This patient had malignant neoplasm of the cervix uteri, stage IIB with left parametrial involvement and positive vaginal margin. Her radiation regime entailed 45Gy to the pelvis, 3 HDR vaginal cylinders, a cone-down boost with low midline blocking to treat the bilateral pelvis and pelvic sidewalls for an additional 6Gy followed by a final cone-down to the pelvic sidewall/parametria of 4Gy.
The planning difficulty for this patient is the CT dataset was clipped laterally due to patient size. I chose to do Rapid Arc on this patient. I used 6 arcs with avoidance sectors laterally to miss the cut-off areas.
Plan to 45Gy
DVH to 45Gy
Composite external beam isodose
Composite external beam DVH