Dosimetric evaluation of manually and inversely optimized treatment planning for high dose rate brachytherapy of cervical cancer

BACKGROUND

To compare five inverse treatment planning methods with the conventional manually optimized planning approach for brachytherapy of cervical cancer with respect to dosimetric parameters.

MATERIAL AND METHODS

Eighteen cervical cancer patients treated with magnetic resonance imaging (MRI)-guided high dose rate (HDR) brachytherapy were included in this study. Six plans were created for each of the 4 HDR brachytherapy fractions for each patient: 1 manually optimized and 5 inversely planned. Three of these were based on inverse planning simulated annealing (IPSA) with and without extra constraints on maximum doses of the target volume, and different constraints on doses to the organs at risk (OARs). In addition there were two plans based on dose to target surface points. The resulting dose-volume histograms were analyzed and compared from the dosimetric point of view by quantifying specific dosimetric parameters, such as clinical target volume (CTV) D₉₀, CTV D₁₀₀, conformal index (COIN), and D₂cm3 for rectum, bladder and the sigmoid colon.

RESULTS

Manual optimization led to a mean target coverage of 78.3% compared to 87.5%, 91.7% and 82.5% with the three IPSA approaches (p < 0.001). Similar COIN values for manual and inverse optimization were found. The manual optimization led to better results with respect to the dose to the OARs expressed as D₂cm3. Overall, the best results were obtained with manual optimization and IPSA plans with volumetric constraints including maximum doses to the target volume.

CONCLUSIONS

Dosimetric evaluation of manual and inverse optimization approaches is indicating the potential of IPSA for brachytherapy of cervical cancer. IPSA with constraints of maximum doses to the target volume is closer related to manual optimization than plans with constraints only to minimum dose to the target volume and maximum doses to OARs. IPSA plans with proper constraints performed better than those based on dose to target surface points and manually optimized plans.

Effects of growth factors on growth and radiation sensitivity of the human breast cancer cell line T-47D

Different growth factors are supposed to be involved in evolution of breast cancer. Radiation therapy is used in treatment of breast cancer patients, and the possible relationships between the influence of growth factors on cells and their radiation sensitivity are therefore of interest. Cell growth and radiation sensitivity of the human oestrogen and progesterone receptor positive cell line T-47D were investigated following exposure to the growth factors IGF-1, TGF-alpha and TGF-beta. Experiments were done with standard medium and in growth factor defined medium. Changes in cell cycle distribution were investigated by flow cytometry. The cell growth was significantly decreased by removal of growth factors in the culture medium, an effect which partly could be reversed by supplementation of growth factors. The growth factors decreased the cellular doubling time in standard medium, but to a smaller extent than seen in growth factor defined medium. The radiation sensitivity and plating efficiency were slightly affected by growth factor defined versus standard growth conditions. Additional growth factor exposure was able to some extent to change the radiation sensitivity, mainly by effects due to changes in repair of sublethal damage. Only minor changes were seen in phase distribution of these cells. Cellular growth was dependent on presence of different growth factors, and changes in growth factor conditions greatly influenced the cellular doubling time in vitro. Corresponding changes in radiation sensitivity were minor for doses relevant for radiation therapy.