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Optimized planning target volume for intact cervical cancer.

Alvin Khan1, Lindsay G Jensen, Shuai Sun

  • 1Department of Radiation Oncology, Center for Advanced Radiotherapy Technologies, University of California, San Diego, La Jolla, CA, USA.

International Journal of Radiation Oncology, Biology, Physics
|January 25, 2012
PubMed
Summary

This study optimized planning target volumes (PTV) for cervical cancer radiotherapy, reducing PTV size while ensuring clinical target volume (CTV) coverage. This approach improves treatment precision and minimizes normal tissue exposure.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Accurate delineation of the clinical target volume (CTV) is crucial in radiotherapy for intact cervical cancer.
  • Interfraction variations in CTV position can impact treatment efficacy and normal tissue toxicity.
  • Current planning target volume (PTV) margins may lead to excessive irradiation of healthy tissues.

Purpose of the Study:

  • To model interfraction CTV variations in patients with intact cervical cancer.
  • To design an optimized PTV that maximizes CTV coverage while minimizing dose to surrounding normal tissues.
  • To provide data for refining planning margins in clinical practice and trials.

Main Methods:

  • Analysis of 50 patients with intact cervical cancer undergoing external-beam radiotherapy.
  • Daily online cone-beam computed tomography (CBCT) used to assess interfraction variations (n=972 CBCTs).
  • Surface landmarking on planning CT and CBCTs to compute anisotropic margins for optimized PTV generation.

Main Results:

  • A mean normal vector length of 4.3 mm ensured 95% CTV coverage.
  • The optimized PTV volume (1470 cm³) was significantly smaller than uniform (2110 cm³) or anisotropic (2220 cm³) PTVs (p < 0.001).
  • Specific margin requirements varied by CTV surface region, with higher margins needed anteriorly (10-14 mm) and near bladder/rectum interfaces (5-10 mm).

Conclusions:

  • Optimized PTV definition using surface landmarking achieves high CTV coverage with reduced PTV volumes.
  • This method offers a more precise approach to PTV margin determination in cervical cancer radiotherapy.
  • The findings support the use of these optimized margins in clinical practice and future research.