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The Role of Radiation Therapy in the Treatment of Malignant Gynecological Tumors

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Radiation Therapy for Pelvic Malignancy and its Consequences

Abstract

Radiation therapy is an essential treatment modality incorporated in the management of various gynecological malignancies. In this chapter, we will present in detail the role of radiation therapy in endometrial cancer, being the most common gynecological tumor, and cervical cancer and highlight the role of radiation in ovarian, vulvar and vaginal cancers.

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References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. PubMed PMID: 24399786.

    PubMed  Google Scholar 

  2. Delaney G, Jacob S, Barton M. Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: Part II-carcinoma of the endometrium. Cancer. 2004;101(4):682–92. PubMed PMID: 15305397.

    PubMed  Google Scholar 

  3. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol. 2006;24(1):36–44. PubMed PMID: 16330675.

    CAS  PubMed  Google Scholar 

  4. Lehoczky O, Bosze P, Ungar L, Tottossy B. Stage I endometrial carcinoma: treatment of nonoperable patients with intracavitary radiation therapy alone. Gynecol Oncol. 1991;43(3):211–6. PubMed PMID: 1752489.

    CAS  PubMed  Google Scholar 

  5. Kupelian PA, Eifel PJ, Tornos C, Burke TW, Delclos L, Oswald MJ. Treatment of endometrial carcinoma with radiation therapy alone. Int J Radiat Oncol Biol Phys. 1993;27(4):817–24. PubMed PMID: 8244810.

    CAS  PubMed  Google Scholar 

  6. Rouanet P, Dubois JB, Gely S, Pourquier H. Exclusive radiation therapy in endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1993;26(2):223–8. PubMed PMID: 8491680.

    CAS  PubMed  Google Scholar 

  7. Varia M, Rosenman J, Halle J, Walton L, Currie J, Fowler W. Primary radiation therapy for medically inoperable patients with endometrial carcinoma-stages I-II. Int J Radiat Oncol Biol Phys. 1987;13(1):11–5. PubMed PMID: 3804805.

    CAS  PubMed  Google Scholar 

  8. Fishman DA, Roberts KB, Chambers JT, Kohorn EI, Schwartz PE, Chambers SK. Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma with endometrium. Gynecol Oncol. 1996;61(2):189–96. PubMed PMID: 8626131.

    CAS  PubMed  Google Scholar 

  9. Grigsby PW, Kuske RR, Perez CA, Walz BJ, Camel MH, Kao MS, et al. Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy alone. Int J Radiat Oncol Biol Phys. 1987;13(4):483–8. PubMed PMID: 3558039.

    CAS  PubMed  Google Scholar 

  10. Chao CK, Grigsby PW, Perez CA, Mutch DG, Herzog T, Camel HM. Medically inoperable stage I endometrial carcinoma: a few dilemmas in radiotherapeutic management. Int J Radiat Oncol Biol Phys. 1996;34(1):27–31. PubMed PMID: 12118561.

    CAS  PubMed  Google Scholar 

  11. Patanaphan V, Salazar OM, Chougule P. What can be expected when radiation therapy becomes the only curative alternative for endometrial cancer? Cancer. 1985;55(7):1462–7. PubMed PMID: 3978539.

    CAS  PubMed  Google Scholar 

  12. Nguyen C, Souhami L, Roman TN, Clark BG. High-dose-rate brachytherapy as the primary treatment of medically inoperable stage I-II endometrial carcinoma. Gynecol Oncol. 1995;59(3):370–5. PubMed PMID: 8522257.

    CAS  PubMed  Google Scholar 

  13. Landgren RC, Fletcher GH, Delclos L, Wharton JT. Irradiation of endometrial cancer in patients with medical contraindication to surgery or with unresectable lesions. AJR Am J Roentgenol. 1976;126(1):148–54. PubMed PMID: 175674.

    CAS  PubMed  Google Scholar 

  14. Nguyen TV, Petereit DG. High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer. Gynecol Oncol. 1998;71(2):196–203. PubMed PMID: 9826460.

    CAS  PubMed  Google Scholar 

  15. Knocke TH, Kucera H, Weidinger B, Holler W, Potter R. Primary treatment of endometrial carcinoma with high-dose-rate brachytherapy: results of 12 years of experience with 280 patients. Int J Radiat Oncol Biol Phys. 1997;37(2):359–65. PubMed PMID: 9069308.

