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Gao J, Xu B, Lin Y, Xu Z, Huang M, Li X, Wu X, Chen Y. Stereotactic Body Radiotherapy Boost with the CyberKnife for Locally Advanced Cervical Cancer: Dosimetric Analysis and Potential Clinical Benefits. Cancers (Basel) 2022; 14:cancers14205166. [PMID: 36291951 PMCID: PMC9600637 DOI: 10.3390/cancers14205166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Aim: To compare the treatment plans of stereotactic body radiotherapy (SBRT) with CyberKnife (CK) and high-dose-rate (HDR) intracavitary/interstitial brachytherapy (IC/ISBT) and examine the feasibility of CK-SBRT as a viable alternative to BT in patients with locally advanced cervical cancer (LACC). (2) Methods: A BT plan of 28 Gy in four fractions delivered previously to 20 patients with LACC was compared with a CK plan based on the same CT images with structures delineation for BT. The SBRT treatment plan was further divided according to two different approaches, with the high-risk planning target volume (HR-PTV) defined by the high-risk clinical target volume (HR-CTV) without and with a 5 mm margin, which were named CK-CTV plan and CK-PTV plan, respectively. The dose distributions and dosimetric parameters of the target volumes and organs at risk (OARs) were recorded and compared for the three boost plans. Radiobiological metrics were calculated based on the EUD for the hybrid plans. Additionally, the relationship between tumor volume and tolerance doses for the OARs in the BT plan and CK-PTV plan was investigated. (3) Results: Target coverage was better with the CK plan than with the BT plan, as the D95%, D98%, HI and CI of the CK-CTV plan and CK-PTV plan were higher than those of the BT plan; an exception was the D50%. Similarly, the TCP of the target was also significantly in favor of the CK hybrid plans (p < 0.01). For the OARs, the CK-CTV plan was superior to the BT plan as regards the rectum D2cc, bladder D2cc and bladder Dmax. The CK-PTV plan could achieve dosimetric parameters comparable to those of the BT plan for OARs concerning the small residual tumor volume. The NTCP of the rectum for the WPI+CK-CTV plans was significantly lower than that of the WPI+BT plans (p < 0.01). (4) Conclusions: CK-based SBRT can achieve better target coverage, dose sparing for the OARs and radiobiological effects compared with the BT plan for tumors that are not excessively large. CK-based SBRT could be an alternative option to administer a radiation boost for patients with LACC.
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Affiliation(s)
- Jiaxiang Gao
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou 350001, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou 350001, China
| | - Yibin Lin
- Departments of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Zhenhang Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
| | - Miaoyun Huang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou 350001, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou 350001, China
| | - Xiaobo Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou 350001, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou 350001, China
| | - Xiaodong Wu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Executive Medical Physics Associates, Miami, FL 33179, USA
- Correspondence: (X.W.); (Y.C.); Tel.: +86-135-9939-5381 (Y.C.)
| | - Yuangui Chen
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- The School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350004, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou 350001, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou 350001, China
- Correspondence: (X.W.); (Y.C.); Tel.: +86-135-9939-5381 (Y.C.)
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Major T, Fröhlich G, Ágoston P, Polgár C, Takácsi-Nagy Z. The value of brachytherapy in the age of advanced external beam radiotherapy: a review of the literature in terms of dosimetry. Strahlenther Onkol 2021; 198:93-109. [PMID: 34724086 PMCID: PMC8789711 DOI: 10.1007/s00066-021-01867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/03/2021] [Indexed: 12/29/2022]
Abstract
Brachytherapy (BT) has long been used for successful treatment of various tumour entities, including prostate, breast and gynaecological cancer. However, particularly due to advances in modern external beam techniques such as intensity-modulated radiotherapy (IMRT), volume modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT), there are concerns about its future. Based on a comprehensive literature review, this article aims to summarize the role of BT in cancer treatment and highlight its particular dosimetric advantages. The authors conclude that image-guided BT supported by inverse dose planning will successfully compete with high-tech EBRT in the future and continue to serve as a valuable modality for cancer treatment.
