clinical practice- cervical Flashcards
Dose for Defintive chemoradiotherapy and POST OP
50.4Gy/28#/1.8Gy
Planning Volumes:
GTV
CTV
PTV
-primary lesion and local spread
- GTV + 0.5-1cm
-CTV and 1-1,5 cm margin OR ITV and 0.7-1cm margin
Planning Volumes:ITV
when to use
what is it
If using IMRT
combined volume of the primary CTV
that is in both the fused empty and full bladder CT scans.
OAR
rectum
bladder
femoral heads
small bowel
dose constraints
rectum
small bowel
bladder
femoral heads
V40 GY < 60%
V40 GY < 30%
V45 GY < 35%
V45 GY < 50%
what technique
- IMRT/VMAT
◦ Recommended due to more conformal dose
distribution
◦ Increase normal tissue sparing compared to 4
field box
why use IMRT
- More Uniform doses
-Reduce early and late toxicities
-Minimal dose to small bowel, rectum and
bladder.
-Less movement in pelvis post
-operatively vaginal vault may still move(5-10mm A/P, bladder and rectum)
VERFICATION PROTOCOL
-Gold standard (IMRT/VMAT)–
Daily online IGRT –
-images should be registered to boney stable pelvic anatomy
- bladder and rectum volume reviewed
-the effect of target volume coverage assessed
- accounts for both systematic and random errors
2D or 3D?
-To assess target volume, OARs - 3D information is required (CBCT)
*-Additional 2D image may be taken to assess paraortic volume.
What needs to be considered?
- Uterus removed-internal motion reduced
-Internal motion from Bladder&Rectal filling
-Conventional Borders= Boney match - IMRT Soft tissue match
acute side effects
-Diarrhea
-erthyma
management for abdomical crampsm
low residue diet with increased fluids (decrease gastrointestinal symptoms)
management for stenosis
Vaginal dilators several times daily to
prevent stenosis ( not to be used during RT)
management for the acute side effects
weekly review - FBC and U+E
Psychosocial Care
Change in body Image (how you think it looks)
-Affect ability to have sex and feel less sexual
Feeling Alone-coping with diagnosis
