Does ITV vaginal procedure ensure dosimetric coverage during IMRT of post-operative gynaecological tumours without instructions concerning rectal filling?

Abstract

Aim

To find out whether the internal target volume (ITV) vaginal procedure ensures dosimetric coverage during intensity-modulated radiation therapy (IMRT) of post-operative gynaecological tumours without instructions on rectal filling.

Background

The ITV vaginal procedure does not necessarily include all movements of the bladder, and does not include changes in the rectal volume. We should know if the vaginal ITV is a useful tool in maintaining CTV coverage during treatment.

Materials and methods

A retrospective analysis of 24 patients treated between July 2012 and July 2014 with adjuvant IMRT for gynaecological cancer. All patients underwent empty and full bladder CT on simulation (CT-planning) and three weeks later (CT-control). ITV displacement was measured and the 3D vector was calculated. ITV coverage was then evaluated by comparing the volume covered by the prescription isodose on both CT's. Patients were asked to have full bladder but they did not follow recommendations for the rectum.

Results

The mean 3D vector was 0.64[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.32[[ce:hsp sp="0.25"/]]cm (0.09–1.30). The mean ITV coverage loss was 5.8[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]5.7% (0–20.2). We found a significant positive correlation between the 3D vector and the loss of coverage (Pearson correlation, r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.493, 95% CI: 0.111–0.748, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.0144). We did not find any significant correlation between the bladder and rectal parameters with the 3D vector and loss of dosimetric coverage. We found a trend between the maximum rectal diameter in CT-planning and 3D vector (r[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.400, 95% CI: −0.004 to 0.692, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.0529).

Conclusion

ITV vaginal procedure contributed to ensuring a good dose coverage without instructions on rectal filling.