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Case I: Cervix sufficient response -residual parametrial involvement- unfavourable topography

Case I: Cervix sufficient response -residual parametrial involvement- unfavourable topography. H.R. 44 years old patient with FIGO Stage IIB, SCC, G2 cervical carcinoma Post laparoscopic lymph node staging(0/19) Involvement of both parametria (right distal, left proximal) and middle vagina

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Case I: Cervix sufficient response -residual parametrial involvement- unfavourable topography

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  1. Case I:Cervix sufficient response-residual parametrial involvement-unfavourable topography • H.R. 44 years old patient with FIGO Stage IIB, SCC, G2 cervical carcinoma • Post laparoscopic lymph node staging(0/19) • Involvement of both parametria (right distal, left proximal) and middle vagina • Ectocervical tumor growth • Treatment strategy: 45 Gy EBT+ 4x7Gy HDR-BT • Response: good

  2. MRI sagittal coronal axial Findings prior therapy: Involvement of both parametria (right=distal, left=proximal) Invasion of anterior upper vagina

  3. At Diagnosis w h t Infiltrative Cervix Vagina Parametria w = _7_ _ cm h = _5__ cm t = _5_ _ cm vaginal involvement = 4cm

  4. Tumour extension: MRI sagittal coronal axial

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  15. Findings at brachytherapy: Proximal residual involvement of both parametria Hardening of the anterior upper vagina

  16. At Brachytherapy w h t Hardening w =3 cm h =3 cm t =3 cm Vaginal involvement =1 cm

  17. MRI sagittal coronal axial Tumour extension: 3.1 cm 2 cm 4.5 cm

  18. Tumour response: Findings prior therapy: Involvement of both parametria (right=distal,left=proximal) Invasion of anterior middle vagina Findings at the time of Brachytherapy: Proximal residual involvement of both parametria Hardening of the anterior fornix

  19. Contouring cervix large insufficient response • GTV: macroscopic tumour extension at time of brachytherapy… High signal intensity mass(es) (FSE, T2) in cervix/corpus, parametria, vagina, bladder and rectum • HR-CTV: includes gtv, whole cervix, and presumed extracervical tumour extension. Pathologic residual tissue(s) as defined by palpable indurations and/or grey zones in parametria, uterine corpus, vagina or rectum and bladder are included in HR-CTV. No safety margin are added. • IR-CTV: encompasses theHR-CTV different safety margins are added according to the treatment strategy, tumour size and tumour regression. In any case a minimal safety margin of 5 to 15 mm have to be added. Extensive disease: Good remission: HR-CTV and the initial tumour extension

  20. IR CTV HR CTV GTV

  21. GTV Tumor at time of diagnosis. GTV IR CTV HR CTV

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