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Affiliation(s)
- Tibor Major
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary. .,Department of Oncology, Semmelweis University, Budapest, Hungary.
| | - Georgina Fröhlich
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Faculty of Science, Eötvös Loránd University, Budapest, Hungary
| | - Péter Ágoston
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgár
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zoltán Takácsi-Nagy
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
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Campitelli M, Lazzari R, Piccolo F, Ferrazza P, Marsella AR, Macchia G, Fodor A, Santoni R, Tagliaferri L, Cerrotta A, Aristei C. Brachytherapy or external beam radiotherapy as a boost in locally advanced cervical cancer: a Gynaecology Study Group in the Italian Association of Radiation and Clinical Oncology (AIRO) review. Int J Gynecol Cancer 2021; 31:1278-1286. [PMID: 33632703 DOI: 10.1136/ijgc-2020-002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/04/2022] Open
Abstract
This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.
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Affiliation(s)
- Maura Campitelli
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Federica Piccolo
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | | | | | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Santoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, UNIROMA2, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
| | - Annamaria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Umbria, Italy
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Lazzari R, Riva G, Augugliaro M, Vavassori A, Dicuonzo S, Cattani F, Comi S, Colombo N, Jereczek-Fossa BA. Intensity modulated radiation therapy boost in locally-advanced cervical cancer in the absence of brachytherapy. Int J Gynecol Cancer 2020; 30:607-612. [PMID: 32188626 DOI: 10.1136/ijgc-2019-000735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Standard treatment in locally-advanced cervical cancer is external beam radiotherapy concomitant with platinum-based chemotherapy, followed by brachytherapy. The goal of our study was to determine whether an intensity modulated radiation therapy (IMRT) boost is feasible in patients unfit for brachytherapy. METHODS We retrospectively analyzed data of 25 patients unfit for brachytherapy with median age 55 years (range, 30-82) with locally-advanced/metastatic cervical cancer who underwent external beam radiotherapy to pelvis ±para-aortic lymph nodes and sequential IMRT boost between July 2014 and December 2017. Total dose of 45-50.4 Gy in 25-28 fractions (1.8 Gy/fraction) was administered to the cervix, uterus, parametria, ovaries, vaginal tissues (based on vaginal extension), involved lymph nodes, or relevant draining lymph-nodal groups. Para-aortic nodes were included if involved at radiological staging or if common iliac nodes were positive. The IMRT boost included all residual tumor after external beam radiotherapy identified on MRI. The Kaplan-Meier method was used to calculate 2 years' overall survival, 2 years' progression-free survival, and 2 years' local control. Overall survival- and progression-free survival were calculated considering the starting of radiotherapy or neo-adjuvant chemotherapy if prescribed, while local control was calculated from the end of radiotherapy. RESULTS Median radiation dose to pelvis ±para-aortic lymph nodes was 50.4 Gy (45-50.4), boost treatment was homogeneously performed to a total dose of 25 Gy in five fractions every other day.After a median follow-up of 26 months (range, 4-77), tumor persistence at cervix at 6 months from the end of radiotherapy or local recurrence occurred in five women (20%), eight (32%) experienced a further distant progression (two of them had also tumor persistence). Two-year local control and overall survival rates for all stages were 78% and 67%, respectively. According to Common Terminology Criteria for Adverse Events v.4 scoring criteria, 10 patients experienced gastrointestinal and/or genitourinary grade G1-2 acute toxicity. G2 rectal late toxicity requiring laser-coagulation was registered in two patients, there were no gastrointestinal and/or genitourinary acute or late toxicities≥G3. CONCLUSION The combination of external beam radiotherapy and brachytherapy remains the standard of care, however our preliminary data show the feasibility of IMRT boost in terms of toxicity with promising results in terms of local control and overall survival.
