Bladder and rectum dose defined from MRI based treatment planning for cervix cancer brachytherapy:: Comparison of dose-volume histograms for organ contours and organ wall, comparison with ICRU rectum and bladder reference point

Purpose: To analyze the correlation between dose-volume histograms based on organ contour and organ wall delineation for bladder and rectum, and to compare the doses to these organs with the absorbed doses at the ICRU bladder and rectum reference points. Material and methods: Individual MRI based brachytherapy treatment planning was performed in 15 patients as part of a prospective comparative trial. The external contours and the organ walls were delineated for the bladder and rectum in order to compute the corresponding dose-volume histograms. The minimum dose in 2 cm(3), 5 cm(3) and 10 cm(3) volumes receiving the highest dose were referred to as [D2], [D5] and [D10] and compared with the absorbed dose at the ICRU rectum and bladder reference point. Results: The bladder (bext) and rectal (text) doses derived from external contours and computed for volumes of 2 cm 3 [132], provided a good estimate for the doses computed for the organ walls (bw and rw) only (mean ratio [D2]b(ext)/[D2](bw) = 1.1 +/- 0.2 and [D2](rext)/[D2](rw) = 1.2 +/- 0.1, respectively). This correspondence was no longer true when larger volumes were considered (5 and 10 cm 3). The dose at the ICRU rectum reference point did overestimate the dose computed for 2 cm 3 of the rectum wall (mean ratio: 1.5 +/- 0.4). In contrast, the dose at the ICRU bladder reference point did-in the case of inappropriate topographic location of the balloon-underestimate the dose computed for 2 cm 3 of the bladder wall (overall mean ratio: 0.9 +/- 0.4). Conclusion: For clinical applications, when volumes smaller than 5 cm(3) are considered, the dose-volume histograms computed from external organ contours for the bladder and rectum can be used instead of dose-volume histograms computed for the organ walls only. External organ contours are indeed easier to obtain. The dose at the ICRU rectum reference point provides a good estimate of the rectal dose computed for volumes smaller than 2 cm(3) [D2] only for a midline position of the rectum. The ICRU bladder reference point provides a good estimate of the dose computed for the bladder wall [D2] only in cases of appropriate balloon position. (C) 2003 Elsevier Ireland Ltd. All rights reserved.