PMID- 33556579
OWN - NLM
STAT- MEDLINE
DCOM- 20210917
LR  - 20210917
IS  - 1879-8519 (Electronic)
IS  - 1879-8500 (Linking)
VI  - 11
IP  - 4
DP  - 2021 Jul-Aug
TI  - Computed Tomography-Guided Optimization of Needle Insertion for Combined 
      Intracavitary/Interstitial Brachytherapy With Utrecht Applicator in Locally 
      Advanced Cervical Cancer.
PG  - 272-281
LID - S1879-8500(21)00043-6 [pii]
LID - 10.1016/j.prro.2021.01.008 [doi]
AB  - PURPOSE: There are no international guidelines for optimal needle insertion 
      during interstitial intracavitary brachytherapy (IS-ICBT) for cervical cancer. We 
      aimed to investigate the clinical feasibility and added value of computed 
      tomography (CT) guidance to optimize needle insertion in IS-ICBT using the 
      Utrecht applicator and to evaluate needle shifts. METHODS AND MATERIALS: We 
      enrolled 24 patients who were treated with interstitial-brachytherapy. Two CT 
      scans each were performed for every patient: (1) after applicator insertion 
      without needles (CT(preneedle)) and (2) after needle insertion (CT(postneedle)). 
      In addition to magnetic resonance imaging after external-beam radiation therapy, 
      CT(preneedle) was used to determine optimal needle locations and insertion 
      lengths based on applicator and organs at risk positioning on the day of 
      treatment; CT(postneedle) was used for IS-ICBT planning. The needle-channel axis 
      was used as a reference to determine needle-shift evolution. RESULTS: A total of 
      266 interstitial needles were inserted in 76 of 93 BT fractions with high intra- 
      and interpatient variations in the number of inserted needles. Based on 
      CT(preneedle) findings, needle insertion was avoided in 9, 4, 2, and 2 patients 
      at the first, second, third, and fourth fractions, respectively. The unloaded 
      needle frequency was 4%. Average needle contribution to total dwell time was 
      37.2% +/- 19.2%. Shifting was observed in 68% of the needles (mean shift 2.0 +/- 2.3 
      mm), mostly in the posterior direction, and in needles with a larger insertion 
      length. Needle reinsertion was not needed in any patient. No complication due to 
      needle insertion was observed, except for minor vaginal bleeding in 1 patient 
      after needle removal. CONCLUSIONS: The adaptive CT-guided IS-ICBT application was 
      feasible and resulted in fewer unloaded needle insertions or complications and 
      more efficient use with higher needle contribution to the treatment. Needle shift 
      was frequent but did not require needle reinsertion with the proposed method.
CI  - Copyright (c) 2021 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Tambas, Makbule
AU  - Tambas M
AD  - University of Groningen, University Medical Center Groningen, Department of 
      Radiation Oncology, Groningen, The Netherlands. Electronic address: 
      m.tambas@umcg.nl.
FAU - Tavli, Busra
AU  - Tavli B
AD  - Liv Hospital Ulus, Department of Radiation Oncology, Istanbul, Turkey.
FAU - Bilici, Nazli
AU  - Bilici N
AD  - Liv Hospital Ulus, Department of Radiation Oncology, Istanbul, Turkey.
FAU - Dizman, Aysen
AU  - Dizman A
AD  - Liv Hospital Ulus, Department of Radiation Oncology, Istanbul, Turkey.
FAU - Sertel, Huseyin
AU  - Sertel H
AD  - Liv Hospital Ulus, Department of Radiation Oncology, Istanbul, Turkey.
FAU - Fayda, Merdan
AU  - Fayda M
AD  - Liv Hospital Ulus, Department of Radiation Oncology, Istanbul, Turkey; Istinye 
      University, Faculty of Medicine, Department of Radiation Oncology, Istanbul, 
      Turkey.
LA  - eng
PT  - Journal Article
DEP - 20210205
PL  - United States
TA  - Pract Radiat Oncol
JT  - Practical radiation oncology
JID - 101558279
SB  - IM
MH  - *Brachytherapy
MH  - Female
MH  - Humans
MH  - Needles
MH  - Organs at Risk
MH  - Tomography, X-Ray Computed
MH  - *Uterine Cervical Neoplasms/diagnostic imaging/radiotherapy
EDAT- 2021/02/09 06:00
MHDA- 2021/09/18 06:00
CRDT- 2021/02/08 20:12
PHST- 2020/10/31 00:00 [received]
PHST- 2021/01/19 00:00 [revised]
PHST- 2021/01/26 00:00 [accepted]
PHST- 2021/02/09 06:00 [pubmed]
PHST- 2021/09/18 06:00 [medline]
PHST- 2021/02/08 20:12 [entrez]
AID - S1879-8500(21)00043-6 [pii]
AID - 10.1016/j.prro.2021.01.008 [doi]
PST - ppublish
SO  - Pract Radiat Oncol. 2021 Jul-Aug;11(4):272-281. doi: 10.1016/j.prro.2021.01.008. 
      Epub 2021 Feb 5.