16 Cervix Carcinoma

Cervix Cancer 341

Fig 14.15: ICRU 38 Recommendations (Continued 1) B: Rectum and Bladder ICRU reference points, lateral view.

Related to bony structures and lymph node topography two sets of reference points relatively far from the sources are defined: the pelvic wall reference points (Fig 14.15C) and the points in the lymphatic trapezoid (Fig 14.15D). They indicate the dose to the lateral margins of the small pelvis and to the different lymph node regions: external iliac, common iliac, low paraaortic.

Fig 14.15: ICRU 38 Recommendations (continued 2 (compare for details also Fig 6.25 and 6.26)): C: Pelvic wall point; D: Lymphatic Trapezoid, AP and lateral Time dose pattern The total duration of the brachytherapy application and the dose rate are to be reported. If several sessions are performed, the duration of each session and the interval(s) have also to be indicated. When brachytherapy is combined with external beam irradiation all the data concerning time dose pattern are also reported: dose per fraction, total dose, treatment time of external beam irradiation and overall treatment time. 8.6.2 Recent and future developments for recommendations for a common language in endocavitary brachytherapy The recommendations given in the ICRU report 38 (63) were developed 15 - 20 years ago. More recently, important changes have taken place in the field of brachytherapy: dramatic progress in imaging, more powerful and accurate 3D treatment planning, and the development of high dose rate (HDR) and pulsed dose rate (PDR) stepping source brachytherapy.