Image-Guided Radiotherapy and Chemotherapy in Gynaecological Cancer

To consider beyond dose constraints and DVH parameters

• Cooperation of radiation oncologist, clinical physicist and RTT essential

• Understand why an individual plan is not further improving

• Important to realize that treatment planning reflects anatomical situation at one moment in time

• Current CTV-ITV-PTV margins take into account anatomical changes of targets but not OAR

• Adaptive IGRT (e.g. library plans) accounts for these changes in a structured way and may further help to improve balance between tumor and OAR dose

• Our knowledge on dose constraints and DVH parameters is constantly improving