title: Reduction of late complications after irregularly shaped four-field whole pelvic radiotherapy using computed tomographic simulation compared with parallel-opposed whole pelvic radiotherapy.
abstract: BACKGROUND
  Tumor control and late complication rates of irregularly shaped four-field whole pelvic radiotherapy using CT simulation were compared with those of whole pelvic radiotherapy using parallel-opposed fields in a non-randomized study.
  
  
  METHODS
  From 1986 to 1996, 74 patients who underwent surgery for clinical stage I, II or III squamous or adenosquamous cell carcinoma of the uterine cervix were treated with postoperative radiotherapy consisting of 50 Gy in 25 fractions in 6 weeks. Thirty-four patients were treated with an irregularly shaped four-field technique following computed tomography (CT) simulation using beam's eye view and three-dimensional treatment planning and lead blocks. Forty patients received the conventional two-field technique, with CT simulation in 13 patients and X-ray simulation in 27 patients. There was no significant difference in patients' characteristics between the two groups.
  
  
  RESULTS
  There was no statistical difference in survival, relapse-free survival or pelvic control rate between the two-field and irregularly shaped four-field groups with a mean follow-up period of 60 months. The actual 5-year pelvic control rate was 94% for the two-field technique and 100% for the irregularly shaped four-field technique. The incidence of grade II-III bowel complications in the irregularly shaped technique group (2.9%, 1/34) was significantly lower than that in the two-field technique group (17.5%, 7/40) (p < 0.05). The actual 5-year complication rates of grade II leg edema were 28.6 and 3.1% for the two-field technique and irregularly shaped four-field technique groups, respectively (p = 0.0123).
  
  
  CONCLUSIONS
  Irregularly shaped four-field post-operative pelvic radiotherapy using CT simulation appears to be as effective as parallel-opposed whole pelvic radiotherapy with a lower incidence of bowel complication and chronic leg edema.
authors.affiliation: Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yamazaki
authors.forename: H
authors.initials: H
authors.lastname: Shirato
authors.forename: T
authors.initials: T
authors.lastname: Nishioka
authors.forename: S
authors.initials: S
authors.lastname: Hashimoto
authors.forename: T
authors.initials: T
authors.lastname: Kitahara
authors.forename: K
authors.initials: K
authors.lastname: Kagei
authors.forename: K
authors.initials: K
authors.lastname: Miyasaka
mesh_terms: D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D003198:Computer Simulation; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004487:Edema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D007422:Intestines / Q000528:radiation effects; D007866:Leg / Q000528:radiation effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010388:Pelvis / Q000528:radiation effects*; D018714:Radiotherapy, Adjuvant; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000601:surgery