    CAS  PubMed  Google Scholar 

  16. Rose PG, Baker S, Kern M, Fitzgerald TJ, Tak WK, Reale FR, et al. Primary radiation therapy for endometrial carcinoma: a case controlled study. Int J Radiat Oncol Biol Phys. 1993;27(3):585–90. PubMed PMID: 8226152.

    CAS  PubMed  Google Scholar 

  17. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a gynecologic oncology group study. Gynecol Oncol. 1991;40(1):55–65. PubMed PMID: 1989916.

    CAS  PubMed  Google Scholar 

  18. Coon D, Beriwal S, Heron DE, Kelley JL, Edwards RP, Sukumvanich P, et al. High-dose-rate Rotte “Y” applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer: 10-year results. Int J Radiat Oncol Biol Phys. 2008;71(3):779–83. PubMed PMID: 18258388.

    PubMed  Google Scholar 

  19. Olson SB AC, Kim H, Houser C, et al. Dosimetry and early clinical outcomes of 3D treatment planning for high dose rate brachytherapy of medically inoperable endometrial cancer. Int J Radiat Oncol Biol Phys. 2011;81(2):S475.

    Google Scholar 

  20. Eifel PJ, Ross J, Hendrickson M, Cox RS, Kempson R, Martinez A. Adenocarcinoma of the endometrium. Analysis of 256 cases with disease limited to the uterine corpus: treatment comparisons. Cancer. 1983;52(6):1026–31. PubMed PMID: 6883271.

    CAS  PubMed  Google Scholar 

  21. Price JJ, Hahn GA, Rominger CJ. Vaginal involvement in Endometrial Carcinoma. Am J Obstet Gynecol. 1965;91:1060-5. PubMed PMID: 14280154.

    CAS  PubMed  Google Scholar 

  22. Fanning J, Alvarez PM, Tsukada Y, Piver MS. Prognostic significance of the extent of cervical involvement by endometrial cancer. Gynecol Oncol. 1991;40(1):46–7. PubMed PMID: 1989914.

    CAS  PubMed  Google Scholar 

  23. Larson DM, Copeland LJ, Gallager HS, Gershenson DM, Freedman RS, Wharton JT, et al. Nature of cervical involvement in endometrial carcinoma. Cancer. 1987;59(5):959–62. PubMed PMID: 3815275.

    CAS  PubMed  Google Scholar 

  24. Onsrud M, Aalders J, Abeler V, Taylor P. Endometrial carcinoma with cervical involvement (stage II): Prognostic factors and value of combined radiological-surgical treatment. Gynecol Oncol. 1982;13(1):76–86. PubMed PMID: 7060995.

    CAS  PubMed  Google Scholar 

  25. Wallin TE, Malkasian GD Jr, Gaffey TA, O’Brien PC, Fountain KS. Stage II cancer of the endometrium: a pathologic and clinical study. Gynecol Oncol. 1984;18(1):1–17. PubMed PMID: 6714798.

    CAS  PubMed  Google Scholar 

  26. Tsuruchi N, Kaku T, Kamura T, Tsukamoto N, Tsuneyoshi M, Akazawa K, et al. The prognostic significance of lymphovascular space invasion in endometrial cancer when conventional hemotoxylin and eosin staining is compared to immunohistochemical staining. Gynecol Oncol. 1995;57(3):307–12. PubMed PMID: 7539772.

    CAS  PubMed  Google Scholar 

  27. Sivridis E, Buckley CH, Fox H. The prognostic significance of lymphatic vascular space invasion in endometrial adenocarcinoma. Br J Obstet Gynaecol. 1987;94(10):991–4. PubMed PMID: 3689731.

    CAS  PubMed  Google Scholar 

  28. Hanson MB, van Nagell JR Jr, Powell DE, Donaldson ES, Gallion H, Merhige M, et al. The prognostic significance of lymph-vascular space invasion in stage I endometrial cancer. Cancer. 1985;55(8):1753–7. PubMed PMID: 3978563.

    CAS  PubMed  Google Scholar 

  29. Zaino RJ, Kurman RJ, Diana KL, Morrow CP. Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage-a gynecologic oncology group study. Cancer. 1996;77(6):1115–21. PubMed PMID: 8635132.

    CAS  PubMed  Google Scholar 

  30. Lurain JR, Rice BL, Rademaker AW, Poggensee LE, Schink JC, Miller DS. Prognostic factors associated with recurrence in clinical stage I adenocarcinoma of the endometrium. Obstet Gynecol. 1991;78(1):63–9. PubMed PMID: 2047070.

