RADIATION DOSE COMPARISON BETWEEN THE TWO TECHNIQUES OF INTRACAVITARY BRACHYTHERAPY IN CERVICAL CANCER
Abstract
Background and purpose: Radiotherapy is effective in the treatment of locally advanced cervical cancer. However, the treatment is associated with significant morbidity of the urinary bladder and rectum. This study has been designed to ascertain the potential for dose reduction to bladder and rectal points by using intravaginal foley balloon catheters as a mechanism for structural displacement during tandem and ovoid in high-dose-rate intracavitary brachytherapy of the uterine cervix. Materials and Methods: Twenty four patients of cervical carcinoma stage IIB-IIIB, were received four times of 600 cGy high dose rate intracavitary brachytherapy(ICBT) treatment. Two times of ICBT with conventional gauze packing (control arm) were compared with two times of ICBT with two foley balloons placed intravaginally(study arm), one balloon was placed anterior and another balloon was placed posterior to the tandem, as close to the flange as patient geometry allowed. A series of 96 consecutive digitized treatment plans was assessed: 48 plans with control arm and 48 plans of study arm. Planning orthogonal X-rays were acquired and digitized. Dose reference points of bladder and rectum were calculated following ICRU No. 38 guideline, both with control and study arm. We compared the rectal dose and bladder dose between conventional gauze packing and foley balloon catheters Results: The Foleys balloon catheter significantly reduced the bladder point dose comparing with conventional gauze packing from 77.87% to 69.83% (p=0.008). There was no difference in rectal point dose between the conventional gauze packing and the foley balloon catheter respectively (58.65% and 58.39%; p=0.561). Conclusion: A significant reduction in radiation dose to the bladder can be achieved by intravaginal insertion of the foley balloon catheters. This technique is simple, consistent and reproducible within an acceptable range. As such, further exploration of this technique is warranted.
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