ArticleQuantitative imaging in medicine and surgery2025
Dosimetric impact of bladder volume variation on online adaptive radiotherapy for cervical cancer based on cone-beam computed tomography and clinical management strategies.
Article in Quantitative imaging in medicine and surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: During cervical cancer radiotherapy, unstable bladder volume can compromise target accuracy and increase radiation exposure to organs at risk (OARs). Although online adaptive radiotherapy (ART) can correct for interfractional variations, intrafractional bladder filling may still lead to dose deviations. This study aimed to evaluate the dosimetric optimization of ART for interfractional bladder fluctuations, analyze the impact of intrafractional dynamics, and evaluate the clinical benefits of personalized bladder management. Methods: Fourteen patients with cervical cancer receiving radical radiotherapy with a prescription dose of 45-50 Gy/25 fractions from December 2023 to July 2024 were analyzed. Online ART for cervical cancer was applied in 350 external beam radiotherapy fractions. Two bladder preparation protocols were compared: personalized prefilling (2 hours before treatment) and natural filling. The personalized protocol involved weight-adjusted water intake: consumed within 20 minutes for patients ≤50 years, or within 30 minutes with fractionated intake for those >50 years. Two cone-beam computed tomography (CBCT) scans were acquired per fraction: initial (CBCT Results: Interfractional bladder volume inversely correlated with bladder volume percentage receiving ≥30 Gy (V Conclusions: ART for cervical cancer mitigates interfractional bladder-related dosimetric variations, while personalized bladder management enhances intrafractional stability. Combining ART with personalized bladder protocols for cervical cancer ensures target coverage while simultaneously enhancing protection of OARs.
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