title: Assessment of improved organ at risk sparing for advanced cervix carcinoma utilizing precision radiotherapy techniques.
abstract: OBJECTIVE
  To evaluate the potential benefit of proton therapy and photon based intensity-modulated radiotherapy in comparison to 3-D conformal photon radiotherapy (3D-CRT) in locally advanced cervix cancer.
  
  
  METHODS
  In five patients with advanced cervix cancer 3D-CRT (four-field box) was compared with intensity modulated photon (IMXT) and proton therapy (IMPT) as well as proton beam therapy (PT) based on passive scattering. Planning target volumes (PTVs) included primary tumor and pelvic and para-aortic lymph nodes. Dose-volume histograms (DVHs) were analyzed for the PTV and various organs at risk (OARs) (rectal wall, bladder, small bowel, colon, femoral heads, and kidneys). In addition dose conformity, dose inhomogeneity and overall volumes of 50% isodoses were assessed.
  
  
  RESULTS
  All plans were comparable concerning PTV parameters. Large differences between photon and proton techniques were seen in volumes of the 50% isodoses and conformity indices. DVH for colon and small bowel were significantly improved with PT and IMPT compared to IMXT, with D(mean) reductions of 50-80%. Doses to kidneys and femoral heads could also be substantially reduced with PT and IMPT. Sparing of rectum and bladder was superior with protons as well but less pronounced.
  
  
  CONCLUSIONS
  Proton beam RT has significant potential to improve treatment related side effects in the bowel compared to photon beam RT in patients with advanced cervix carcinoma.
authors.affiliation: Division Medical Radiation Physics, Department of Radiotherapy, Medical University Vienna/AKH Vienna, Vienna, Austria. Dietmar.Georg@akhwien.at
authors.forename: Dietmar
authors.initials: D
authors.lastname: Georg
authors.forename: Petra
authors.initials: P
authors.lastname: Georg
authors.forename: Martin
authors.initials: M
authors.lastname: Hillbrand
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Ulrike
authors.initials: U
authors.lastname: Mock
mesh_terms: D000005:Abdomen / Q000528:radiation effects; D005260:Female; D005269:Femur / Q000528:radiation effects; D006801:Humans; D007668:Kidney / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D061766:Proton Therapy; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011522:Protons
chemical_list: D011522:Protons