Changes in the BV have an influence on the RT of cervical cancer. A consistent and reproducible BV is acquired by using a portable BS, whereby the target displacement and CTV-to-PTV margin can be both reduced in the SI direction.

Background: The aim of this study was to compare the dosimetric parameters, clinical complications, and efficacy of volumetric modulated arc therapy (VMAT) and fixed-field intensity-modulated radiotherapy (f-IMRT) in radical radiotherapy for cervical cancer without lymphadenectasis. Methods: 84 cervical cancer patients undergoing treatment with VMAT and f-IMRT were selected. Dose-volume histograms were used to evaluate the dose distribution in the planning target volume (PTV) and organs at risk. The clinical complications and efficacy were observed. Results: The homogeneity index (HI) and the conformity index (CI) of VMAT plans were both superior to the HI and CI of f-IMRT plans (p = 0.043, 0.025). VMAT plans resulted in a reduction in the V₃₀ of the rectum and V₄₀ of the bladder (p = 0.002). Furthermore, the monitor units (MUs) for VMAT were less than a quarter of those for f-IMRT. The treatment time for VMAT was less than a half of that for f-IMRT. Both clinical complications and efficacy showed no significant differences. Conclusion: VMAT plans showed superior dose coverage of the PTV, better protection of the rectum and bladder in dosimetry, and significantly reduced MUs and treatment time compared with f-IMRT. Clinical results were similar for both plans.

Purpose To evaluate the effectiveness and safety of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) in preventing neutropenia during chemoradiotherapy in patients with cervical cancer. Methods From August 2018 to April 2020, 60 patients who were pathologically confirmed as cervical cancer were randomly divided into two groups at a ratio of 2:1: PEG-modified-rhG-CSF experimental group and control group. The primary endpoints were the incidence of grade 3–4 neutropenia. Secondary endpoints included the duration of grade 3–4 neutropenia, the incidence of grade 4 neutropenia, the incidence of febrile neutropenia (FN), delay rate of chemotherapy, prolonged time of chemotherapy, time to complete radiotherapy and safety. Results The incidence of grade 3–4 neutropenia in the experimental group was significantly lower than the control group (10% vs. 77.78%, P < 0.001). However, there was no statistical significance between the two groups in the duration of grade 3–4 neutropenia (3.75 days vs. 5.07 days, P = 0.871). The experimental group was better than the control group in the incidence of grade 4 neutropenia, the incidence of FN and delay rate of chemotherapy, and the difference was statistically significant (P < 0.05). Besides, the prolonged time of chemotherapy and the time to complete radiotherapy in the experimental group were less than those in the control group, but the difference was not statistically significant (P > 0.05). The incidence of adverse events in the experimental group and control group were 55.00 and 94.44%, respectively, and the difference was statistically significant (P = 0.003). Conclusion PEG-rhG-CSF preventive treatment used in the course of chemoradiotherapy for patients with cervical cancer can reduce the incidence of neutropenia and improve the incidence of delayed chemotherapy cycles. Trial registration ClinicalTrials.gov, NCT04542356. Registered 9 September 2020 - Retrospectively registered.

The study aimed to investigate clinical impact of the flattening filter free (FFF) irradiation in fixed-field intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for patients with stage I-II nasal natural killer/T-cell lymphoma (NNKTCL). Four different plans, fixed-field IMRT, and VMAT plans with and without flattening filter (FF) (IMRT FF, IMRT FFF, VMAT FF, and VMAT FFF) were created for each of selected patients. Target quality, organs at risk (OARs) sparing, and tumor control probability (TCP) were compared between IMRT and VMAT with and without FF. The values of D 98% , V 95% , and conformal index were 0.03 Gy (P = 0.028), 0.03% (P = 0.048), and 0.002 (P = 0.002) lower with IMRT FFF than with IMRT FF, and the values of D 2% , D mean , and homogeneity index were 0.14 Gy (P = 0.018), 0.1 Gy (P = 0.007), and 0.002 (P = 0.008) higher with VMAT FFF than with VMAT FF. The TCP was higher with FFF beam than flattened beam in IMRT and VMAT. The results show that FFF irradiation achieved slightly worse target quality than FF irradiation in IMRT and VMAT for stage I-II NNKTCL. FFF beam was advantageous to increase the TCP in IMRT and VMAT.

