Image-guided cervix high-dose-rate brachytherapy treatment planning: Does custom computed tomography planning for each insertion provide better conformal avoidance of organs at risk?

A duplication of planned dwell times and positions from one insertion to the next does not duplicate dose distributions in HDR cervix applications. A single plan used for an entire course of BT can result in significant increases to OAR doses for TR and unpredictable OAR doses for TO applicators. Treatment plans should be tailored for each insertion to reflect current applicator and anatomical geometry.