Problems of Radiation Medicine and Radiobiology

O. M. Sukhina, A. S. Simbirova, V. S. Sukhin

State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska Str., Kharkiv 61024, Ukraine

DEVIATION BETWEEN THE PLANNED DOSE AND THE IN VIVO DOSIMETRY RESULTS DURING POSTOPERATIVE IRRADIATION IN PATIENTS WITH UTERINE CANCER DEPENDING ON ANTHROPOMETRIC DATA

Topometry is an integral part of irradiation whose task is to repeat the position of the patient set by the simulator to repeat the PTV and the spatial relationship between the radiation field and the risk organs that were identified during planning. The dose distribution formulated in the plan is only an ideal model. There is some gap between the actual and planned dose distribution, especially in overweight patients.
Objective: evaluate the effect of anthropometric data on the deviation between the planned dose and the results of dosimetry in vivo in patients with uterine cancer during postoperative irradiation.
Materials and Methods. The authors analyzed the results of treatment of 110 patients with stage IB–II uterine cancer who were treated at the Department of Radiation Therapy of the Institute of Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine from 2016 to 2019. The technique of classical fractionation was used with a single focal dose of 2.0 Gy 5 times a week, the total focal dose was 42.0–50.0 Gy. To assess the effect of the patient’s anthropometric data on the difference between the actual and calculated dose, the authors performed in vivo dosimetry after the first session and in the middle of the postoperative course of external beam radiation therapy.
Results. Рatients with BSA < 1.92 m², had the median relative deviation at the first session -4.12 %, after 20.0 Gy – 3.61 %, patients with BSA > 1.92 m²: -2.06 % and -1.55 % respectively. After 20 Gy 34.8 % of patients with BSA < 1.92 m² there was an increase in deviation from the planned dose, 65.2 % a decrease, while in 56.1 % of patients with BSA > 1.92 m² there was an increase, and in 43.9 % – its reduction. With increasing BMI, the actual dose received on the rectal mucosa in the tenth session of irradiation is approaching the calculated one.
Conclusions. When irradiated on the ROKUS-AM device, we did not find a probable dependence of the influence of the constitutional features of patients between the received and planned radiation dose. When treated with a Clinac 600 C, only body weight and body mass index at the tenth irradiation session have a likely effect on the dose difference. Therefore, issues related to the individual approach to the treatment of uterine cancer, depending on anthropometric data is an urgent problem of modern radiotherapy.
Key words: anthropometric data, obesity, radiation therapy, preradiation preparation, in vivo dosimetry, uterine cancer.

Problems of Radiation Medicine and Radiobiology.
2021;26:573-586. doi: 10.33145/2304-8336-2021-26-573-586

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1. Piulats JM, Guerra E, Gil-Martin M, Roman-Canal B, Gatius S, Sanz-Pamplona R, et al. Molecular approaches for classifying endometrial carcinoma. Gynecol Oncol. 2017;145(1):200-207.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29. doi: 10.3322/caac.21254
3. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Pineros M, et al. Global cancer observatory: cancer today. Lyon, France: International agency for research on cancer [Internet]. 2018. Available from: https://gco.iarc.fr/today.
4. Svintsitsky VS, Ligirda NF. [Cervical cancer.] In: Vorobieva LI, editor. Practical gynecological oncology. Kyiv: National Institution of Cancer; 2012. p. 51-78. Russian.
5. Cahan B, Kim JH, Schultheiss TE, Wong JYC, Chen YJ. Stage I and II endometrial adenocarcinoma: analysis of 2009 FIGO staging revision and impact on survival by adjuvant therapy. Am J Clin Oncol. 2018;41(3):302-306.
6. Gunther JR, Christensen EN, Allen PK, Ramondetta LM, Jhingran A, Fleming ND, et al. Role of radiation therapy in the multidisciplinary management of uterine carcinosarcoma. Int J Gynecol Cancer. 2018;28(1):114-121. doi: 10.1097/IGC.0000000000001135.
7. Gadhi MA, Fatmi S, Chughtai GM, Arshad M, Shakil M, Rahmani UM, et al. Verification of absorbed dose using diodes in cobalt-60 radiation therapy. Australas Phys Eng Sci Med. 2016;39(1):211-219. doi: 10.1007/s13246-016-0422-5.
8. Eminowicz G, Motlib J, Khan S, Perna C, McCormack M. Pelvic organ motion during radiotherapy for cervical cancer: understanding patterns and recommended patient preparation. Clin Oncol (R Coll Radiol). 2016;28(9):e85-e91.
9. Gonzalez VJ, Hullett CR, Burt L, Rassiah-Szegedi P, Sarkar V, Tward JD, et al. Impact of prone versus supine positioning on small bowel dose with pelvic intensity modulated radiation therapy. Adv Radiat Oncol. 2017;2(2):235-243. doi: 10.1016/j.adro.2017.01.005.
10. Kim H, Beriwal S, Huq MS, Kannan N, Shukla G, Houser C. Evaluation of set-up uncertainties with daily kilovoltage image guidance in external beam radiation therapy for gynaecological cancers. Clin Oncol (R Coll Radiol). 2012;24(2):39-45. doi: 10.1016/j.clon.2011.09.007.
11. Bray TS, Kaczynski A, Albuquerque K, Cozzi F, Roeske JC. Role of image guided radiation therapy in obese patients with gynecologic malignancies. Pract Radiat Oncol. 2013;3(4):249-255. doi: 10.1016/j.prro.2012.09.001.
12. Wu WC, Chang YR, Lai YL, Shiau AC, Liang JA, Chien CR, et al. Impact of body-mass factors on setup displacement during pelvic irradiation in patients with lower abdominal cancer. Radiol Oncol. 2019;53(2). doi: 10.2478/raon-2019-0017.
13. Kwak YK, Lee SW, Kay CS, Park HH. Intensity-modulated radiotherapy reduces gastrointestinal toxicity in pelvic radiation therapy with moderate dose. PLoS One. 2017;12(8):e0183339. doi: 10.1371/journal.pone.0183339.
14. Tan LT, Tanderup K, Kirisits C, de Leeuw A, Nout R, Duke S, et al. Image-guided adaptive radiotherapy in cervical cancer. Semin Radiat Oncol. 2019;29(3):284-298. doi: 10.1016/j.semradonc.2019.02.010.
15. Lin LL, Hertan L, Rengan R, Teo BK. Effect of body mass index on magnitude of setup errors in patients treated with adjuvant radiotherapy for endometrial cancer with daily image guidance. Int J Radiat Oncol Biol Phys. 2012;83(2):670-675. doi: 10.1016/j.ijrobp.2011.07.026.