    CAS  PubMed  Google Scholar 

  31. Mariani A, Webb MJ, Keeney GL, Aletti G, Podratz KC. Endometrial cancer: predictors of peritoneal failure. Gynecol Oncol. 2003;89(2):236–42. PubMed PMID: 12713986.

    PubMed  Google Scholar 

  32. Jeffrey JF, Krepart GV, Lotocki RJ. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol. 1986;67(5):670–4. PubMed PMID: 3960439.

    CAS  PubMed  Google Scholar 

  33. Carcangiu ML, Chambers JT. Early pathologic stage clear cell carcinoma and uterine papillary serous carcinoma of the endometrium: comparison of clinicopathologic features and survival. Int J Gynecol Pathol. 1995;14(1):30–8. PubMed PMID: 7883423.

    CAS  PubMed  Google Scholar 

  34. Rosenberg P, Blom R, Hogberg T, Simonsen E. Death rate and recurrence pattern among 841 clinical stage I endometrial cancer patients with special reference to uterine papillary serous carcinoma. Gynecol Oncol. 1993;51(3):311–5. PubMed PMID: 8112638.

    CAS  PubMed  Google Scholar 

  35. Ward BG, Wright RG, Free K. Papillary carcinomas of the endometrium. Gynecol Oncol. 1990;39(3):347–51. PubMed PMID: 2258082.

    CAS  PubMed  Google Scholar 

  36. Sutton GP, Brill L, Michael H, Stehman FB, Ehrlich CE. Malignant papillary lesions of the endometrium. Gynecol Oncol. 1987 Jul;27(3):294–304. PubMed PMID: 3623228.

    CAS  PubMed  Google Scholar 

  37. Chapman GW Jr. Papillary adenocarcinoma of the endometrium: a retrospective study of stage I and II disease. J Natl Med Assoc. 1994;86(2):118–21. PubMed PMID: 8169986. Pubmed Central PMCID: 2568163.

    PubMed Central  PubMed  Google Scholar 

  38. Gallion HH, van Nagell JR Jr, Powell DF, Donaldson ES, Higgins RV, Kryscio RJ, et al. Stage I serous papillary carcinoma of the endometrium. Cancer. 1989;63(11):2224–8. PubMed PMID: 2720572.

    CAS  PubMed  Google Scholar 

  39. Christopherson WM, Alberhasky RC, Connelly PJ. Carcinoma of the endometrium. II. Papillary adenocarcinoma: a clinical pathological study, 46 cases. Am J Clin Pathol. 1982;77(5):534–40. PubMed PMID: 7081149.

    CAS  PubMed  Google Scholar 

  40. O’Hanlan KA, Levine PA, Harbatkin D, Feiner C, Goldberg GL, Jones JG, et al. Virulence of papillary endometrial carcinoma. Gynecol Oncol. 1990;37(1):112–9. PubMed PMID: 2323606.

    PubMed  Google Scholar 

  41. Kurman RJ, Scully RE. Clear cell carcinoma of the endometrium: an analysis of 21 cases. Cancer. 1976;37(2):872–82. PubMed PMID: 943228.

    CAS  PubMed  Google Scholar 

  42. Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: a histopathological and clinical study of 97 cases. Gynecol Oncol. 1991;40(3):207–17. PubMed PMID: 2013441.

    CAS  PubMed  Google Scholar 

  43. Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol. 1980;56(4):419–27. PubMed PMID: 6999399.

    CAS  PubMed  Google Scholar 

  44. Piver MS, Yazigi R, Blumenson L, Tsukada Y. A prospective trail comparing hysterectomy, hysterectomy plus vaginal radium, and uterine radium plus hysterectomy in stage I endometrial carcinoma. Obstet Gynecol. 1979;54(1):85–9. PubMed PMID: 450367.

    CAS  PubMed  Google Scholar 

  45. Piver MS, Hempling RE. A prospective trial of postoperative vaginal radium/cesium for grade 1–2 less than 50 % myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion in surgical stage I endometrial adenocarcinoma. Cancer. 1990;66(6):1133–8. PubMed PMID: 2400965.

    CAS  PubMed  Google Scholar 

  46. Grigsby PW, Perez CA, Kuten A, Simpson JR, Garcia DM, Camel HM, et al. Clinical stage I endometrial cancer: results of adjuvant irradiation and patterns of failure. Int J Radiat Oncol Biol Phys. 1991;21(2):379–85. PubMed PMID: 2061114.

