Settle-Back And Rest While You Are Figuring Out The Secrets To PDK4
  • Computed tomography images were then acquired using a Siemens Somatom Emotion CT-scanner (Siemens Medical Systems, Erlangen, Germany), with 2 mm slice intervals from the iliac crest to the distal end of RGFP966 manufacturer the applicator. The clinical-target-volume (CTV) and OARs volumes were defined on axial CT images for each brachytherapy fraction at the time of treatment planning, and retrospectively reviewed by one radiation oncologist, for the purpose of this study. The gross-target-volume (GTV) was delineated based on the CT information at the time of the brachytherapy and clinical findings. Isotropic margin (usually 1 cm) was added to generate the CTV. Primarily, the cervix and the lower uterine segment were included. If there was an involvement of the fornices or proximal vagina, these were also encompassed. Organ-at-risk volumes were the rectum and bladder. The outer rectal wall was contoured from the recto-sigmoid junction till 1 cm above the anal verge, and the outer bladder wall was contoured till the urethra. Demographic and clinical data such as: patients�� age, International Federation of Gynecology and Obstetrics (FIGO) stage, initial tumor volume and residual tumor volume after EBRT were collected. Computed tomography-based treatment plans were reviewed for uterine perforation or near-perforation (sub-serosal insertion of tandem, i.e. within 5 mm from the uterine serosa), as presented in Figure Pifithrin-�� ic50 1. For each patient, the plans showing sub-optimal insertion of intra-uterine tandem were analyzed and compared to plans with optimal insertion for the same patient. The difference in dose coverage of CTV was evaluated by the doses delivered to 90% (D90) and 100% (D100) of CTV. The variation of the dose received by 1 cc (D1cc) and 2 cc (D2cc) of OARs was also determined and analyzed to assess any possible correlation with the position of the uterine tandem relative to the uterus. All CT-based brachytherapy plans were generated using PDK4 Varian Brachyvision planning system, versions 8.0 and 10.0, for Varian HDR VariSource 200 and iX (Varian Medical Systems Inc., Palo Alto, CA, USA). Fig. 1 Examples of uterine perforation (A) and sub-serosal insertion of intra-uterine tandem (B), in sagittal and coronal views The correlation between incidence of uterine perforation and patients�� variables was assessed using logistic regression analysis. The statistical analysis of dosimetry data was performed using the Student's t-test and a p value of < 0.05 was considered significant. Results A total of 231 brachytherapy plans for 82 patients were reviewed. We identified 34 (14.7%) treatment plans with sub-optimal insertion of intra-uterine tandem in 20 (24.4%) patients: 14 (6%) applications with uterine perforation and 20 (8.6%) applications with sub-serosal insertion of tandem. Four patients (4.8%) presented both uterine perforation and sub-serosal insertion. Patient clinical characteristics are summarized in Table 1.

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