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Pelvic OARs constraints: sparing the bowel
- Practical planning approach with
IMRT: «as low as possible»,
avoidance of peritoneal space
outside PTV starting to spare from
«high» doses (V40-V50) and
continuing to intermediate dose
(V15-V20)
- Avoiding hot spots in the bowel
loops overlapped with PTV
- Residual GI toxicity likely to be
due mainly to the irradiation of
rectum and bowel within PTV,
CHT (surgery…..)
- Lack of dose-volume effect studies
with prospective, patient-reported
scoring of toxicity