Radiation Oncology/IMRT/Pelvis

This page is for IMRT topics that apply to any pelvic malignancy. Dosimetry U. Chicago, 2000 - 11121668 — "Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies." Roeske JC et al. Int J Radiat Oncol Biol Phys. 2000 Dec 1;48(5):1613-21. 10 pts (5 cervix, 5 endometrium). LN CTV based on expanding vessel contours by 2 cm. Compared 3D-CRT "4-field box" (based on PTV) vs IMRT. Volume of small bowel > 30 Gy, 17.4% (IMRT) vs 33.8% (3D). Reduced volume of rectum and bladder receiving prescription dose by 23% Conclusion: IMRT reduces volume of small bowel irradiated. Pelvis + para-aortic U. Chicago, 2006 (2002-2005) - 16730136 — "Preliminary outcome and toxicity report of extended-field, intensity-modulated radiation therapy for gynecologic malignancies." Salama JK et al. Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1170-6. 13 pts with gynecologic malignancies. CTV included pelvic and presacral LN + para-aortic LN. Low incidence of acute toxicity. UAB, 2005 - 15380585 — "IMRT dose escalation for positive para-aortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk." Ahmad RS et al. Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):505-12. 5 cervical ca pts with positive PA LN. Treatment included pelvis + para-aortics. Compare 3 techniques: 1) AP-PA (both regions), 2) 4-field box (both regions), 3) IMRT to PA matched to 4-field box to pelvis. Bone marrow sparing See also: Radiation Oncology/Toxicity/Bone marrow U. Chicago 2003 12957265 — "Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy." Lujan AE et al. Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):516-21. 10 pts with gynecologic cancer. Compared 3 plans: 1) standard 4-field, 2) IMRT (sparing normal tissues but not bone marrow), and 3) bone-marrow sparing IMRT. Bone marrow sparing IMRT reduced amount of BM treated to >50% of prescription dose from 87.4% (std) and 75.7% (IMRT) to 60%. 2002 12459361 — "Impact of intensity-modulated radiotherapy on acute hematologic toxicity in women with gynecologic malignancies." Brixey CJ et al. Int J Radiat Oncol Biol Phys. 2002 Dec 1;54(5):1388-96. 36 pts with gynecologic cancer, treating the pelvis using IMRT (that did not include bone marrow sparing in the cost function). Compared hematologic toxicity to 88 pts treated with standard fields. No S.S. seen in grade 2 or higher WBC, ANC, and Hgb toxicity (19.4%, 9.1%, and 8.6% IMRT; 21.6%, 8.3%, 9.2% std). No grade 2 platelet toxicity. Significant difference in WBC toxicity for pts treated with chemo: 31.2% vs 60% (IMRT vs std). Standard IMRT planning resulted in less bone marrow being irradiated, particularly in the iliac crests.