Concurrent chemoradiation is the definitive treatment for advanced cervical cancer. Pelvic radiation is known to damage the adjacent normal tissues thereby causing acute toxicities. The modern conformal radiation techniques like three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy are known to reduce the toxicities and improve clinical outcomes.

To retrospectively evaluate the frequency and severity of acute toxicities encountered during concurrent chemoradiation of locally advanced cancer cervix treated with 3D-CRT.

The medical case records of 174 cervical cancer patients treated between November 2015 and November 2018 were studied. One hundred and thirteen histologically proven locally advanced cancer cervix patients (Stage IIB–IIIB) treated with concurrent 3D conformal chemoradiation between were included in the study. Patients received 46 Gy in 23 fractions with concurrent weekly cisplatin (40 mg/m2) on days 1, 8, 15 and 22 of radiation. The study endpoints were treatment-related toxicities which were graded according to CTCAE version 5.0.

One hundred and thirteen patients were analysed for the study. Gastrointestinal toxicity was the predominant toxicity observed followed by haematological toxicity. 31·7% patients reported grade 1–2 diarrhoea and 39·7% reported grade 1–2 leucopenia. None of the patients reported grade 3 or higher toxicities. Treatment interruptions were noted due to these toxicities.

Concurrent chemoradiation is the definitive treatment for locally advanced carcinoma cervix with acceptable toxicities. Proper management measures should be undertaken for these toxicities to avoid treatment interruptions and ensure better treatment compliance.

Whole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.

Aim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).

Whole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.

In total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.

HI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

For chest wall irradiation in breast cancer patients, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) have made tremendous changes in treatment delivery.

The purpose of this study is to compare the dosimetric parameters in IMRT and 3DCRT plans.

IMRT and 3DCRT plans were generated for 25 randomly selected postmastectomy breast cancer patients. The prescribed dose (PD) was 50 Gray (Gy) in 25 fractions (#) at the rate of 2 Gy/# with 5#/week. Dose volume histogram was evaluated for planning target volume (PTV) coverage and dose to organs at risk (OARs). All the dosimetric parameters were compared using unpaired student’s t-test.

PTV coverage was significantly better in IMRT, although the 90% of PTV was well covered by 90% of PD in all plans by both the techniques. Homogeneity index and conformity index were better in IMRT. V5 Gy and Dmean of contralateral lung, contralateral breast and heart (right side chest wall cases) were found to be lesser in 3DCRT compared with that in IMRT. However, there was no significant difference in V20 Gy of ipsilateral lung and V25 Gy of heart (left side chest wall cases) in all the plans by both the techniques.

Adequate target coverage was achieved by both the techniques, however, dose to OARs were lesser in 3DCRT plans as compared with that in IMRT plans. Thus, it can be concluded that 3DCRT is as efficient as IMRT for the chest wall irradiation.

Geometric uncertainties limit the accuracy of three-dimensional conformal radiotherapy treatments. This study aims to evaluate typical random and systematic set-up errors and analyse the impact of no action level (NAL) correction protocol on systematic set-up errors and clinical target volume (CTV)–planning target volume (PTV) margins.

A total 668 pairs of orthogonal electronic portal images were compared with digitally reconstructed radiographs from computed tomography planning scans for 100 patients consecutively treated during 2011. Patients were divided into groups depending on the treated anatomical region. Patient-specific and population random and systematic set-up errors were calculated. Impact of application of NAL correction protocol on systematic set-up errors and CTV–PTV expansions were evaluated.

Population set-up errors resulted from about 1 mm in head and neck to 2–3 mm in prostate, rectum, lung, breast and gynaecological districts. Patient-specific systematic set-up errors were higher for breast and gynaecological districts and application of NAL correction protocol gave significant reductions, even higher than 30%. Calculated CTV–PTV margins ranged from 10 mm on left–right direction for prostate to 20 mm on superior–inferior direction for lung.

Set-up errors resulted reasonably controlled and application of NAL correction protocol could further improve the level of accuracy. However, the NAL application alone did not seem to add any substantial benefit on CTV–PTV total margins without the adoption of corrective strategies to reduce other important uncertainties limiting accuracy of three-dimensional conformal radiotherapy.