Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients

Our purpose was to develop recommendations for contouring the computed tomography (ct)-based high-risk clinical target volume (ctvhr) for 3d image-guided brachytherapy (3d-igbt) for cervical cancer. a 15-member japanese radiation oncology study group (jrosg) committee with expertise in gynecological radiation oncology initiated guideline development for ct-based ctvhr (based on a comprehensive literature review as well as clinical experience) in july 2014. extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. the ct-based ctvhr boundaries were defined by each anatomical plane (cranial-caudal,lateral,or anterior-posterior) with or without tumor progression beyond the uterine cervix at diagnosis. since the availability of magnetic resonance imaging (mri) with applicator insertion for 3d planning is currently limited,t2-weighted mri obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. furthermore,utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. in conclusion,these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of mri for 3d treatment planning. © the author 2016. published by oxford university press on behalf of the japan radiation research society and japanese society for radiation oncology.