Filling the gap in central shielding: three-dimensional analysis of the EQD2 dose in radiotherapy for cervical cancer with the central shielding technique

This study aimed to provide accurate dose distribution profiles of radiotherapy for cervical cancer when treated with the central shielding technique by analysing the composite 3D EQD2 dose distribution of external beam radiotherapy (EBRT) plus intracavitary brachytherapy (ICBT). On a phantom, four patterns of the combinations of whole pelvis irradiation (WP) (4 fields), pelvis irradiation with central shielding technique (CS) [anterior–posterior/posterior–anterior (AP-PA fields), shielding width of 3 or 4 cm] and ICBT using Point-A prescription were created: 30 Gy/15 fractions + 20 Gy/10 fractions + 24 Gy/4 fractions [Plan (30 + 20 + 24)], 40 Gy/20 fractions + 10 Gy/5 fractions + 18 Gy/3 fractions [Plan (40 + 10 + 18)], 40 Gy/20 fractions + 10 Gy/5 fractions + 24 Gy/4 fractions [Plan (40 + 10 + 24)] and 45 Gy/25 fractions + 0 Gy + 28 Gy/4 fractions [Plan (45 + 0 + 28)]. The composite EQD2 dose distributions of the complete treatment were analysed. The Point-A dose of Plan (30 + 20 + 24), Plan (40 + 10 + 18), Plan (40 + 10 + 24) and Plan (45 + 0 + 28) were 78.0 Gy (CS 3 cm)/71.8 Gy (CS 4 cm), 72.1 Gy (CS 3 cm)/69.0 Gy (CS 4 cm), 80.1 Gy (CS 3 cm)/77.0 Gy (CS 4 cm) and 84.1 Gy, whereas it has been previously reported to be 62 Gy, 64 Gy, 72 Gy and 84 Gy, respectively. For all the treatment plans with CS, equivalent or wider coverage of 60 Gy (EQD2) was achieved in the right–left direction, while coverage in the anterior–posterior direction decreased in plans with CS. There were no irregularly ‘cold’ regions around the central target. The use of CS in radiotherapy for cervical cancer resulted in tumor coverage in the lateral direction with doses higher than the previously reported Point-A doses.