Yadav Jagrati, Gupta Seema, Venugopal Ajay K, Ghosh Arunima, Gupta Indra J
Department of Medical Oncology, Jawaharlal Nehru Medical College, Wardha, IND.
Department of Radiation Oncology, King George's Medical University, Lucknow, IND.
Cureus. 2025 Aug 11;17(8):e89799. doi: 10.7759/cureus.89799. eCollection 2025 Aug.
Intensity-modulated radiotherapy (IMRT) and 3D-conformal radiotherapy (3D-CRT) have transformed radiation therapy in gynecologic cancers. However, access to advanced techniques in resource-limited settings is constrained. This study proposes a comparative dosimetric analysis using the cervical dosimetry mapping and planning (CERV-DOSIMAP) framework to evaluate the efficacy of 3D-CRT versus the conventional four-field box technique in locally advanced cervical cancer.
Radiotherapy planning was performed on 30 individuals with biopsy-confirmed International Federation of Gynaecology and Obstetrics (FIGO) stage IIB-IIIB cervical carcinoma using both conventional and 3D-CRT methods. Using CT-based organizing, volume goals (gross tumor volume (GTV), clinical target volume (CTV), and planning target volume (PTV)) and the organs at risk (OAR) were defined. Dose-volume histogram (DVH) data were analyzed. Key indices such as conformity index (CI), homogeneity index (HI), and dose coverage to PTV and OAR were statistically compared using paired t-tests.
The 3D-CRT demonstrated significantly higher conformity (CI: 0.92 ± 0.03; p=0.001) and better homogeneity (HI: 0.08 ± 0.01; p=0.002) compared to conventional plans (CI: 0.85 ± 0.04; HI: 0.13 ± 0.02; p=0.003). There was a meaningful reduction in bladder, rectum, and femoral head doses with 3D-CRT.
The CERV-DOSIMAP framework validates 3D-CRT as a superior alternative to conventional techniques in improving target dose conformity while minimizing exposure to critical pelvic structures.
调强放射治疗（IMRT）和三维适形放射治疗（3D-CRT）已经改变了妇科癌症的放射治疗方式。然而，在资源有限的环境中，获得先进技术受到限制。本研究提出使用宫颈剂量测定映射和规划（CERV-DOSIMAP）框架进行比较剂量分析，以评估3D-CRT与传统四野盒式技术在局部晚期宫颈癌中的疗效。
对30例经活检确诊为国际妇产科联盟（FIGO）IIB-IIIB期宫颈癌的患者，分别采用传统方法和3D-CRT方法进行放射治疗计划。通过基于CT的组织分析，定义了体积目标（大体肿瘤体积（GTV）、临床靶体积（CTV）和计划靶体积（PTV））以及危及器官（OAR）。分析剂量体积直方图（DVH）数据。使用配对t检验对适形指数（CI）、均匀性指数（HI）以及PTV和OAR的剂量覆盖等关键指标进行统计学比较。
与传统计划（CI：0.85±0.04；HI：0.13±0.02；p=0.003）相比，3D-CRT显示出显著更高的适形性（CI：0.92±0.03；p=0.001）和更好的均匀性（HI：0.08±0.01；p=0.002）。3D-CRT使膀胱、直肠和股骨头的剂量有了显著降低。
CERV-DOSIMAP框架验证了3D-CRT是传统技术的一种更好替代方案，可提高靶区剂量适形性，同时将关键盆腔结构的受照剂量降至最低。