    CAS  PubMed  Google Scholar 

  47. Nori D, Hilaris BS, Tome M, Lewis JL Jr, Birnbaum S, Fuks Z. Combined surgery and radiation in endometrial carcinoma: an analysis of prognostic factors. Int J Radiat Oncol Biol Phys. 1987;13(4):489–97. PubMed PMID: 3104248.

    CAS  PubMed  Google Scholar 

  48. Mayr NA, Wen BC, Benda JA, Sorosky JI, Davis CS, Fuller RW, et al. Postoperative radiation therapy in clinical stage I endometrial cancer: corpus, cervical, and lower uterine segment involvement-patterns of failure. Radiology. 1995;196(2):323–8. PubMed PMID: 7617840.

    CAS  PubMed  Google Scholar 

  49. Huguenin PU, Glanzmann C, Hammer F, Lutolf UM. Endometrial carcinoma in patients aged 75 years or older: outcome and complications after postoperative radiotherapy or radiotherapy alone. Strahlenther Onkol (Organ der Deutschen Rontgengesellschaft [et al]). 1992;168(10):567–72. PubMed PMID: 1440228.

    CAS  PubMed  Google Scholar 

  50. Boz G, De Paoli A, Innocente R, Del Pup L, Talamini R, Scarabelli C, et al. Endometrial stage I carcinoma treated with surgery and adjuvant irradiation: a retrospective analysis. Tumori. 1995;81(4):256–60. PubMed PMID: 8540122.

    CAS  PubMed  Google Scholar 

  51. Reddy S, Lee MS, Hendrickson FR. Pattern of recurrences in endometrial carcinoma and their management. Radiology. 1979;133(3 Pt 1):737–40. PubMed PMID: 504656.

    CAS  PubMed  Google Scholar 

  52. Seski JTM, Kalnicki S. Aretrospective review of postoperative radiation therapy in patients with endometrial carcinoma. Gynecol Oncol. 1996;60:97.

    Google Scholar 

  53. Petereit DGTJ, Schink BR, et al. Adjuvant high dose rate vaginal cuff brachytherapy for early-stage endometrial carcinoma. Gynecol Oncol. 1996;60:97.

    Google Scholar 

  54. Gretz HFr,E, Economos K, Husain A, Lesser M, Kaplan E, Caputo TA, et al. The practice of surgical staging and its impact on adjuvant treatment recommendations in patients with stage I endometrial carcinoma. Gynecol Oncol. 1996;61(3):409–15. PubMed PMID: 8641624.

    Google Scholar 

  55. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a gynecologic oncology group study. Gynecol Oncol. 2004;92(3):744–51. PubMed PMID: 14984936.

    PubMed  Google Scholar 

  56. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in Endometrial Carcinoma. Lancet. 2000;355(9213):1404–11. PubMed PMID: 10791524.

    CAS  PubMed  Google Scholar 

  57. Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, Lybeert ML, et al. Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys. 2005;63(3):834–8. PubMed PMID: 15927414.

    PubMed  Google Scholar 

  58. Creutzberg CL, Nout RA, Lybeert ML, Warlam-Rodenhuis CC, Jobsen JJ, Mens JW, et al. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e631–8. PubMed PMID: 21640520.

    PubMed  Google Scholar 

  59. Chadha M, Nanavati PJ, Liu P, Fanning J, Jacobs A. Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy. Gynecol Oncol. 1999;75(1):103–7. PubMed PMID: 10502434.

    CAS  PubMed  Google Scholar 

  60. Pearcey RG, Petereit DG. Post-operative high dose rate brachytherapy in patients with low to intermediate risk endometrial cancer. Radiother Oncol. 2000;56(1):17–22. PubMed PMID: 10869750.

    CAS  PubMed  Google Scholar 

  61. Anderson JM, Stea B, Hallum AV, Rogoff E, Childers J. High-dose-rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer. Int J Radiat Oncol Biol Phys. 2000;46(2):417–25. PubMed PMID: 10661349.

    CAS  PubMed  Google Scholar 

  62. Eltabbakh GH, Piver MS, Hempling RE, Shin KH. Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial. Int J Radiat Oncol Biol Phys. 1997;38(2):373–80. PubMed PMID: 9226326.

    CAS  PubMed  Google Scholar 

  63. Nori D, Merimsky O, Batata M, Caputo T. Postoperative high dose-rate intravaginal brachytherapy combined with external irradiation for early stage endometrial cancer: a long-term follow-up. Int J Radiat Oncol Biol Phys. 1994;30(4):831–7. PubMed PMID: 7960984.

