Abstract
PURPOSE: The aim of this study is to investigate the rational effects of packing, which has seen reduced use after the introduction of fixators that perform the stabilization function-on rectum, bladder, and A point doses when used in conjunction with fixators. METHODS: A retrospective analysis was conducted on inoperable-cervical-cancer patients who underwent brachytherapy with tandem and ovoid at Kocaeli University Hospital between January 2023 and May 2024. Patients received external beam radiotherapy (EBRT), followed by high-dose-rate brachytherapy with either standard or packed plans. In all patient plans, a perineal bar served as the external fixator. Dosimetric outcomes for the rectum and bladder were compared, focusing on D0.1 cc, D1 cc, D2 cc, D5 cc, and D10 cc dose parameters. RESULTS: A total of 34 patients and 68 plans were compared. Each patient's standard plan (SP) and vaginal gauze packing (VGP) plan were compared. In both plans, the doses to the right and left A points were kept identical. VGP plan significantly reduced rectal doses by 23.79% for D0.1 cc, 22.94% for D1 cc, 22.20% for D2 cc, 20.29% for D5 cc, and 18.43% for D10 cc. No significant differences were observed in bladder dose parameters between the two plans. The rectal volumes were similar in both groups. CONCLUSION: VGP effectively reduces rectal radiation exposure during cervical cancer brachytherapy, providing a cost-effective and feasible protective measure. Even when an external fixator is used, packing should not be discontinued. However, additional strategies may be needed to optimize bladder protection. Further research with larger patient cohorts and long-term follow-ups are recommended to enhance clinical practice.