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Affiliation(s)
- Roberta Lazzari
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Matteo Augugliaro
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Vavassori
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit, IEO European Institute of Oncology, IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Yin G, Wang P, Lang J, Tian Y, Luo Y, Fan Z, Tam KY. Dosimetric study for cervix carcinoma treatment using intensity modulated radiation therapy (IMRT) compensation based on 3D intracavitary brachytherapy technique. J Contemp Brachytherapy 2016; 8:221-32. [PMID: 27504132 DOI: 10.5114/jcb.2016.60590] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose Intensity modulated radiation therapy (IMRT) compensation based on 3D high-dose-rate (HDR) intracavitary brachytherapy (ICBT) boost technique (ICBT + IMRT) has been used in our hospital for advanced cervix carcinoma patients. The purpose of this study was to compare the dosimetric results of the four different boost techniques (the conventional 2D HDR intracavitary brachytherapy [CICBT], 3D optimized HDR intracavitary brachytherapy [OICBT], and IMRT-alone with the applicator in situ). Material and methods For 30 patients with locally advanced cervical carcinoma, after the completion of external beam radiotherapy (EBRT) for whole pelvic irradiation 45 Gy/25 fractions, five fractions of ICBT + IMRT boost with 6 Gy/fractions for high risk clinical target volume (HRCTV), and 5 Gy/fractions for intermediate risk clinical target volume (IRCTV) were applied. Computed tomography (CT) and magnetic resonance imaging (MRI) scans were acquired using an in situ CT/MRI-compatible applicator. The gross tumor volume (GTV), the high/intermediate-risk clinical target volume (HRCTV/IRCTV), bladder, rectum, and sigmoid were contoured by CT scans. Results For ICBT + IMRT plan, values of D90, D100 of HRCTV, D90, D100, and V100 of IRCTV significantly increased (p < 0.05) in comparison to OICBT and CICBT. The D2cc values for bladder, rectum, and sigmoid were significantly lower than that of CICBT and IMRT alone. In all patients, the mean rectum V60 Gy values generated from ICBT + IMRT and OICBT techniques were very similar but for bladder and sigmoid, the V60 Gy values generated from ICBT + IMRT were higher than that of OICBT. For the ICBT + IMRT plan, the standard deviations (SD) of D90 and D2cc were found to be lower than other three treatment plans. Conclusions The ICBT + IMRT technique not only provides good target coverage but also maintains low doses (D2cc) to the OAR. ICBT + IMRT is an optional technique to boost parametrial region or tumor of large size and irregular shape when intracavitary/interstitial brachytherapy cannot be used.
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Merrow C, deBoer S, Podgorsak MB. VMAT for the treatment of gynecologic malignancies for patients unable to receive HDR brachytherapy. J Appl Clin Med Phys 2014; 15:4839. [PMID: 25207568 PMCID: PMC5711077 DOI: 10.1120/jacmp.v15i5.4839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 06/03/2014] [Accepted: 05/23/2014] [Indexed: 12/01/2022] Open
Abstract
This investigation studies the use of volumetric‐modulated arc therapy (VMAT) to deliver the following conceptual gynecological brachytherapy (BT) dose distributions: Type 1, traditional pear‐shaped dose distribution with substantial dose gradients; Type 2, homogeneous dose distribution throughout PTV (BT prescription volume); and Type 3, increased dose to PTV without organ‐at‐risk (OAR) overdose. A tandem and ovoid BT treatment plan, with the prescription dose of 6 Gy to point A, was exported into the VMAT treatment planning system (TPS) and became the baseline for comparative analysis. The 200%, 150%, 130%, 100%, 75%, and 50% dose volumes were converted into structures for optimization and evaluation purposes. The 100% dose volume was chosen to be the PTV. Five VMAT plans (Type 1) were created to duplicate the Ir‐192 tandem and ovoid inhomogeneous dose distribution. Another five VMAT plans (Type 2) were generated to deliver a homogeneous dose of 6 Gy to the PTV. An additional five VMAT plans (Type 3) were created to increase the dose to the PTV with a homogeneous dose distribution. In the first set of plans, the dose given to 99% of the 200%–100% dose volumes agreed within 2% of the BT plan on average. Additionally, it was found that the 75% dose volumes agreed within 5% of the BT plan and the 50% dose volumes agreed within 6.4% of the BT plan. In the second set of comparative analyses, the 100% dose volume was found to be within 1% of the original plan. Furthermore, the maximum increase of dose to the PTV in the last set of comparative analyses was 8 Gy with similar doses to OARs as the other VMAT plans. The maximum increase of dose was 2.50 Gy to the rectum and the maximum decrease of dose was 0.70 Gy to the bladder. Henceforth, VMAT was successful at reproducing brachytherapy dose distributions demonstrating that alternative dose distributions have the potential to be used in lieu of brachytherapy. It should also be noted that differences in radiobiology need to be further investigated. PACS numbers: 87.50.