Effect of model-based dose-calculation algorithms in high dose rate brachytherapy of cervical carcinoma

Background: Task Group 43 (TG-43) formalism does not consider the tissue and applicator heterogeneities. This study is to compare the effect of model-based dose calculation algorithms, like Advanced Collapsed Cone Engine (ACE), on dose calculation with the TG-43 dose calculation formalism in patients with cervical carcinoma. Materials and methods: 20 patients of cervical carcinoma treated with a high dose rate of intracavitary brachytherapy were prospectively studied. The target volume and organs at risk (OARs) were contoured in the Oncentra treatment planning system (Elekta, Veenendaal, The Netherlands). All patients were planned with cobalt-60 (Co-60) and iridium-192 (Ir-192) sources with doses of 21 Gy in 3 fractions. These plans were calculated with TG-43 formalism and a model-based dose calculation algorithm ACE. The dosimetric parameters of TG-43 and ACE-based plans were compared in terms of target coverage and OAR doses. Results: For Co-60-based plans, the percentage differences in the D90 and V100 values for high-risk clinical target volume (HR-CTV) were 0.36 +/- 0.43% and 0.17 +/- 0.31%, respectively. For the bladder, rectum and sigmoid, the percentage differences for D2cc volumes were -0.50 +/- 0.51%, -0.16 +/- 0.53% and -0.37 +/- 1.21%, respectively. For Ir-192-based plans, the percentage difference in the D90 for HR-CTV was 0.54 +/- 0.79%, while V100 was 0.24 +/- 0.29%. For the bladder, rectum and sigmoid, the doses to 2cc volume were 0.35 +/- 1.06%, 0.99 +/- 0.74% and 0.74 +/- 1.92%, respectively. No significant differences were found in the dosimetric parameters calculated with ACE and TG-43. Conclusion: The ACE algorithm reduced doses to OARs and targets. However, ACE and TG-43 did not show significant differences in the dosimetric parameters of the target and OARs with both sources.