    CAS  PubMed  Google Scholar 

  64. Solhjem MC, Petersen IA, Haddock MG. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. Int J Radiat Oncol Biol Phys. 2005;62(5):1379–84. PubMed PMID: 16029796.

    PubMed  Google Scholar 

  65. Jolly S, Vargas C, Kumar T, Weiner S, Brabbins D, Chen P, et al. Vaginal brachytherapy alone: an alternative to adjuvant whole pelvis radiation for early stage endometrial cancer. Gynecol Oncol. 2005;97(3):887–92. PubMed PMID: 15943991.

    PubMed  Google Scholar 

  66. Group AES, Blake P, Swart AM, Orton J, Kitchener H, Whelan T, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373(9658):137–46. PubMed PMID: 19070891. Pubmed Central PMCID: 2646125.

    Google Scholar 

  67. Nout RA, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27(21):3547–56. PubMed PMID: 19546404.

    PubMed  Google Scholar 

  68. Nout RA, Smit VT, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375(9717):816–23. PubMed PMID: 20206777.

    CAS  PubMed  Google Scholar 

  69. Surwit EA, Fowler WC Jr, Rogoff EE, Jelovsek F, Parker RT, Creasman WT. Stage II carcinoma of the endometrium. Int J Radiat Oncol Biol Phys. 1979;5(3):323–6. PubMed PMID: 457477.

    CAS  PubMed  Google Scholar 

  70. Homesley HD, Boronow RC, Lewis JL Jr. Stage II endometrial adenocarcinoma. Memorial Hospital for Cancer, 1949–1965. Obstet Gynecol. 1977;49(5):604–8. PubMed PMID: 850578.

    CAS  PubMed  Google Scholar 

  71. Bruckman JE, Goodman RL, Murthy A, Marck A. Combined irradiation and surgery in the treatment of stage II carcinoma of the endometrium. Cancer. 1978;42(3):1146–51. PubMed PMID: 100205.

    CAS  PubMed  Google Scholar 

  72. Gagnon JD, Moss WT, Gabourel LS, Stevens KR Jr. External irradiation in the management of stage II endometrial carcinoma. Cancer. 1979;44(4):1247–51. PubMed PMID: 115571.

    CAS  PubMed  Google Scholar 

  73. Grigsby PW, Perez CA, Camel HM, Kao MS, Galakatos AE. Stage II carcinoma of the endometrium: results of therapy and prognostic factors. Int J Radiat Oncol Biol Phys. 1985;11(11):1915–23. PubMed PMID: 4055452.

    CAS  PubMed  Google Scholar 

  74. Maruyama Y, Yoneda J, Coffey C, Wierzbicki J. Tandem-vaginal cylinder applicator for radiation therapy of uterine adenocarcinoma. Radiother Oncol. 1992;25(2):140–1. PubMed PMID: 1438932.

    CAS  PubMed  Google Scholar 

  75. Reisinger SA, Staros EB, Feld R, Mohiuddin M, Lewis GC. Preoperative radiation therapy in clinical stage II endometrial carcinoma. Gynecol Oncol. 1992;45(2):174–8. PubMed PMID: 1317330.

    CAS  PubMed  Google Scholar 

  76. Boente MP, Orandi YA, Yordan EL, Miller A, Graham JE, Kirshner C, et al. Recurrence patterns and complications in endometrial adenocarcinoma with cervical involvement. Ann Surg Oncol. 1995;2(2):138–44. PubMed PMID: 7728567.

    CAS  PubMed  Google Scholar 

  77. Parthasarathy A, Kapp DS, Cheung MK, Shin JY, Osann K, Chan JK. Adjuvant radiotherapy in incompletely staged IC and II endometrioid uterine cancer. Obstet Gynecol. 2007;110(6):1237–43. PubMed PMID: 18055715.

    PubMed  Google Scholar 

  78. Greven K, Olds W. Radiotherapy in the management of endometrial carcinoma with cervical involvement. Cancer. 1987;60(8):1737–40. PubMed PMID: 3115558.

    CAS  PubMed  Google Scholar 

  79. Carl UM, Bahnsen J, Edel B, Chandra A. The value of a postoperative radiation therapy in FIGO stage I and II endometrial cancers. Strahlenther Onkol (Organ der Deutschen Rontgengesellschaft [et al.]). 1995;171(6):322-5. PubMed PMID: 7597617.

