16 Cervix Carcinoma

310 Cervix Cancer

A

B

C

Fig 14.5: GTV at diagnosis (A,B) and after 45 Gy EBT at the time of brachytherapy (C) in extended disease (stage IIBd with distal parametrial extension): Drawing (A) based on clinical examination; MRI study (B,C) (T2-weighted). The tumour (white arrows) expands the uterine cervix, infiltrates the left parametrium (open white arrows) and the uterine body (white arrows). Dimensions of the GTV at diagnosis and after EBT are 5/4 cm width, 4/3 cm thickness, and 5.5/5 cm height, respectively. The corresponding volume was 57 cm 3 at diagnosis and 31 cm 3 at the time of brachytherapy. With regard to the intrauterine canal, the extension is 3 cm into the left lateral parametrium and 2 cm into the left posterior direction (compare Fig 14.14B) possible of the GTV at diagnosis should be included into the treated volume considering the tolerance of normal tissue. With distal parametrial tumour extension which cannot be included in the treated volume, endocavitary brachytherapy must be combined with a boost given by external beam therapy and/or interstitial brachytherapy.