Gynae BT 2017

• Based on broader treatment planning experience DVH constraints could be adapted for patients with and without nodes

• Current table is provided based on data from 52 patients and 3 centers

• Aim is that values for soft constraints should be reached in 70-80%, allowing for outliers in case of exceptional anatomy or other planning problems

• DVH parameters are tight but feasible for different treatment planning systems

70-80 th percentile

Percentage of patients complying to original

Updated planning guidelines

EMBRACEII protocol planning guidelines

OAR

Soft constraint

Results

V40Gy (cm 3 ) V30Gy (cm 3 ) V40Gy (cm 3 ) V30Gy (cm 3 )

Bowel No para-aortic irradiation Bowel Para-aortic irradiation

< 100 < 275 < 220 < 450

20% 28% 36% 29% 60% 60% 69% 54% 88%

221 - 276 491 - 500 319 - 355 678

< 250 < 500 < 300 < 650

V40Gy (%) V30Gy (%) V40Gy (%) V30Gy (%)

< 55 < 80 < 75 < 90 1.15

60 - 69 85 - 92 77 - 82 94 - 97

< 60 < 80 < 75 < 95 1.10

Bladder

Rectum

Body Conformality

(V43/Volume of PTV)

1.10 - 1.11

Data September 2017

• Try to find the best balance between tumor and OAR dose!