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Background and Objective: Cervical cancer (CC), the most common gynecological malignancy, is divided into two categories: human papillomavirus-related [HPV positive (HPV+)] and non-HPV-related [HPV negative (HPV−)]. Compared with HPV− CC, HPV+ CC has better radiosensitivity and prognosis. We conducted a literature search and summarized relevant studies to explore the detailed mechanisms by which HPV+ improves the prognosis of CC compared to HPV−. Methods: PubMed was used to search the literature on human papillomavirus, cervical cancer, and radiotherapy up to June 2022.

Background Cervical cancer is still present a major public health problem, especially in developing countries. In International Federation of Gynaecology and Obstetrics 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopical positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. However, there are no prospective study reporting that resecting macroscopic nodes before concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer and no guidelines for surgical resection of bulky lymph nodes. The CQGOG0103 study is a prospective, multicenter and randomized controlled trial (RCT) evaluating lymph node dissection on stage IIICr of cervical cancer. Methods Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by computed tomography [CT]/magnetic resonance imaging/positron emission tomography/CT) and the short diameter of image-positive lymph node ≥15 mm. 452 patients will be equally randomized to receive either CCRT (pelvic external-beam radiotherapy [EBRT]/extended-field EBRT + cisplatin [40 mg/m 2 ] or carboplatin [the area under curve=2] every week for 5 cycles + brachytherapy) or open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. A total of 452 patients will be enrolled from multiple hospitals in China within 4 years and followed up for 5 years. Trial Registration ClinicalTrials.gov Identifier: NCT04555226

Purpose/Objective(s): Moderately hypo-fractionated radiation therapy has recently been shown to be a non-inferior treatment for select men with localized prostate cancer. However, the optimal incorporation of such regimens for men at higher risk of lymph-node involvement, such that elective targeting of the regional lymph nodes may be warranted, has not been defined. The purpose of this study is to evaluate the oncologic outcomes associated with moderately hypo-fractionated intensity-modulated radiation therapy using a synchronous integrated boost (IMRT-SIB) for elective pelvic lymph node targeting. Materials/Methods: A retrospective chart review at a single institution was conducted to identify men with localized (N0; M0), prostate cancer classified as National Comprehensive Cancer Center Network (NCCN) intermediate or high risk, treated with IMRT-SIB, and with a minimum of 2-years follow-up. Radiation treatment plans delivered 70 Gy to the prostate +/-seminal vesicle in 28 fractions (2.5 Gy/fraction) while simultaneously delivering 50.4 Gy (1.8 Gy/fraction) to the pelvic lymph nodes. The Phoenix definition (PSA nadir + 2 ng/ml) defined biochemical failure. The Kaplan-Meier method was used to estimate freedom from biochemical failure, distant metastases, and survival. Results: Forty-eight men were identified with treatment delivered between 5/2004 and 11/2013. The median follow-up from IMRT-SIB completion was 62.2 months (range 27.7-137). Eighty-eight percent also received androgen deprivation therapy. Clinical characteristics were as follows: NCCN risk stratified high-riskZ69%, intermediate-riskZ31%; T1Z73%; T2Z23%, T3Z4%; Gleason score 6Z2%, 7Z 40%, 8Z25%, 9Z33%; Mean PSA Z 29.08 ng/ml (range 1.79-279); percent biopsy cores involved !50%Z56%; <50%Z42%; unknownZ2%. Nine men developed biochemical failure; seven metastases, and three men died. Two observed deaths were attributable to prostate cancer. Estimates of 5 and 10-year freedom from biochemical recurrence are 83.6% (95%CI 68.4-91.9%) and 60.1% (95%CI 35.7-77.7%). Estimates of 5 and 10-year freedom from distant metastases are 84.5% (95% CI 68.5-92.8%) and 77.4% (95%CI 54.8-89.7%). Ten-year estimates for freedom from prostate cancer specific death and overall survival are 95.3% (95%CI 82.3-98.8%) and 93.1% (95%CI 80.1-97.7%). Conclusion: IMRT-SIB appears to be an efficacious method of delivering definitive radiation therapy for men at relatively high risk of therapeutic failure. This technique may be a consideration when delivering moderately hypo-fractionated radiation therapy where elective lymph node targeting is desirable.