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Pelvic OARs constraints: genitals
- Dose to genitals (female)
- Under-estimated problem in the past, now
quite «hot»
- Any effort should be activated to efficiently
spare genitals outside PTV: beams
geometry, blocking options in rotational
techniques, ….
- IMRT highly effective in sparing external
genitals to very low dose (even <5-10 Gy)
- Vaginal dryness/dyspareunia very commun
problems importantly affecting QoL; impact
of RT+CHT vs SURG only
(Lange 2009, 2011,
Bruheim 2010, Braendengen 2011, Incrocci 2013,
Marijnen 2014, Ye 2014, Kunnemann 2015, Jensen 2015,
Gilbert 2015)
- relationship with dose-volume parameters of
vagina is lacking; some evidence of a dose-
volume effect in cervix cancer braky
(Park 2015)