Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study

Monica Serban & Kari Tanderup et al. · 2020-01-30

The aim of this study was to investigate the influence of brachytherapy technique and applicator type on target dose, isodose surface volumes, and organ-at-risk (OAR) dose. Nine hundred two patients treated with tandem/ovoids (T&O) (n = 299) and tandem/ring (T&R) (n = 603) applicators from 16 EMBRACE centers were analyzed. Patients received external beam radiation therapy and magnetic resonance imaging guided brachytherapy with dose prescription according to departmental practice. Centers were divided into 4 groups, according to applicator/technique: Ovoids and ring centers treating mainly with the intracavitary (IC) technique and ovoids and ring centers treating routinely with the intracavitary/interstitial (IC/IS) technique. V85Gy EQD2 For similar point A doses, mean CTV T&R-IC applicators have better target dose and dose conformity than T&O-IC in this representative patient cohort. IC applicators fail to cover large target volumes, whereas routine application of IC/IS improves target and OAR dose considerably. Patients treated with T&R show a more favorable therapeutic ratio when evaluating target, bladder/rectum doses, and V85Gy. A comprehensive view on technique/applicators should furthermore include practical considerations and clinical outcome.
Authors
Monica Serban, Christian Kirisits, Astrid de Leeuw, Richard Pötter, Ina Jürgenliemk-Schulz, Nicole Nesvacil, Jamema Swamidas, Robert Hudej, Gerry Lowe, Taran Paulsen Hellebust, Geetha Menon, Arun Oinam, Peter Bownes, Bernard Oosterveld, Marisol De Brabandere, Kees Koedooder, Anne Beate Langeland Marthinsen, Diane Whitney, Jacob Lindegaard, Kari Tanderup