‐a, 87.53.‐j, 87.55.‐x, 87.55.D‐, 87.55.dk, 87.55.de
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Sharma DN, Gandhi AK, Sharma S, Rath GK, Jagadesan P, Julka PK. Interstitial brachytherapy vs. intensity-modulated radiation therapy for patients with cervical carcinoma not suitable for intracavitary radiation therapy. Brachytherapy 2013; 12:311-6. [DOI: 10.1016/j.brachy.2012.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/27/2012] [Accepted: 10/19/2012] [Indexed: 11/30/2022]
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Shwetha B, Ravikumar M, Palled SR, Supe SS, Sathiyan S. Dosimetric comparison of high dose rate brachytherapy and intensity-modulated radiation therapy for cervical carcinoma. J Med Phys 2011; 36:111-6. [PMID: 21731228 PMCID: PMC3119952 DOI: 10.4103/0971-6203.79687] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/24/2010] [Accepted: 12/17/2010] [Indexed: 12/02/2022] Open
Abstract
Intracavitary brachytherapy is an integral part of radiotherapy for locally advanced gynecologic malignancies. A dosimetric intercomparison of high dose rate intracavitary brachytherapy (HDR_BT) and intensity-modulated radiotherapy in cervical carcinoma has been made in the present study. CT scan images of 10 patients treated with HDR_BT were used for this study. A sliding-window IMRT (IMRT_SW) and step-and-shoot IMRT plans were generated using 6-MV X-rays. The cumulative dose volume histograms of target, bladder, rectum and normal tissue were analyzed for both techniques and dose distributions were compared. It was seen that the pear-shaped dose distribution characteristic of intracavitary brachytherapy with sharp dose fall-off outside the target could be achieved with IMRT. The integral dose to planning target volume was significantly higher with HDR_BT in comparison with IMRT. Significant differences between the two techniques were seen for doses to 1 cc and 2 cc of rectum, while the differences in 1 cc and 2 cc doses to bladder were not significant. The integral doses to the nontarget critical and normal structures were smaller with HDR_BT and with IMRT. It is concluded that IMRT can be the choice of treatment in case of non-availability of HDR brachytherapy facilities or when noninvasive treatments are preferred
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Affiliation(s)
- B Shwetha
- Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, India
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Gielda BT, Shah AP, Marsh JC, Smart JP, Bernard D, Rotmensch J, Griem KL. Helical Tomotherapy Delivery of an IMRT Boost in Lieu of Interstitial Brachytherapy in the Setting of Gynecologic Malignancy: Feasibility and Dosimetric Comparison. Med Dosim 2011; 36:206-12. [PMID: 20537887 DOI: 10.1016/j.meddos.2010.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/06/2010] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
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Taylor A, Powell ME. Conformal and intensity-modulated radiotherapy for cervical cancer. Clin Oncol (R Coll Radiol). 2008;20:417-425. [PMID: 18558480 DOI: 10.1016/j.clon.2008.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 04/01/2008] [Accepted: 04/17/2008] [Indexed: 12/28/2022]
Abstract
Three-dimensional radiotherapy planning techniques, including conformal radiotherapy and intensity-modulated radiotherapy, have potential for improving outcomes in cervical cancer. Accurate target volume definition is essential in order to maximise normal tissue sparing while minimising the risk of a geographical miss. This reduction in toxicity provides the option of dose escalation, particularly with simultaneous integrated boost intensity-modulated radiotherapy. The evidence for the current use and potential applications of these techniques in the treatment of cervical cancer are discussed.
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