Increased dose at parametrium using intensity modulated radiotherapy in locally advanced cervical cancer treated with 2D brachytherapy

Parametrial simultaneous integrated boost via linear accelerator using intensity modulated radiotherapy or volumetric modulated arc therapy, is delineated by a radiation oncologist and planned by a medical physicist. Prior to treatment delivery performed by radiotherapists, the plan is evaluated by the radiation oncologist. Dose for parametrial simultaneous integrated boost is 55 Gray (Gy) in 25 fractions (5 fractions per week), concomitant with whole pelvic radiation with dose of 50Gy. During and after external beam radiotherapy, brachytherapy is performed with total dose of 7Gy times 4, weekly. The total treatment time should not be more than 56 days. All the treatments are delivered in radiotherapy unit, Vajira Hospital, Bangkok, Thailand. To assess or monitor adherence or fidelity to the intervention, audit of medical records by principal investigator and/or secondary investigator is done. If there is any protocol deviation, the issue will be discussed and informed to the subject(s) involved in order to maintain or improve fidelity.