medical Faculty, Department of Medical Radiation Physics, Skopje, FYR Macedonia)
Stefanovski Zoran (University Clinic of Radiotherapy and Oncology, Medical Faculty, Department of Medical Radiation Physics, Skopje, FYR Macedonia)
Lazarova Emilija (University Clinic of Radiotherapy and Oncology, Department of Breast Cancer, Skopje, FYR Macedonia)

Introduction/Objective. The aim of this study was to dosimetric comparison of two-dimensional (2D) with three-dimensional (3D) planning for high-dose-rate intracavitary brachytherapy (HDR-BT) in locally advanced cervical cancer by dose evaluation in given International Commission on Radiation Units and Measurements (ICRU) reference points, as well as in target volume and organs at risk (OAR). Methods. 66 sessions of HDR-BT were performed in 22 patients, with 3D planning, but also virtual 2D plan for dosimetric comparison was made. 2D planning was performed on radiography obtained by C-arm in ICRU points, while 3D planning in volumes delineated on computer tomography. Results. The comparative analysis has indicated a significant mean dose difference of point “A” left (p=0.00014) and right (p=0.003), through higher doses in 2D and lower doses in 3D reconstructed points "A". According to the dose volume histograms 56.88% and 61.41% mean target volume received 100% and 90% of prescribed dose, respectively. 2D bladder analysis showed a mean dose of 3.487 Gy in ICRU point, while in 3D analysis a maximum mean dose of 8.804 Gy and mean dose of 4.716 Gy in 2ccm volume. 2D analysis showed rectal mean dose of 2.892 Gy in ICRU points, while 3D analysis maximum mean dose of 6.411 Gy and 3.947 Gy mean dose in 2ccm volume. Conclusion. 2D planning showed unreal higher doses in the ICRU points for the target and lower doses for the OAR.

Keywords: cervical cancer, intracavitary brachytherapy, organs at risk, target volume