    CAS  PubMed  Google Scholar 

  80. Cox JD, Komaki R, Wilson JF, Greenberg M. Locally advanced adenocarcinoma of the endometrium: results of irradiation with and without subsequent hysterectomy. Cancer. 1980;45(4):715–9. PubMed PMID: 6766796.

    CAS  PubMed  Google Scholar 

  81. Aalders JG, Abeler V, Kolstad P. Clinical (stage III) as compared to subclinical intrapelvic extrauterine tumor spread in endometrial carcinoma: a clinical and histopathological study of 175 patients. Gynecol Oncol. 1984;17(1):64–74. PubMed PMID: 6693053.

    CAS  PubMed  Google Scholar 

  82. Mackillop WJ, Pringle JF. Stage III endometrial carcinoma. A review of 90 cases. Cancer. 1985;56(10):2519–23. PubMed PMID: 2412690.

    CAS  PubMed  Google Scholar 

  83. Danoff BF, McDay J, Louka M, Lewis GC, Lee J, Kramer S. Stage III Endometrial carcinoma: analysis of patterns of failure and therapeutic implications. Int J Radiat Oncol Biol Phys. 1980;6(11):1491–5. PubMed PMID: 7462052.

    CAS  PubMed  Google Scholar 

  84. Genest P, Drouin P, Girard A, Gerig L. Stage III carcinoma of the endometrium: a review of 41 cases. Gynecol Oncol. 1987;26(1):77–86. PubMed PMID: 3792938.

    CAS  PubMed  Google Scholar 

  85. Potish RA, Twiggs LB, Adcock LL, Savage JE, Levitt SH, Prem KA. Paraaortic lymph node radiotherapy in cancer of the uterine corpus. Obstet Gynecol. 1985;65(2):251–6. PubMed PMID: 3969238.

    CAS  PubMed  Google Scholar 

  86. Delclos L, Fletcher GH, Gutierrez AG, Rutledge FN. Adenocarcinoma of the uterus. Am J Roentgenol. 1969;105(3):603–8. PubMed PMID: 5775018.

    CAS  Google Scholar 

  87. Rose PG, Cha SD, Tak WK, Fitzgerald T, Reale F, Hunter RE. Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1992;24(2):229–33. PubMed PMID: 1526860.

    CAS  PubMed  Google Scholar 

  88. Gibbons S, Martinez A, Schray M, Podratz K, Stanhope R, Garton G, et al. Adjuvant whole abdominopelvic irradiation for high risk endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1991;21(4):1019–25. PubMed PMID: 1917597.

    CAS  PubMed  Google Scholar 

  89. Greer BE, Hamberger AD. Treatment of intraperitoneal metastatic adenocarcinoma of the endometrium by the whole-abdomen moving-strip technique and pelvic boost irradiation. Gynecol Oncol. 1983;16(3):365–73. PubMed PMID: 6654180.

    CAS  PubMed  Google Scholar 

  90. Potish RA, Twiggs LB, Adcock LL, Prem KA. Role of whole abdominal radiation therapy in the management of endometrial cancer; prognostic importance of factors indicating peritoneal metastases. Gynecol Oncol. 1985;21(1):80–6. PubMed PMID: 3886495.

    CAS  PubMed  Google Scholar 

  91. Loeffler JS, Rosen EM, Niloff JM, Howes AE, Knapp RC. Whole abdominal irradiation for tumors of the uterine corpus. Cancer. 1988;61(7):1332–5. PubMed PMID: 3345489.

    CAS  PubMed  Google Scholar 

  92. Smith RS, Kapp DS, Chen Q, Teng NN. Treatment of high-risk uterine cancer with whole abdominopelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2000;48(3):767–78. PubMed PMID: 11020574.

    CAS  PubMed  Google Scholar 

  93. Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol. 2006;103(1):155–9. PubMed PMID: 16545437.

    CAS  PubMed  Google Scholar 

  94. Hogberg T, Signorelli M, de Oliveira CF, Fossati R, Lissoni AA, Sorbe B, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer-results from two randomised studies. Eur J Cancer. 2010;46(13):2422–31. PubMed PMID: 20619634. Pubmed Central PMCID: 3552301.

    PubMed Central  CAS  PubMed  Google Scholar 

  95. Mundt AJ, McBride R, Rotmensch J, Waggoner SE, Yamada SD, Connell PP. Significant pelvic recurrence in high-risk pathologic stage I-IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys. 2001;50(5):1145–53. PubMed PMID: 11483323.

    CAS  PubMed  Google Scholar 

  96. Frank AH, Tseng PC, Haffty BG, Papadopoulos DP, Kacinski BM, Dowling SW, et al. Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma. Cancer. 1991;68(7):1516–9. PubMed PMID: 1893350.

