Comparative dosimetric assessment of combined treatment modalities in cervical cancer radiotherapy for optimal organ protection
External radiotherapy combined with internal radiotherapy in cervical cancer can provide a boost to the target volume to increase tumour control. At the same time internal radiotherapy protects neighboring organs. The aim of the present study was to dosimetrically compare three external beam radiotherapy techniques each combined with internal radiotherapy to evaluate the combination that offers the best organ protection. Treatment plans of 20 cervical cancer patients were created for external (including three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT)) as well as brachytherapy. The prescribed dose was 50 Gy in 25 fractions for external and 21 Gy in three fractions for internal radiotherapy. The following organs at risk (OARs) were evaluated: bladder, rectum, sigmoid and bowel bag. The study analyzed the results of different treatment combinations in terms of dosimetric values for various parameters. The D90 for the clinical target volume was around 120 Gy, with the highest value seen in 3D-CRT + BT (brachytherapy) combination at 120.59 Gy. For the bladder, the D2cc remained below the recommended threshold of 90 Gy, with the lowest value obtained for the BT + IMRT combination at 79.2 Gy. For the rectum, both D2cc and D1cc remained below the recommended threshold of 75 Gy for both parameters. All techniques fell below the recommended dose of 75 Gy for the sigmoid. For the intestine, there were statistically significant differences between BT + IMRT and BT + 3D-CRT. The VMAT technique showed superiority over IMRT in tumour volume coverage and several organ-at-risk parameters. Generally, intensity-modulated techniques showed dosimetric advantage over the traditional 3D technique in cervical cancer. In addition to providing better compliance and homogeneity, they provided superior protection for organs at risk, especially for bowel bag. It is concluded that the BT + IMRT technique provided the best protection for organs at risk based on the lowest OAR dosimetric values, especially for the intestine.
