Cervix Worksheet

Site: Cervix
Student Name: Ray Date:

Patient Info:
Age: 41 Gender:F Diagnosis: FIGO stage 2B
(left) grade 2 squamous cell carcinoma cervix

Symptoms: heavy PV bleeding and an HB of 84 to Wellington Hospital.

Medical history/comorbidities: Previous heavy smoker 1 pack/day – recently quit, still using
nicotine patches Moderate alcohol consumption

Prescription: EBRT = 45Gy in 25# daily, followed by a brachytherapy boost of 28Gy in 4#, delivered
in 2#/week. Because the PTV is quite large (to take into account affected lymph nodes) it is extending
superiorly into the small bowel – it can cause endpoint reactions to the small bowel

Intent: Curative

Other treatments for this diagnosis (concurrent or adjuvant?): Chemo radiotherapy:

concurrent chemotherapy (Cisplatin IV = radiosensitizer). Followed by a brachytherapy boost

CT:
Positioning/Immobilisation:
How would this pt be set-up in your department?
Standard Pelvis setup: HFS, NRF, LR, HOA+Ring

CT preparation required:
Is there anything this pt needs to do to prepare for CT in your department?
Bladder filling protocol “comfortably full” variations in bladder volume have been shown to influence
mobility and position of the uterus and cervix

Scan Levels:
What anatomy needs to be included in the scan and why?

Do any markers/wires or bolus or packing need to be placed for CT?:

Department of Radiation Therapy, University of Otago Wellington 2019

Planning:
Volumes:
List the volumes present, what is included in each (including margin size) and whether the
margin seems appropriate.
GTV = X
CTV= GTV, cervix, vagina, uterus, (common, external/internal iliac and presacral nodes)
PTV = CTV and its contest (taking into account internal and external movement)

For the PTV note the size, shape and location: Large in relation to bladder/rectum, irregular oval
shaped and centrally located in the pelvis

OAR:
List the OAR present and their tolerance doses (use departmental tolerance doses where
applicable). Indicate which structures will need to be contoured.
Rectum =25-30 Gy (proctitis)
Bladder = 25Gy (cystitis)
Femoral head R/L (V50Gy<5%) osteoradionecrosis

Inhomogeneities:
List inhomogeneities present and their RED’s. Indicate if any density overrides are required.
Air
bone
Contrast - tampon soaked with the contrast was inserted into the vagina to help define the
structure’s borders
 The planning system initially assigned the tampon to be a ~456HU, which is a medium
between air and bone. So, it is important that the HU was change to 0 (RED 1.0) (represent
soft tissue in vagina) to allow for an accurate dose distribution around the vagina.

Proposed Beam Arrangement:

Consider size, shape and location of PTV as well as surrounding OAR - draw a diagram below
4 Field Box (2 POP’s AP/PA and Laterals

Energy:
Considering depth to the PTV and entry and exit dose to OAR, indicate which energies you
think you will use for each beam
High energy Photons

Department of Radiation Therapy, University of Otago Wellington 2019

Weightings:
Considering depth to the PTV and entry and exit dose to OAR, list your beams below in
order of expected weighting, highest to lowest

Wedges:
List the beams which will require wedges, note the orientation and estimate the size (this
may just be “large” or “small”)

Treatment:
Isocentre position:
What information will you need to give treatment so that they can locate the planned
treatment isocentre? Think about the process you have seen in your department on day 1 of
treatment.
“Iso” moves after you’ve line the pt

Imaging:
What kind of imaging would this patient receive whilst on treatment if they were to be
treated in your department? How frequent would this imaging be? What structures would
be matched to?
KV imaging
CBCT

Treatment preparation:
Is there anything this pt needs to do to prepare for treatment in your department?
1. Bladder Prep
2. Pre tmt antiemetics

Department of Radiation Therapy, University of Otago Wellington 2019

Clinical Acceptability:
On completion on your plan state whether or not you think it is a clinically acceptable plan
and why. You will need to consider:
 Dose distribution
o ICRU dose variation (dose coverage and CSM)
o Dose homogeneity
o Dose conformity (including hotspots)
 Dose to OAR
o Acute reactions that will occur
o Endpoint reactions that will occur

Department of Radiation Therapy, University of Otago Wellington 2019