    CAS  PubMed  Google Scholar 

  97. Small W Jr, Mahadevan A, Roland P, Vallow L, Zusag T, Fishman D, et al. Whole-abdominal radiation in endometrial carcinoma: an analysis of toxicity, patterns of recurrence, and survival. Cancer J. 2000;6(6):394–400. PubMed PMID: 11131490.

    PubMed  Google Scholar 

  98. Sutton G, Axelrod JH, Bundy BN, Roy T, Homesley HD, Malfetano JH, et al. Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: a gynecologic oncology group study. Gynecol Oncol. 2005;97(3):755–63. PubMed PMID: 15913742.

    PubMed  Google Scholar 

  99. Sutton G, Axelrod JH, Bundy BN, Roy T, Homesley H, Lee RB, et al. Adjuvant whole abdominal irradiation in clinical stages I and II papillary serous or clear cell carcinoma of the endometrium: a phase II study of the gynecologic oncology group. Gynecol Oncol. 2006;100(2):349–54. PubMed PMID: 16213007.

    PubMed  Google Scholar 

  100. Mallipeddi P, Kapp DS, Teng NN. Long-term survival with adjuvant whole abdominopelvic irradiation for uterine papillary serous carcinoma. Cancer. 1993;71(10):3076–81. PubMed PMID: 8490835.

    CAS  PubMed  Google Scholar 

  101. Soper JT, Creasman WT, Clarke-Pearson DL, Sullivan DC, Vergadoro F, Johnston WW. Intraperitoneal chromic phosphate P 32 suspension therapy of malignant peritoneal cytology in endometrial carcinoma. Am J Obstet Gynecol. 1985;153(2):191–6. PubMed PMID: 4037013.

    CAS  PubMed  Google Scholar 

  102. Corn BW, Lanciano RM, Greven KM, Noumoff J, Schultz D, Hanks GE, et al. Impact of improved irradiation technique, age, and lymph node sampling on the severe complication rate of surgically staged endometrial cancer patients: a multivariate analysis. J Clin Oncol. 1994;12(3):510–5. PubMed PMID: 8120549.

    CAS  PubMed  Google Scholar 

  103. Herbert SH, Curran WJ Jr, Solin LJ, Stafford PM, Lanciano RM, Hanks GE. Decreasing gastrointestinal morbidity with the use of small bowel contrast during treatment planning for pelvic irradiation. Int J Radiat Oncol Biol Phys. 1991;20(4):835–42. PubMed PMID: 2004962.

    CAS  PubMed  Google Scholar 

  104. Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G, et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2002;52(5):1330–7. PubMed PMID: 11955746.

    PubMed  Google Scholar 

  105. Portelance L, Chao KS, Grigsby PW, Bennet H, Low D. Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys. 2001;51(1):261–6. PubMed PMID: 11516876.

    CAS  PubMed  Google Scholar 

  106. Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt A. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2000;48(5):1613–21. PubMed PMID: 11121668.

    CAS  PubMed  Google Scholar 

  107. Sminia P, Schneider CJ, van Tienhoven G, Koedooder K, Blank LE, Gonzalez Gonzalez D. Office hours pulsed brachytherapy boost in breast cancer. Radiother Oncol. 2001;59(3):273–80. PubMed PMID: 11369068.

    CAS  PubMed  Google Scholar 

  108. Heyman J. The so-called Stockholm method and results of treatment of uterine cancer at the Radiumhemmet. 1935;16(2):129–148.

    Google Scholar 

  109. Simon N, Silverstone SM. Intracavitary radiotherapy of endometrial cancer by afterloading. Gynecol Oncol. 1972;1(1):13–6. PubMed PMID: 4669439.

    PubMed  Google Scholar 

  110. Small W Jr, Erickson B, Kwakwa F. American Brachytherapy Society survey regarding practice patterns of postoperative irradiation for endometrial cancer: current status of vaginal brachytherapy. Int J Radiat Oncol Biol Phys. 2005;63(5):1502–7. PubMed PMID: 16109462.

    PubMed  Google Scholar 

  111. Ahmad NR, Lanciano RM, Corn BW, Schultheiss T. Postoperative radiation therapy for surgically staged endometrial cancer: impact of time factors (overall treatment time and surgery-to-radiation interval) on outcome. Int J Radiat Oncol Biol Phys. 1995;33(4):837–42. PubMed PMID: 7591891.

