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margin around the fundus in the uterine shift.     REFERENCES

            The incidence of early bladder and rectal toxicities   1.   Mundt  AJ,  Lujan  AE, Rotmensch J,  Waggoner SE,  Yamada
            amongst all our patients were mild with all of them except   SD, Fleming  G, Roeske  JC. Intensity-modulated  whole  pelvic
            two showing Grade 2 cystitis and mild diarrhea. Only one   radiotherapy in women with gynecologic malignancies. Int J Radiat
                                                                  Oncol Biol Phys 2002;52:1330-7.
            patient had Grade 2 diarrhea which was controlled with   2.   Portelance L, Chao KS, Grigsby PW, Bennet H, Low D. Intensity
            conservative measures [Table 4].                      modulated  radiation  therapy  (IMRT)  reduces  small  bowel,  rectum,
                                                                  and bladder doses in patients with cervical cancer receiving pelvic and
            Despite  maintaining  a  strict  bladder  filling  and  rectal   paraaortic irradiation. Int J Radiat Oncol Biol Phys 2001;51:261-6.
            emptying protocol, the interfraction movement in the   3.   Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt
            uterine position during the course of radiotherapy may   AJ. Intensity-modulated whole pelvic radiation therapy in patients
                                                                  with gynecologic  malignancies.  Int J Radiat Oncol Biol Phys
            lead to a miss in target or overtreatment of the rectum,   2000;48:1613-21.
            which  lead  to  toxicity.  We  could  not  find  any  study  in   4.   ICRU Report 83. Prescribing, Recording, and Reporting Photon-Beam
            which uterine shift was observed during the whole course   Intensity-Modulated Radiation  Therapy (IMRT). Bethesda, MD:
            of radiotherapy hence, we were unable to compare the   5.   International Commission on Radiation Units and Measurements; 2010.
                                                                  Gerstner N, Wachter S, Knocke TH, Fellner C, Wambersie A, Pötter
            results with other works.                             R. The benefit of Beam’s eye view based 3D treatment planning for
                                                                  cervical cancer. Radiother Oncol 1999;51:71-8.
            In conclusion, interfraction movement of the target organs   6.   Weiss E, Eberlein  K, Pradier O,  Schmidberger H,  Hess CF. The
            may lead to overdosing or underdosing of the target or   impact of patient positioning on the adequate coverage of the uterus in
            the normal structures during IMRT, hence at least once   the primary irradiation of cervical carcinoma: a prospective analysis
            a week CBCT imaging might be necessary to minimize   7.   using magnetic resonance imaging. Radiother Oncol 2002;63:83-7.
                                                                  Thomas L, Chacon B, Kind M, Lasbareilles  O,  Muyldermans P,
            the geometrical miss of the tumor and deliver the planned   Chemin A, Le Treut A, Pigneux J, Kantor G. Magnetic resonance
            doses to the target and normal structures for the best local   imaging in the treatment planning of radiation therapy in carcinoma
            control with minimum toxicity which is the primary aim of   of the cervix treated with the four-field pelvic technique. Int J Radiat
            IMRT. This would also aid in the selection of appropriate   Oncol Biol Phys 1997;37:827-32.
            and adequate planning target margins and provide an   8.   ICRU Report 62. Prescribing, recording and reporting photon beam
                                                                  therapy (supplement to ICRU report 50). Bethesda, MD: International
            asymmetrical PTV conforming to the daily anatomical   Commission on Radiation Units and Measurements; 1999.
            shift and contour of the patients. We also recommend a   9.   Huh SJ, Park W, Han Y. Interfractional variation in position of the
            tapered CTV to PTV margin especially around the fundus   uterus during radical radiotherapy  for cervical  cancer.  Radiother
            of the uterus as maximum uterine motion is known at the   Oncol 2004;71:73-9.
            fundus however further studies with larger numbers of   10.  Lee JE, Han Y, Huh SJ, Park W, Kang MG, Ahn YC, Lim do H.
                                                                  Interfractional variation of uterine position during radical RT: weekly
            patients and exact point localization of the uterus will be   CT evaluation. Gynecol Oncol 2007;104:145-51.
            required for this purpose.                         11.  Taylor  A, Powell ME.  An assessment of interfractional  uterine
                                                                  and cervical  motion: implications  for radiotherapy target volume
            Financial support and sponsorship                     definition in gynaecological cancer. Radiother Oncol 2008;88:250-7.
            Nil.                                               12.  Buchali A, Koswig S, Dinges S, Rosenthal  P, Salk  J, Lackner  G,
                                                                  Böhmer D, Schlenger L, Budach V. Impact of the filling status of
            Conflicts of interest                                  the bladder and rectum on their integral  dose distribution and the
                                                                  movement of the uterus in the treatment planning of gynaecological
            There are no conflicts of interest.                   cancer. Radiother Oncol 1999;52:29-34.




























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