title: Clinical implementation of coverage probability planning for nodal boosting in locally advanced cervical cancer.
abstract: To implement coverage probability (CovP) for dose planning of simultaneous integrated boost (SIB) of pathologic lymph nodes in locally advanced cervical cancer (LACC).
  
  
  
  CovP constraints for SIB of the pathological nodal target (PTV-N) with a central dose peak and a relaxed coverage at the perimeter were generated for use with the treatment planning system Eclipse: PTV-N D98 >90%, CTV-N D98 >100% and CTV-N D50 >101.5% of prescribed dose. Dose of EBRT was 45Gy/25 fx with a SIB of 55-57.5Gy depending on expected dose from brachytherapy (BT). Twenty-five previously treated patients with 47 boosted nodes were analysed. Nodes were contoured on cone beam CT (CBCT) and the accumulated dose in GTV-NCBCTand volume of body, pelvic bones and bowel receiving >50Gy (V50) were determined.
  
  
  
  Nearly all nodes (89%) were visible on CBCT and showed considerable concentric regression during EBRT. Total EBRT and BT D98 was >57 GyEQD2in 98% of the visible nodes. Compared to treatment plans aiming for full PTV-N coverage, CovP significantly reduced V50 of body, bones and bowel (p<0.001) CONCLUSION: CovP is clinically feasible for SIB of pathological nodes and significantly decreases collateral SIB dose to nearby OAR.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: anraml@rm.dk.
authors.forename: Anne
authors.initials: A
authors.lastname: Ramlov
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Assenholt
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Jensen
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Caroline
authors.initials: C
authors.lastname: Grønborg
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Remi
authors.initials: R
authors.lastname: Nout
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark; Department of Medical Physics, Aarhus University Hospital, Denmark and Heidelberg, Institute for Radiation Oncology (HIRO), Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Alber
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Fokdal
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Tanderup
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Jacob Chr
authors.initials: JC
authors.lastname: Lindegaard
mesh_terms: D001918:Brachytherapy; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D011336:Probability; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*
keywords: Cervical cancer; Coverage probability; Nodal boosting; Radiotherapy