Magnitude of interfractional vaginal cuff movement

Implications for external irradiation

Daniel J. Ma, Martha Michaletz-Lorenz, S. Murty Goddu, Perry W. Grigsby

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average (± standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 ± 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 ± 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 ± 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

Original languageEnglish (US)
Pages (from-to)1439-1444
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number4
DOIs
StatePublished - Mar 15 2012
Externally publishedYes

Fingerprint

cuffs
Fiducial Markers
irradiation
bladder
Urinary Bladder
markers
Endometrial Neoplasms
Uterine Cervical Neoplasms
margins
apexes
education
simulation
cancer
Brachytherapy
Standard of Care
dosage
Gold
Seeds
Radiotherapy
Therapeutics

Keywords

  • Daily imaging
  • External-beam radiation
  • Gynecologic cancer
  • Interfractional movement
  • Vaginal cuff

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Magnitude of interfractional vaginal cuff movement : Implications for external irradiation. / Ma, Daniel J.; Michaletz-Lorenz, Martha; Goddu, S. Murty; Grigsby, Perry W.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 4, 15.03.2012, p. 1439-1444.

Research output: Contribution to journalArticle

Ma, Daniel J. ; Michaletz-Lorenz, Martha ; Goddu, S. Murty ; Grigsby, Perry W. / Magnitude of interfractional vaginal cuff movement : Implications for external irradiation. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 4. pp. 1439-1444.
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abstract = "Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average (± standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 ± 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 ± 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 ± 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53{\%}, 26{\%}, 4.2{\%}, and 1.4{\%} for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.",
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