Chowdhury Amani A, Bolton Steve, Lowe Gerry, Vasquez Osorio Eliana, Hamblyn William, Hoskin Peter J
Mount Vernon Cancer Centre, Northwood, United Kingdom.
Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
Tech Innov Patient Support Radiat Oncol. 2024 Nov 16;33:100290. doi: 10.1016/j.tipsro.2024.100290. eCollection 2025 Mar.
Brachytherapy is a key treatment for gynaecological malignancies, delivering high doses to the tumour volume whilst sparing nearby normal tissues due to its steep dose gradient. Accuracy is imperative as small shifts can lead to clinically significant under- or over-dosing of the target volume or organs at risk (OARs), respectively. Independent verification of dose delivered during brachytherapy is not routinely performed but it is important to identify gross errors and define action thresholds to guide inter-fraction treatment decisions. In vivo dosimetry (IVD) is one strategy for improving accuracy and identifying potential errors. Despite promising phantom work, clinical application of IVD is lacking. A literature search was performed using Medline and EMBASE without date limits and based on the PICO framework to evaluate the clinical application of IVD in gynaecological brachytherapy. After screening of titles and abstracts, full text papers were reviewed and 28 studies were identified. Several dosimeters were utilised and measurements were typically taken from the rectum, bladder, vagina and within interstitial catheters. Significant differences between calculated and measured dose were attributed to geometric shifts. The studies reviewed demonstrated the feasibility of IVD in brachytherapy for dose verification but further work is required before IVD can be used to optimise treatment. The purpose of this scoping review is to investigate the clinical application of IVD in gynaecological brachytherapy, understand its challenges and identify the steps required to facilitate integration into everyday clinical practice.
近距离放射治疗是妇科恶性肿瘤的关键治疗方法，由于其剂量梯度陡峭，可在向肿瘤体积输送高剂量的同时保护附近的正常组织。准确性至关重要，因为微小的移位可能分别导致靶体积或危及器官（OARs）出现临床上显著的剂量不足或过量。近距离放射治疗期间所输送剂量的独立验证并非常规进行，但识别严重误差并定义行动阈值以指导分次治疗决策很重要。体内剂量测定（IVD）是提高准确性和识别潜在误差的一种策略。尽管在体模研究方面前景良好，但IVD的临床应用仍很缺乏。使用Medline和EMBASE进行了无日期限制的文献检索，并基于PICO框架评估IVD在妇科近距离放射治疗中的临床应用。在筛选标题和摘要后，对全文进行了审查，共确定了28项研究。使用了几种剂量计，测量通常取自直肠、膀胱、阴道以及间质导管内。计算剂量和测量剂量之间的显著差异归因于几何移位。所审查的研究证明了IVD在近距离放射治疗中进行剂量验证的可行性，但在IVD可用于优化治疗之前还需要进一步的工作。本范围综述的目的是研究IVD在妇科近距离放射治疗中的临床应用，了解其挑战，并确定促进其融入日常临床实践所需的步骤。
