16 Cervix Carcinoma

Cervix Cancer 337

beginning of sectional image based treatment planning about one third of treatment plans were individually adjusted, nowadays based on MRI this is about 80 - 90%. Fig 14.14: Typical MRI based treatment planning based on ring applicator and stepping source technology (Vienna method) (continued 1)

Fig 14.14.B: MRI study with the applicator in place for a patient with stage IIB disease with distal parametrial extension treated in 3/99 (patient from Fig 14.5) and favourable anatomy. According to individual tumour topography, the dwell times and positions were adapted in the left lateral and posterior part of the ring. At the same time the dwell times and positions on the right side of the ring could be reduced to spare the rectum (rectal probe inside). No adjustment was made for bladder sparing. The PTV of brachytherapy including cervix and adjacent proximal part of the uterine body