Statistical Analysis of Interfraction Dose Variations of High-Risk Clinical Target Volume and Organs at Risk for Cervical Cancer High-Dose-Rate Brachytherapy

PURPOSE: High-dose-rate (HDR) brachytherapy for cervical cancer treatment includes significant uncertainties. The aim of this study was to quantify the interfraction dosimetric variation (IDV) of the high-risk clinical target volume (HRCTV) from the prescribed dose and the corresponding effect on organ-at-risk (OAR) dose based on a comprehensive statistical analysis. METHODS AND MATERIALS: Fifty patients with cervical cancer treated with high-dose-rate intracavity brachytherapy from October 2019 to December 2020 were retrospectively analyzed. The OARs of interest were the rectum, bladder, sigmoid, and bowel. The dosimetric parameters evaluated for all patients was the dose absorbed by 90% of the HRCTV ([Formula: see text]) and the dose absorbed by 0.1 ([Formula: see text]) and 2 cm(3) ([Formula: see text]) of each respective OAR. The HRCTV variations were from the prescribed dose and the OAR variations were from the corresponding tolerance dose. Distribution fitting of the HRCTV variations was determined to quantify the IDV. Comparative statistics of the HRCTV variations with the OAR variations were conducted to determine correlations. RESULTS: The mean HRCTV variation from the prescribed dose was –2.53% ± 8.74%. The HRCTV variations and OAR variations showed moderate to weak linear correlations despite the variations being relative to each other, with the bladder [Formula: see text] having the strongest correlation. There was a 30.0% (±2.62%, 95% confidence interval) probability of underdosing the HRCTV (–5% variation from prescription) and a 23.3% (±2.62%, 95% confidence interval) probability of overdosing the HRCTV (+5% variation from prescription). This tendency to underdose the HRCTV was a consequence of HRCTV IDV not being normally distributed. CONCLUSIONS: HRCTV dosimetric variations and OAR variations were complexly correlated with the bladder [Formula: see text] having the strongest correlation. HRCTV IDV was best described as a left-skewed distribution that indicates a tendency of underdosing the HRCTV. The clinical significance of such dose variations is expected and will be further investigated.