PMC5304382_01
CT sagittal view of the patient's pelvis before EBRT (anteverted position of the uterus)
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F1
The patient underwent a thorax-abdominal-pelvic CT scan that identified an anteverted uterus (Fig. 1), presenting a large tumoral mass, without a well-defined border with the rectum and the urinary bladder.
EBRT target volumes contoured according to ICRU62 recommendations (CTV-red, ITV-green, PTV-violet) and their relationship with the rectum (brown) and urinary bladder (yellow)
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F2
Protocol [] recommendations; therefore, the internal target volumes (ITV) were obtained for both CTV's by adding a 1 cm internal margin (IM) into the urinary bladder. Planning target volumes (PTV), PTV_45 and PTV_54 resulted by adding a 0.5 cm margin around the ITV_45 and ITV_54 respectively (Fig. 2).
EBRT treatment planning by using the 7-field IMRT technique
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F3
Radiotherapy planning was performed by using the inverse planning approach and xiO planning system, resulting in a 7-field treatment (Fig. 3).
MRI sagittal view of the pelvis of the patient at the end of EBRT (retroverted position of the uterus)
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F4
This identified a significant reduction of more than 50% of the tumor mass, but also a change of the local anatomy, the uterus being retroverted (Fig. 4).