Potential Advantages of Intensity-Modulated Radiation Therapy in Gynecologic Malignancies

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Radiation therapy (RT) plays a critical role in the management of gynecologic malignancies. Conventional RT may treat a large amount of normal tissue, which results in increased toxicities and a limitation on total dose. Intensity-modulated radiation therapy (IMRT) helps reduce the dose to normal tissue while delivering a higher dose to the tissues with microscopic or gross disease. This may have a potential benefit in the treatment of gynecologic malignancies especially in difficult cases such as grossly positive nodes, recurrent disease, and vulvar cancer. However, there is very little clinical data and very little experience with the use of IMRT in gynecologic malignancies. Therefore, before complete acceptance of IMRT in the treatment of gynecologic malignancies, large multicenter trials are needed to help develop guidelines and standards.

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Pelvic RT

Pelvic RT is used in the treatment of cervical and endometrial cancers. In the treatment of cervical cancer, pelvic RT is used as part of the definitive treatment of locally advanced cervical cancer. It is also used in the postoperative setting to improve local control and survival in patients with positive pelvic nodes, positive margins, or a positive parametrium and for patients with other high-risk factors, such as a combination of deep stromal invasion, lymph–vascular space invasion, and

Summary Advantages of IMRT for Pelvic Irradiation

In summary, IMRT to the pelvis, especially in the postoperative setting, treats less small bowel than the standard 4-field technique according to both preclinical and clinical data. This probably will translate into lower rates of acute and chronic bowel side effects compared with standard 4-field treatment; however, larger multicenter studies will be needed to verify the few clinical studies that are currently available. IMRT may also treat less bone marrow, which may lead to better tolerance

Summary Advantages of IMRT for Special Situations in Patients With Gynecologic Malignancies

On the basis of limited preclinical data and anecdotal clinical reports, IMRT appears to have some advantages over conventional RT in some difficult situations in patients with gynecologic malignancies. IMRT may be useful in the treatment of grossly positive, unresectable nodes, either definitively or in the boost situation between implants. IMRT can be used to treat recurrent disease above or within the previously treated field. IMRT may be able to replace brachytherapy in patients who are

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    2016, International Journal of Gerontology
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    IMRT alone has been documented with lower treatment related toxicity and better tumor control than conventional radiotherapy alone6,7,11. There are many dosimetric studies that show a reduction of dose delivered to the pelvic organs-at-risk with IMRT compared with conventional RT in the treatment of cervical cancer12–14. However, whole pelvis IMRT is still associated with considerable rectal and cystic toxicity11.

  • Proof of principle: Applicator-guided stereotactic IMRT boost in combination with 3D MRI-based brachytherapy in locally advanced cervical cancer

    2014, Brachytherapy
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    Pelvic pain (frozen pelvis) has been described as a side effect following radiotherapy and may be related to large volumes irradiated to high or intermediate doses. Prompted by EBRT technological developments during the last decades, it has been speculated whether BT of the primary cervix tumor could be replaced by, for example, IMRT, stereotactic boost, or proton boost (28, 29). However, most of the published treatment planning studies have been based on non-optimized BT and have neglected that EBRT boosting volumes must be larger than BT volumes due to the need for application of appropriate PTV margins in EBRT (24, 30).

  • A phase II trial of radiation therapy and weekly cisplatin chemotherapy for the treatment of locally-advanced squamous cell carcinoma of the vulva: A gynecologic oncology group study

    2012, Gynecologic Oncology
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    In order to encompass the target volume, conventional radiation therapy may treat a large amount of normal tissue, with resulting toxicity and limitations on tumor dose. Intensity-modulated radiation therapy (IMRT) may have potential benefits by reducing the dose to normal tissue while delivering a higher dose to the tumor [13]. Preliminary results of IMRT in combination with chemotherapy show promise for the treatment of vulvar carcinoma, apparently with a low incidence of severe toxicity [14,15].

  • PTV margins should not be used to compensate for uncertainties in 3D image guided intracavitary brachytherapy

    2010, Radiotherapy and Oncology
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    Fig. 3 shows dose profiles across the rectum, sigmoid, target and bladder for an intracavitary dose distribution as compared with an EBRT (IMRT) dose distribution which has been constructed to cover the same target volume, but with a PTV margin of 5 mm on top. Prompted by improved EBRT technology it has been speculated to replace the BT boost of the primary cervix tumour with IMRT [32,33]. However, most of the published treatment planning studies have been based on non-optimised standard BT, and it has not been recognised that PTV margins must be applied in IMRT whereas in BT no expansion of the dose distribution is performed in the radial direction.

  • Automated weekly replanning for intensity-modulated radiotherapy of cervix cancer

    2010, International Journal of Radiation Oncology Biology Physics
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