Dosimetric Evaluation of Different Optimization Algorithms Used in Interstitial Brachytherapy of Cervical Carcinoma

Background: Conventional optimization techniques are based on the planning approach in which positions and weights are varied to generate the desired dose distribution. Inverse planning simulated annealing (IPSA) is an advanced optimization method developed to automatically determine a suitable combination of positions to design an acceptable plan. Objective: In this study, three optimization techniques namely IPSA, graphical optimization (GROPT), and geometrical optimization (GOPT) methods are compared in high-dose-rate interstitial brachytherapy of cervical carcinoma.Material and Methods: In this retrospective study, twenty computed tomography (CT) data sets of ۱۰ cervical cancer patients treated with Martinez Universal Perineal Interstitial Template-based interstitial brachytherapy were studied. The treatment plans generated were optimized using the IPSA, and GOPT methods. The prescribed dose was ۲۴ Gy in ۴ fractions. Plans produced using IPSA, GrOPT, and GOPT techniques were analyzed for comparison of dosimetric parameters, including target coverage, homogeneity, conformity, and organs at risk (OAR) doses. Results: V۱۰۰ values for IPSA, GrOPT and GOPT plans were ۹۵.۸۱±۲.۳۳%, ۹۳.۱۲±۲.۷۶% and ۸۸.۹۰±۴.۹۵%, respectively. The mean D۹۰ values for the IPSA, GrOPT, and GOPT plans were ۶.۴۵±۰.۱۵ Gy, ۶.۱۲±۰.۲۱ Gy, and ۵.۸۵±۰.۵۷ Gy, respectively. Significantly lower doses of OAR were in the IPSA plans that were more homogeneous (HI=۰.۶۶). Conformity was comparatively higher in IPSA-based plans (CI=۰.۷۵).  Conclusion: IPSA plans were superior and resulted in better target coverage, homogeneity, conformity, and minimal OAR doses.

Keywords:

Brachytherapy , Cervical Cancer , Conformity , Algorithms , Tomography Uterine Cervical Neoplasms