Conventional four field radiotherapy versus computed tomography-based treatment planning in cancer cervix: A dosimetric study.
BACKGROUND
With advancements in imaging, wide variations in pelvic anatomy have been observed, thus raising doubts about adequate target volume coverage by conventional external radiotherapy fields based on bony landmarks. The present study evaluates the need for integrating computed tomography (CT)-based planning in the treatment of carcinoma cervix.


OBJECTIVE
To estimate inadequacies in target volume coverage when using conventional planning based on bony landmarks.


METHODS
The study consisted of 50 patients. Target volume delineation was done on planning CT scans, according to the guidelines given in literature. The volume of target receiving 95% of prescribed dose (V95) was calculated after superimposing a conventional four field box on digitally reconstructed radiograph. The geographic miss with conventional four field box technique was compared with the CT-based target volume delineation.


RESULTS
In 48 out of 50 patients, the conventional four field box failed to encompass the target volume. The areas of miss were at the superior and lateral borders of the anterior-posterior fields, and the anterior border of the lateral fields. The median V95 for conventional fields marked with bony landmarks was only 89.4% as compared to 93% for target delineation based on CT contouring.


CONCLUSIONS
Our study shows inadequate target volume coverage with conventional four field box technique. We recommend routine use of CT-based planning for treatment with radiotherapy in carcinoma cervix.
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abhishek
A
Gulia
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Firuza
F
Patel
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Bhavana
B
Rai
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Anshuma
A
Bansal
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Suresh C
SC
Sharma
Four field technique; carcinoma cervix; geographic miss