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. 2022 Aug 10;95(1137):20220046. doi: 10.1259/bjr.20220046

Table 1.

Summary of identified studies of HRCTV and OAR movement during cervical brachytherapy

Year Authors (citation) Number of patients (fractions) Brachytherapy type and applicator Scans compared Displacement (mean ± 1 SD) Dosimetric impact (mean ± 1 SD) Comments
2021 Yan et al. 17 9 (38) HDR
Fletcher/Utrecht CT/MR applicator		 Pre-fraction CBCT compared to planning CT

  • HRCTV: -2.0±3.3%

  • Bladder: +7.9±36.7%

  • Rectum: -6.9±34.1%

  • Sigmoid: +19.9±68.2%

  • Small intestine: -0.5±26.7%

  • HRCTV D90: -1.2±4.5%

  • Bladder D2cc: -0.6±17.1%

  • Rectum D2cc: +9.3±14.6%

  • Sigmoid D2cc: +7.2±20.5%

  • Small intestine D2cc: +1.5±12.6%
2020 Miyasaka et al. 18 15 (58) HDR
Fletcher CT/MRI applicator		 Post-fraction CT compared to planning CT

  • Bladder: +65.1±84.3%

  • Rectum: -5.9±19.0%
  • Bladder:
    • D2cc: +4.6±15.1%
    • D1cc: +3.8±15.7%
    • D0.1cc: +4.3±20.7%
  • Rectum :
    • D2cc: -3.3±16.1%
    • D1cc: -3.1±17.5%
    • D0.1cc: -2.1±21.6%
  • 15% dose difference:
    • Rectum D2cc: 13.8% of total fractions
    • Bladder D2cc: 11.1% of total fractions
2015 Mazeron et al. 19 19 (57) PDR
Personalised vaginal mould		 CTs performed prior to each fraction and compared to planning MRI Mean intersection volume between 10 Gy isodose and OAR:
  • Bladder:
    • Day 1–2: -1.1±6.0 cc
    • Day 2–3: -1.1±4.0 cc
  • Rectum:
    • Day 1–2: +2.0 cc
    • Day 2–3: +0.1 cc
  • Sigmoid:
    • Day 1–2 +0.1±5.5 cc
    • Day 2–3: -0.50±6.0 cc
  • Bladder:
    • D2cc: +0.2±6.1%, 0.06±4.6 Gy
    • D0.1cc: +0.5±11.9%, 0.6±12.3 Gy
  • Rectum:
    • D2cc: +6.3±5.6%, +3.7±3.5 Gy
    • D0.1cc: +9.0±8.3%, +6.0±5.6 Gy
  • Sigmoid:
    • D2cc: +1.1±6.4%, +0.4±4.2 Gy
    • D0.1cc: -0.4±11.6%, 1.6±10.2 Gy

  • Rectum D2cc increased in 17/19 patients, with 2 (10.5%) exceeding dose constraint of 75 Gy EQD2.

  • Delivered bladder D2cc = 94 Gy (+9.1%) in one patient.

  • Only 3/19 (15.8%) of patients had delivered D2cc within ±5% of planned dose.
2014 Simha et al. 20 50 (50) HDR
Applicator not specified but tandem/ring visible in figures.		 Pre-fraction MRI compared to pre-fraction CT

  • Bladder: 15.7±13.8 cc

  • Rectum: 7.8±6.7 cc

  • Sigmoid: 14.9±13.25 cc

  • Bladder D2cc: 0.5±0.4 Gy

  • Rectum D2cc: 0.3±0.3 Gy

  • Sigmoid D2cc: 0.6±0.6 Gy
2014 Nomden et al. 21 HDR: 15 (30)
PDR: 10 (20)		 HDR, PDR
Tandem/ovoid		 Pre-fraction MRI compared to post-fraction MRI compared to planning MRI Not reported Total estimated dose - total planned dose:

  • HRCTV D90: -0.4±2.1 Gy

  • Bladder D2cc: -0.3±3.8 Gy

  • Rectum D2cc: +2.1±4.0 Gy

  • Sigmoid D2cc: +0.9±2.9 Gy
2013 Anderson et al. 22 21 (36) HDR
Tandem/ring ± interstitial needles		 Pre-treatment MRI compared to planning MRI

  • Bladder: 22.5±24.7 cc

  • Rectum: 20.0±20.8 cc

  • Bowel: 57.9±56.9 cc
  • >10% deviation from planning D2cc:
    • Bladder: 38.9%
    • Rectum: 58.3%
    • Bowel: 52.8%

  • D2cc changed by at least 10% for at least one OAR in 61% of cases

  • Rectum D2cc: maximum absolute difference = -3.3 Gy
2013 Lang et al. 23 21 (84) HDR
Tandem/ring		 Pre-fraction MRI compared to planning MRI Not reported

  • HRCTV D90: -1.2 Gy±2.7 Gy

  • Bladder:
    • D2cc: +0.7±4.7 Gy
    • D0.1cc: +1.7±10.7 Gy

  • Rectum;

    • D2cc: +1.1±2.4 Gy

    • 0.1 cc: +2.4±5.1 Gy

  • Sigmoid:
    • D2cc: -0.8±3.4 Gy
    • D0.1cc: −1.5±8.2 Gy

  • Target dose constraint of ≥85 Gy EQD2 met in all cases.

  • All differences within 3±10%
2013 Nesvacil et al. 24 120 (363) HDR (four centres) PDR (two centres),
Tandem/ring (five centres)
Tandem/ovoid (one centre)
Interstitial needles (four centres)		 MRI/CT compared: intrafraction (three centres) & interfraction (three centres) Not reported Intra fraction movement vs reference image:

  • HRCTV D90: -2.5±10.8%

  • Bladder D2cc: +1.3±17.7%

  • Rectum D2cc: +3.8±20.5%

  • Sigmoid D2cc: -2.3±23.5%


Inter fraction movement vs reference image:

  • HRCTV D90: +0.4±15.1%

  • Bladder D2cc: -0.1±21.2%

  • Rectum D2cc: +4.3±22.8%

  • Sigmoid D2cc: +6.8±30.2%
2013 Rey et al. 25 10 (50) HDR
Interstitial needles		 four models:

  • D1 plan applied to D2 & D3 CT using updated catheter positions.

  • Replanning performed for D2 & D3.

  • Dwell positions/times from D2 replan applied over D3 CT & compared with D3 CT replan.

  • Target volumes recontoured & replanned based on daily MRI.

 Catheter:

  • D1 to D2: +0.14±0.36 cm (maximum 1.11 cm)

  • D1 to D3: +0.10±0.40 cm (maximum 1.63 cm)

  • D2 to D3: -0.03±0.42 cm (maximum 1.85 cm)

 HRCTV D90:

  • D1 plan on D2 CT: -4.1%, SD not available.

  • D1 plan on D3 CT: -5.7%, SD not available.

  • Mean D2cc rectum was significantly higher with model 1 vs model 3 (59.1±4.7 vs 60.9 ±4.8 Gy EQD2; p = 0.04).

  • No significant difference in bladder / sigmoid D2cc.

CBCT, cone-beam computed tomography; D1/2/3, day 1,2,3; D2cc, the minimum dose received by the most irradiated 2 cc of the volume; D90, dose delivered to a minimum of 90% of the volume; HDR, high dose rate; HRCTV, high risk clinical target volume; OAR, organ at risk; PDR, pulsed dose rate

Values in Gy reported as EQD2.