title: Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique.
abstract: OBJECTIVE
  Reduction of irradiated small bowel volume, using a conformal three-dimensional treatment planning technique in postoperative radiotherapy of cervical cancer patients.
  
  
  METHODS
  Large gynecological treatment fields including the para-aortic nodes were analyzed in 15 patients. A conventional treatment plan with anterior and posterior (AP-PA) parallel opposed fields and a 3D 4-field conformal radiotherapy plan with a central blocking of small bowel were compared for each patient. Dose-volume histograms and dose parameters were established. Because of the tolerance constraints of the small bowel, the cumulative dose applied to the target was 48.6 Gy.
  
  
  RESULTS
  The mean Tumor Control Probability (TCP) values for both the conventional and the conformal technique were 0.60 and 0.61, respectively, with ranges of 0.56 to 0.67 and 0.57 to 0.66, respectively. The mean volume receiving 95% or more of the prescribed dose (V95) of the small bowel was 47.6% (32.5 to 66.3%) in the AP-PA technique and 14.9% (7.0 to 22.5%) in the conformal technique (p < 0.001), indicating a significant reduction in irradiated volume of small bowel in the higher dose range. The mean Normal Tissue Complication Probability (NTCP) decreased from 0.11 to 0.03 with the conformal plan. In patients who received a pedicled omentoplasty during surgery, the mean V95 for small bowel could be reduced to 8.5% (7.0 to 9.9%). The mean median dose to the kidneys was only slightly elevated in the conformal treatment. Especially the mean dose to the right kidney in conventional vs conformal treatment was 3.3 vs 7.9 Gy. The mean near-minimum dose (D95) to the rectosigmoid decreased from 48.4 to 30.1 Gy in the conformal plan compared to the conventional plan.
  
  
  CONCLUSIONS
  The small bowel dose can be significantly reduced with 3D treatment planning, particularly if a pedicled omentoplasty is performed. This allows dose escalation to the tumor region without unacceptable toxicity for the small bowel.
authors.affiliation: Department of Radiation Oncology, University Hospital Rotterdam-Daniel den Hoed Cancer Center/Dijkzigt Hospital, Rotterdam, The Netherlands. olofsen@rtdh.azr.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Olofsen-van Acht
authors.forename: S
authors.initials: S
authors.lastname: Quint
authors.forename: M
authors.initials: M
authors.lastname: Seven
authors.forename: J P
authors.initials: JP
authors.lastname: van Santvoort
authors.forename: H A
authors.initials: HA
authors.lastname: van den Berg
authors.forename: A
authors.initials: A
authors.lastname: Logmans
authors.forename: P C
authors.initials: PC
authors.lastname: Levendag
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D007421:Intestine, Small / Q000528:radiation effects; D007668:Kidney / Q000528:radiation effects; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000517:prevention & control; D011836:Radiation Tolerance; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation*; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000295:instrumentation*; D012007:Rectum / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery