Detection of air gaps around the cylinder by postinsertion computed tomography in vaginal cuff brachytherapy: A prospective series, systematic review, and meta-analysis

Lucas Gomes Sapienza, Matthew Stephen Ning, Antônio Cássio de Assis Pellizzon, Anuja Jhingran, Ann H. Klopp, Lilie L. Lin, Marisa A. Kollmeier, Vinícius Fernando Calsavara, Naira dos Santos Gutierrez, Rubens Chojniak, Maria José Leite Gomes, Glauco Baiocchi

Research output: Contribution to journalArticle

Abstract

Purpose: Postinsertion computed tomography (CT) can identify air gaps (AGs) around the cylinder in vaginal cuff brachytherapy (VCB). This study investigates the incidence and location of AGs. Methods and Materials: Planning CTs of 22 prospectively recruited patients (NCT02091050) treated with 2.6 cm (n = 8) and 3.0 cm (n = 14) cylinders were evaluated. In addition, a systematic literature review and meta-analysis was performed (PubMed and EMBASE). The pooled incidence of AGs was calculated by using the random-effects model weighted by inverse variance. Results: In 18 cases (82%), a total of 45 AGs were found: 26 within the 2 cm cranial length and 19 between 2 and 4 cm of the cylinder. The mean AG diameter was 3.7 mm (range: 1.3–11.8). Cylinder diameter, primary tumor site, and use of external beam radiotherapy were not associated with AG incidence. Systematic literature review revealed nine additional relevant studies, totaling 657 patients. The pooled incidence of patients with ≥1 AG was 67% (95% confidence interval: 50–83). AGs were located at the apex in 43.4%–94.4% of cases. In patients with ≥1 AG (n = 244), the pooled mean number of AGs was 2.18 per patient. The mean dose reduction varied from 9.6% to 29.3%. Conclusion: More than two-thirds of VCB cases present with AGs, which are most commonly at the apex and can potentially reduce mucosal dose. By identifying AGs, postinsertion CT can facilitate selection of optimal cylinder size in VCB.

Original languageEnglish (US)
Pages (from-to)620-626
Number of pages7
JournalBrachytherapy
Volume18
Issue number5
DOIs
StatePublished - Sep 1 2019

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Brachytherapy
Meta-Analysis
Air
Tomography
Incidence
PubMed
Cohort Studies
Radiotherapy
Confidence Intervals

Keywords

  • Air gaps
  • Brachytherapy
  • Cylinder
  • Gynecologic cancer
  • Vaginal vault

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Detection of air gaps around the cylinder by postinsertion computed tomography in vaginal cuff brachytherapy : A prospective series, systematic review, and meta-analysis. / Sapienza, Lucas Gomes; Ning, Matthew Stephen; Pellizzon, Antônio Cássio de Assis; Jhingran, Anuja; Klopp, Ann H.; Lin, Lilie L.; Kollmeier, Marisa A.; Calsavara, Vinícius Fernando; Gutierrez, Naira dos Santos; Chojniak, Rubens; Gomes, Maria José Leite; Baiocchi, Glauco.

In: Brachytherapy, Vol. 18, No. 5, 01.09.2019, p. 620-626.

Research output: Contribution to journalArticle

Sapienza, Lucas Gomes ; Ning, Matthew Stephen ; Pellizzon, Antônio Cássio de Assis ; Jhingran, Anuja ; Klopp, Ann H. ; Lin, Lilie L. ; Kollmeier, Marisa A. ; Calsavara, Vinícius Fernando ; Gutierrez, Naira dos Santos ; Chojniak, Rubens ; Gomes, Maria José Leite ; Baiocchi, Glauco. / Detection of air gaps around the cylinder by postinsertion computed tomography in vaginal cuff brachytherapy : A prospective series, systematic review, and meta-analysis. In: Brachytherapy. 2019 ; Vol. 18, No. 5. pp. 620-626.
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abstract = "Purpose: Postinsertion computed tomography (CT) can identify air gaps (AGs) around the cylinder in vaginal cuff brachytherapy (VCB). This study investigates the incidence and location of AGs. Methods and Materials: Planning CTs of 22 prospectively recruited patients (NCT02091050) treated with 2.6 cm (n = 8) and 3.0 cm (n = 14) cylinders were evaluated. In addition, a systematic literature review and meta-analysis was performed (PubMed and EMBASE). The pooled incidence of AGs was calculated by using the random-effects model weighted by inverse variance. Results: In 18 cases (82{\%}), a total of 45 AGs were found: 26 within the 2 cm cranial length and 19 between 2 and 4 cm of the cylinder. The mean AG diameter was 3.7 mm (range: 1.3–11.8). Cylinder diameter, primary tumor site, and use of external beam radiotherapy were not associated with AG incidence. Systematic literature review revealed nine additional relevant studies, totaling 657 patients. The pooled incidence of patients with ≥1 AG was 67{\%} (95{\%} confidence interval: 50–83). AGs were located at the apex in 43.4{\%}–94.4{\%} of cases. In patients with ≥1 AG (n = 244), the pooled mean number of AGs was 2.18 per patient. The mean dose reduction varied from 9.6{\%} to 29.3{\%}. Conclusion: More than two-thirds of VCB cases present with AGs, which are most commonly at the apex and can potentially reduce mucosal dose. By identifying AGs, postinsertion CT can facilitate selection of optimal cylinder size in VCB.",
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T2 - A prospective series, systematic review, and meta-analysis

AU - Sapienza, Lucas Gomes

AU - Ning, Matthew Stephen

AU - Pellizzon, Antônio Cássio de Assis

AU - Jhingran, Anuja

AU - Klopp, Ann H.

AU - Lin, Lilie L.

AU - Kollmeier, Marisa A.

AU - Calsavara, Vinícius Fernando

AU - Gutierrez, Naira dos Santos

AU - Chojniak, Rubens

AU - Gomes, Maria José Leite

AU - Baiocchi, Glauco

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N2 - Purpose: Postinsertion computed tomography (CT) can identify air gaps (AGs) around the cylinder in vaginal cuff brachytherapy (VCB). This study investigates the incidence and location of AGs. Methods and Materials: Planning CTs of 22 prospectively recruited patients (NCT02091050) treated with 2.6 cm (n = 8) and 3.0 cm (n = 14) cylinders were evaluated. In addition, a systematic literature review and meta-analysis was performed (PubMed and EMBASE). The pooled incidence of AGs was calculated by using the random-effects model weighted by inverse variance. Results: In 18 cases (82%), a total of 45 AGs were found: 26 within the 2 cm cranial length and 19 between 2 and 4 cm of the cylinder. The mean AG diameter was 3.7 mm (range: 1.3–11.8). Cylinder diameter, primary tumor site, and use of external beam radiotherapy were not associated with AG incidence. Systematic literature review revealed nine additional relevant studies, totaling 657 patients. The pooled incidence of patients with ≥1 AG was 67% (95% confidence interval: 50–83). AGs were located at the apex in 43.4%–94.4% of cases. In patients with ≥1 AG (n = 244), the pooled mean number of AGs was 2.18 per patient. The mean dose reduction varied from 9.6% to 29.3%. Conclusion: More than two-thirds of VCB cases present with AGs, which are most commonly at the apex and can potentially reduce mucosal dose. By identifying AGs, postinsertion CT can facilitate selection of optimal cylinder size in VCB.

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