As the external os was digitized on radiograph and CT, all reference

points marked on orthogonal films were automatically transferred to CT films. The DVHs of tumor volumes and OARs were created for each application. The volumes were calculated for the dose matrices receiving 50% (3.5 Gy), 100% (7 Gy), 150% (10.5 Gy), and 200% (14 Gy) of the point-A doses obtained from the conventional plan and the 3D CT plan. The extent of tumor coverage within the prescribed 7 Gy isodose volume obtained from orthogonal films and CT were compared. To compare the respective ICRU rectal and bladder LY3023414 cost point doses with the 3D volume dose, the minimum dose value in the 2.0-cc volume receiving the highest dose (D2) was determined from DVHs for bladder, rectum. The dose of a 5-cc volume (D5), which is defined as the minimum dose value in the 5.0-cc volume receiving check details the highest dose, was also calculated, because this volume was

previously reported as the minimal volume required for fistula formation [7, 8, 15]. The Student’s t test was performed for comparison of GTV, CTV, rectum, bladder, sigmoid colon, and small bowel volumes between groups. A comparison of the conventional plan and CT-plan was performed using the Wilcoxon signed-ranks test for all doses and volumes. P values less than 0.05 were considered statistically significant. Results The mean age of the patients was 56 years (range, 26–77 years). Tumor stage was evaluated according to the International Federation of Gynecology and Obstetrics (FIGO) classification [16]. Two patients (7%) had Stage IB2, 3 (10%) had Stage IIA, 15 (52%) had Stage IIB, 1 (3%) had Stage IIIA, and 8 (28%) had Stage IIIB disease. Plans were categorized into group 1 (n = 24, 39%), where > 95% of the isodose line prescribed to point A in the conventional

plan encompassed the CTV, and group 2 (n = 38, 61%), where < 95% of the prescribed point-A dose on the CT plan encompassed the CTV. The mean GTV and CTV in all patients were 14.1 cc (2.1–38.2 cc) and 36.3 cc (9.7–80.0 cc), respectively. The mean GTV, CTV, rectum, bladder, sigmoid, and bowel volumes according to groups are presented in Table 1. Palmatine The mean GTV and CTV were smaller in group 1 than in group 2 (P < 0.001). The rectum, bladder, sigmoid colon, and small bowel volumes in all patients were 81.6 cc (37.5–177.6 cc), 60.3 cc (30.1–114.5 cc), 40.2 cc (10.8–62.8 cc), and 499.6 (158.1–973.3 cc), respectively. No significant differences were found between groups 1 and 2 in mean OAR volumes (Table 1). Table 1 Mean values of GTV, CTV, and rectum, bladder, sigmoid colon, and small bowel volumes according to groups.   Group 1 (cc ± SD) Group 2 (cc ± SD) P GTV 8.1 ± 5.4 20.6 ± 12.3 < 0.001 CTV 24.7 ± 10.7 48.4 ± 20.8 < 0.001 Rectum 76.1 ± 37.7 82.3 ± 36.9 0.19 Bladder 57.8 ± 19.5 63.0 ± 19.9 0.24 Sigmoid colon 38.2 ± 15.2 40.5 ± 16.3 0.72 Small bowel 508.9 ± 193.6 488.9 ± 226.1 0.