Impact of small variations in LDR for late-reacting tissue in gyn brachytherapy

Introduction: The linear-quadratic model shows that while a slight variation in the LDR Brachytherapy dose rate affects just a little the tumoral tissue ERD (Extrapolated Response Dose), the effect can be very strong in the late reacting tissues. The LDR Brachytherapy in cervix cancer is done with a dose rate in point A that range between 0.5 Gy/h and 0.7 Gy/h. This small range is a very heavy variable to find equivalent schemes. Material and Methods: Whith the LC10 program (based in the linear-quadratic model developed in our centre) a radiobiological analysis of the GYN Brachytherapy considering the dosimetric distribution of the most usual applicators is done. Different studies show that the critical rectal and bladder point doses in reference to point A ranges between 60% and 80%. Bearing this in mind, and the typical variables (tissue parameters, number of fractions, dose per fraction, total dose, etc.) the effect of the LDR dose rate variation in particularly analysed while calculating the equivalent HDR scheme. Result and discussion: When equivalent schemes are calculated in practise it is found that the HDR number of fractions depends highly on the LDR dose rate, that's why for one specific LDR scheme is necessary even to duplicate the HDR number of fractions to find the unique equivalent scheme when varying the dose rate from 0.5 Gy/h to 0.7 Gy/h. This also shows that the same LDR scheme using 0.5 Gy/h or 0.7 Gy/h is radiobiologically different (up to 20% in the late reacting tissue ERD). Conclusion: It is very important to report with great detail the LDR dose rate with which the gynaecological treatments have been performed because this variable is decisive to compare the results with other LDR or HDR schemes