Physician assessed and patient reported lower limb edema after definitive radio(chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: A report from the EMBRACE study

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer

“…Two patients had limited under-dosage after re-planning with 37.8 and 39.1 Gy to CTV-T LR, respectively, and marginally insufficient dose to CTV-T HR (42.5 Gy) in one patient. Furthermore it was found, that it [14][15][16][17][18][19][20] was the "large" rectal fillings assessed by the RTTs, that were most often associated with lack of target coverage during treatment (Fig. 3).…”

“…All measurements are visually assessed. [14][15][16][17][18][19][20] be that the macroscopic tumour occupies only a small fraction of the entire target volume irradiated to 45 Gy [30]. Therefore, the organ motion (and in particular systematic relocation of organs) is by far the most challenging aspect in EBRT for LACC.…”

“…Dosimetric calculation based on 3D target contouring taking the non-rigid motion and deformation of target and OARs into account would in principle be preferable. Due to limitations in soft tissue contrast on CBCTs, deformable registration has not proven successful for Physics and Imaging in Radiation Oncology 9 (2019) [14][15][16][17][18][19][20] registration of CBCTs yet. As a minimum, in case of administration of different treatment plans (e.g.…”

“…In LACC patients, mild and intermediate vaginal [11], rectal- [12], urinary- [13] and gastrointestinal [14] morbidity that potentially impacts the patient's quality of life is prevalent. Non-organ-related morbidity such as fatigue, insomnia and hot flashes as well as pelvic insufficiency fractures and limb edema has also been reported [15][16][17]. In previous studies, these morbidities have been found to be associated with treatment-related factors [12,16,18], and future reduction in treatment-related toxicity may be reached through more conformal RT techniques.…”

“…A learning programme with online self-education (2½ h) as well as class teaching and "hands on training" (7 h) was conducted, N.B.K. Jensen et al Physics and Imaging in Radiation Oncology 9 (2019) [14][15][16][17][18][19][20] similar to previous experience with ART education [24]. Two general online modules introduced adaptive RT and CBCT image quality.…”