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Dosimetric Outcome of Half Beam Block and Junction Translation (Feathering) Technique in Hot Spot Management of PALNs Involved Patient of Ca Cervix using 3DCRT and Hybrid IMRT Technique: A Case Study

*Muhammad Bilal Durrani  -  Working as Medical Physicst at INOR cancer Hospital Abbottabad, Pakistan
Received: 19 Aug 2025; Revised: 14 Mar 2026; Accepted: 18 Mar 2026; Available online: 30 May 2026; Published: 30 May 2026.

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Abstract

Positive Para Aortic Lymph Nodes (PALNs) involved patient of Ca-cervix/Endometrium requires large treatment fields to cover entire planning target volume (PTV) for radiation therapy (RT). RT treatment plan were generated to the contoured PTVusing 3DCRT-3DCRT and IMRT-3DCRT (Hybrid IMRT) for single iso-centric and dual iso-centric technique. Single iso-centric technique was used for   PTV pelvis and PTV aorta for field size (F.S) max < PTV and dual iso-centric was used when (F.S) max > PTV.For single isocentric setup the hot spot at the junction of 3DCRTpelvis -3DCRTaorta was managed by half beam block and optimized using field in field technique (FIF) while in case of 3DCRTaorta-IMRTpelvis the hotspot was managed by changing the position of independent Y-Jaw in IMRTpelvis treatment planonly. For condition of (F.S) max< PTV with dual isocentric set up the hot spot at the junction of PTVPelvis andPTVaorta was reduced to acceptable limits by translating the Y-jaw position in IMRT pelvisonly, whereas due to smaller junction gap of 1.5 cm between 3DCRTpelvis-3DCRTaorta treatment plan the hot spot was managed by only applying FnF technique in 3DCRTpelvis treatment plan.

Keywords: Medical Physics ,Treatment Technique 3DCRT,IMRT
Funding: nil

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Section: Articles
Language : EN
  1. References
  2. Mahdi H, Jernigan A, Nutter B, Michener C, Rose PG. Lymph node metastasis and pattern of recurrence in clinically early stage endometrial cancer with positive lymphovascular space invasion. J Gynecol Oncol. 2015;26(3):208-213. doi: 10.3802/jgo.2015.26.3.208
  3. 2. Lian J, Mackenzie M, Joseph K, et al. Assessment of extended-field radiotherapy for stage IIIC endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Int J Radiat Oncol Biol Phys. 2008;70(3):935-943. doi: 10.1016/j.ijrobp.2007.10.021
  4. 3. 2016 Khan’s Treatment Planning in Radiotherapy 4ed | PDF | Positron Emission Tomography | Ct Scan. Accessed June 21, 2025. https://www.scribd.com/document/387933986/2016-Khan-s-Treatment-Planning-in-Radiotherapy-4ed-1
  5. 4. Dogan N, Leybovich LB, Sethi A, Emami B. Automatic feathering of split fields for step-and-shoot intensity modulated radiation therapy. Phys Med Biol. 2003;48(9):1133-1140. doi: 10.1088/0031-9155/48/9/304
  6. 5. Athiyaman H, Mayilvaganan A, Singh D. A simple planning technique of craniospinal irradiation in the eclipse treatment planning system. J Med Phys Assoc Med Phys India. 2014;39(4):251-258. doi: 10.4103/0971-6203.144495
  7. 6. Perez & Brady’s Principles and Practice of Radiation Oncology (Perez and Bradys Principles and Practice of Radiation Oncology): 9781496386793: Medicine & Health Science Books @ Amazon.com. Accessed June 21, 2025. https://www.amazon.com/Bradys-Principles-Practice-Radiation-Oncology/dp/1496386795
  8. 7. IMRT dose escalation for positive para-aortic lymph nodes in patients with locally advanced cervical cancer while reducing dose to bone marrow and other organs at risk - PubMed. Accessed June 21, 2025. https://pubmed.ncbi.nlm.nih.gov/15380585/
  9. 8. The Physics of Radiation Therapy: 9780781788564: Medicine & Health Science Books @ Amazon.com. Accessed June 24, 2025. https://www.amazon.com/Physics-Radiation-Therapy-Faiz-Khan/dp/0781788560
  10. 9. Rabinovich A, Bernard L, Ramanakumar AV, et al. Para-aortic and pelvic extended-field radiotherapy for advanced-stage uterine cancer: dosimetric and toxicity comparison between the four-field box and intensity-modulated techniques. Curr Oncol Tor Ont. 2015;22(6):405-411. doi: 10.3747/co.22.2727
  11. 10. Intensity-Modulated Radiation Therapy for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy – an Option or a Must?: A Narrative Review - PMC. Accessed July 3, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC10789959/
  12. 11. Practical Radiotherapy Planning | Ann Barrett, Stephen Morris, Jane Do. Accessed July 23, 2025. https://www.taylorfrancis.com/books/mono/10.1201/b13373/practical-radiotherapy-planning-stephen-morris-jane-dobbs-tom-roques-ann-barrett
  13. 12. Practical Radiotherapy Planning | Ann Barrett, Stephen Morris, Jane Do. Accessed July 3, 2025. https://www.taylorfrancis.com/books/mono/10.1201/b13373/practical-radiotherapy-planning-stephen-morris-jane-dobbs-tom-roques-ann-barrett
  14. 13. Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer - ScienceDirect. Accessed July 3, 2025. https://www.sciencedirect.com/science/article/abs/pii/S03
  15. 14. Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis - PMC. Accessed July 3, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC6137729/
  16. 15. Kataria T, Sharma K, Subramani V, Karrthick KP, Bisht SS. Homogeneity Index: An objective tool for assessment of... : Journal of Medical Physics. Accessed July 3, 2025. https://journals.lww.com/jomp/fulltext/2012/37040/homogeneity_index__an_objective_tool_for.6.aspx
  17. 16. Department of Radiotherapy, Harshamithra Oncology Pvt Ltd, Tiruchirappalli-620012, Tamil Nadu, India, Marimuthu PK, Ponniah S, et al. A Case Series of Dosimetric Comparison-VMAT (RapidArc), IMRT, 3DCRT for Extended Field Radiotherapy in Cervical Cancer. Austin J Nucl Med Radiother. 2021;6(1). doi: 10.26420/austinjnuclmedradiother.2021.1028
  18. 17. Jadon R, Higgins E, Hanna L, Evans M, Coles B, Staffurth J. A systematic review of dose-volume predictors and constraints for late bowel toxicity following pelvic radiotherapy. Radiat Oncol. 2019;14(1):57. doi: 10.1186/s13014-019-1262-8
  19. 18. Stanic S, Mayadev JS. Tolerance of the Small Bowel to Therapeutic Irradiation: A Focus on Late Toxicity in Patients Receiving Para-Aortic Nodal Irradiation for Gynecologic Malignancies. Int J Gynecol Cancer. 2013;23(4):592-597. doi: 10.1097/IGC.0b013e318286aa68

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