CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy.
Intensity-modulated radiotherapy (IMRT) is increasingly used in order to minimize the gastrointestinal, genitourinary, and hematological toxicity in cervical and uterine cancers. However, the benefit of this high-precision approach is detracted by the margins applied to the clinical target volume (CTV) to generate the planning tumor volume (PTV), taking into account tumor and surrounding organs movements, deformations, and volume changes. Adequate PTV margins should be large enough to prevent geographical misses, but not excessive, which might end the benefit from IMRT. The objectives of this review were: (a) to present the evidence available for the determination of CTV-PTV margin for uterine cancers; (b) to highlight the impact of these margins in the context of adaptive radiotherapy; and (c) to discuss the role of the PTV concept in intracavitary brachytherapy.
Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France. Electronic address: roger.sun@gustaveroussy.fr.
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Sun
Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France.
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Mazeron
Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France.
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Chargari
Radiation Oncology Department, Bretonneau University Hospital, 37000 Tours, France; François-Rabelais University, 37000 Tours, France.
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Barillot
D001918:Brachytherapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000502:physiology; D009068:Movement / Q000502:physiology; D058958:Organs at Risk; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014599:Uterus / Q000502:physiology
Brachytherapy; Cancer du col; Curiethérapie; IMRT; PTV; Radiotherapy; Radiothérapie; Radiothérapie conformationnelle avec modulation d’intensité; Uterine cervical neoplasms; Volume cible prévisionnel