Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose

ObjectiveThis study aims to investigate the influence of intrafraction DNA damage repair on biologically effective dose (BED) in Ir-192 high-dose-rate (HDR) brachytherapy (BT) for cervical cancer. Specifically, we examine BED variations resulting from source decay at various treatment time points ac...

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Main Authors: Suyan Bi, Jiaomei Zhou, Meiling Xu, Zhitao Dai
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Oncology
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Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2025.1407606/full
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author Suyan Bi
Jiaomei Zhou
Meiling Xu
Zhitao Dai
author_facet Suyan Bi
Jiaomei Zhou
Meiling Xu
Zhitao Dai
author_sort Suyan Bi
collection DOAJ
description ObjectiveThis study aims to investigate the influence of intrafraction DNA damage repair on biologically effective dose (BED) in Ir-192 high-dose-rate (HDR) brachytherapy (BT) for cervical cancer. Specifically, we examine BED variations resulting from source decay at various treatment time points across different tumor cell lines and normal tissues.MethodsInstead of the simplified BED formula, which does not account for intrafraction and interfraction repair or tumor repopulation, we applied the generalized BED (BEDg) formula. BED values for various subtypes of cervical cancer tissues and Organs at Risk (OARs) were calculated using both BED formulas across a full source exchange cycle.ResultsThe results demonstrate that BEDg values are significantly lower and decrease more markedly and extended treatment time compared to BED values. For tumors with α/β = 10, the maximum BED deviation (ΔBED = BED − BEDg) reached 3.05% ± 0.47% at D90% of the High-Risk Clinical Tumor Volume (HRCTV) in BT. For specific cervical cancer subtypes, the three largest ΔBED (%) values at D90% of HRCTV were 14.06 ± 1.67 (stages I–II, α/β = 10), 9.92 ± 1.19 (HX156c, α/β = 16.46), and 7.57 ± 1.05 (HX155c, α/β = 11.40). Similar trends were observed in OARs. As the source decays, the maximum ΔBED (%) at D0.1cc was 13.37 ± 2.27 (bladder), 11.92 ± 2.10 (rectum), 12.45 ± 2.27 (sigmoid), and 11.91 ± 2.62 (small intestine), assuming α/β = 3.ConclusionsThese findings confirm that source decay significantly impacts BED in cervical cancer treatment, affecting both tumor tissues with varying radiosensitivities and normal tissues. The simplified BED formula tends to overestimate the actual dose, especially at a source activity of 2 Ci, highlighting the necessity of using the full BEDg model for accurate dosimetric evaluation in HDR brachytherapy.
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spelling doaj-art-84bc6281e75844e7a62f9bbf1f4c85972025-08-20T01:48:57ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.14076061407606Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological doseSuyan Bi0Jiaomei Zhou1Meiling Xu2Zhitao Dai3School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MalaysiaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaObjectiveThis study aims to investigate the influence of intrafraction DNA damage repair on biologically effective dose (BED) in Ir-192 high-dose-rate (HDR) brachytherapy (BT) for cervical cancer. Specifically, we examine BED variations resulting from source decay at various treatment time points across different tumor cell lines and normal tissues.MethodsInstead of the simplified BED formula, which does not account for intrafraction and interfraction repair or tumor repopulation, we applied the generalized BED (BEDg) formula. BED values for various subtypes of cervical cancer tissues and Organs at Risk (OARs) were calculated using both BED formulas across a full source exchange cycle.ResultsThe results demonstrate that BEDg values are significantly lower and decrease more markedly and extended treatment time compared to BED values. For tumors with α/β = 10, the maximum BED deviation (ΔBED = BED − BEDg) reached 3.05% ± 0.47% at D90% of the High-Risk Clinical Tumor Volume (HRCTV) in BT. For specific cervical cancer subtypes, the three largest ΔBED (%) values at D90% of HRCTV were 14.06 ± 1.67 (stages I–II, α/β = 10), 9.92 ± 1.19 (HX156c, α/β = 16.46), and 7.57 ± 1.05 (HX155c, α/β = 11.40). Similar trends were observed in OARs. As the source decays, the maximum ΔBED (%) at D0.1cc was 13.37 ± 2.27 (bladder), 11.92 ± 2.10 (rectum), 12.45 ± 2.27 (sigmoid), and 11.91 ± 2.62 (small intestine), assuming α/β = 3.ConclusionsThese findings confirm that source decay significantly impacts BED in cervical cancer treatment, affecting both tumor tissues with varying radiosensitivities and normal tissues. The simplified BED formula tends to overestimate the actual dose, especially at a source activity of 2 Ci, highlighting the necessity of using the full BEDg model for accurate dosimetric evaluation in HDR brachytherapy.https://www.frontiersin.org/articles/10.3389/fonc.2025.1407606/fullhigh-dose-rate brachytherapy (HDR BT)cervical cancersource decay impacttumor cell linesintrafraction damage repairbiological effective dose (BED)
spellingShingle Suyan Bi
Jiaomei Zhou
Meiling Xu
Zhitao Dai
Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
Frontiers in Oncology
high-dose-rate brachytherapy (HDR BT)
cervical cancer
source decay impact
tumor cell lines
intrafraction damage repair
biological effective dose (BED)
title Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
title_full Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
title_fullStr Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
title_full_unstemmed Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
title_short Reevaluating BED in cervical cancer HDR brachytherapy: source decay and tissue-specific repair significantly impact radiobiological dose
title_sort reevaluating bed in cervical cancer hdr brachytherapy source decay and tissue specific repair significantly impact radiobiological dose
topic high-dose-rate brachytherapy (HDR BT)
cervical cancer
source decay impact
tumor cell lines
intrafraction damage repair
biological effective dose (BED)
url https://www.frontiersin.org/articles/10.3389/fonc.2025.1407606/full
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