    CAS  PubMed  Google Scholar 

  112. Torrisi JR, Barnes WA, Popescu G, Whitfield G, Barter J, Lewandowski G, et al. Postoperative adjuvant external-beam radiotherapy in surgical stage I endometrial carcinoma. Cancer. 1989;64(7):1414–7. PubMed PMID: 2505921.

    CAS  PubMed  Google Scholar 

  113. Bliss P, Cowie VJ. Endometrial carcinoma: does the addition of intracavitary vault caesium to external beam therapy postoperatively result in improved control or increased morbidity? Clin Oncol. 1992;4(6):373–6. PubMed PMID: 1463690.

    CAS  Google Scholar 

  114. Curran WJ Jr, Whittington R, Peters AJ, Fanning J. Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system. Int J Radiat Oncol Biol Phys. 1988;15(4):803–8. PubMed PMID: 3182319.

    PubMed  Google Scholar 

  115. Aalders JG, Abeler V, Kolstad P. Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients. Gynecol Oncol. 1984;17(1):85–103. PubMed PMID: 6693055.

    CAS  PubMed  Google Scholar 

  116. Kuten A, Grigsby PW, Perez CA, Fineberg B, Garcia DM, Simpson JR. Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients. Int J Radiat Oncol Biol Phys. 1989;17(1):29–34. PubMed PMID: 2745204.

    CAS  PubMed  Google Scholar 

  117. Mandell LR, Nori D, Hilaris B. Recurrent stage I endometrial carcinoma: results of treatment and prognostic factors. Int J Radiat Oncol Biol Phys. 1985;11(6):1103–9. PubMed PMID: 3997592.

    CAS  PubMed  Google Scholar 

  118. Morgan JD 3rd, Reddy S, Sarin P, Yordan E, DeGeest K, Hendrickson FR. Isolated vaginal recurrences of endometrial carcinoma. Radiology. 1993;189(2):609–13. PubMed PMID: 8210396.

    PubMed  Google Scholar 

  119. Poulsen MG, Roberts SJ. The salvage of recurrent endometrial carcinoma in the vagina and pelvis. Int J Radiat Oncol Biol Phys. 1988;15(4):809–13. PubMed PMID: 3182320.

    CAS  PubMed  Google Scholar 

  120. Sears JD, Greven KM, Hoen HM, Randall ME. Prognostic factors and treatment outcome for patients with locally recurrent endometrial cancer. Cancer. 1994;74(4):1303–8. PubMed PMID: 8055452.

    CAS  PubMed  Google Scholar 

  121. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89(2):201–9. PubMed PMID: 12713981.

    PubMed  Google Scholar 

  122. George M, Pejovic MH, Kramar A. Uterine sarcomas: prognostic factors and treatment modalities-study on 209 patients. Gynecol Oncol. 1986;24(1):58–67. PubMed PMID: 3699577.

    CAS  PubMed  Google Scholar 

  123. Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones MW. The impact of adjuvant radiotherapy on carcinosarcoma of the uterus. Gynecol Oncol. 1998;68(1):8–13. PubMed PMID: 9454652.

    CAS  PubMed  Google Scholar 

  124. Kohorn EI, Schwartz PE, Chambers JT, Peschel RE, Kapp DS, Merino M. Adjuvant therapy in mixed mullerian tumors of the uterus. Gynecol Oncol. 1986;23(2):212–21. PubMed PMID: 3002919.

    CAS  PubMed  Google Scholar 

  125. Larson B, Silfversward C, Nilsson B, Pettersson F. Mixed mullerian tumours of the uterus-prognostic factors: a clinical and histopathologic study of 147 cases. Radiother Oncol. 1990;17(2):123–32. PubMed PMID: 2157241.

    CAS  PubMed  Google Scholar 

  126. Moskovic E, MacSweeney E, Law M, Price A. Survival, patterns of spread and prognostic factors in uterine sarcoma: a study of 76 patients. Br J Radiol. 1993;66(791):1009–15. PubMed PMID: 8281375.

    CAS  PubMed  Google Scholar 

  127. Vongtama V, Karlen JR, Piver SM, Tsukada Y, Moore RH. Treatment, results and prognostic factors in stage I and II sarcomas of the corpus uteri. AJR Am J Roentgenol. 1976;126(1):139–47. PubMed PMID: 175673.

    CAS  PubMed  Google Scholar 

  128. Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989–1999. Gynecol Oncol. 2004;93(1):204–8. PubMed PMID: 15047237.

    PubMed  Google Scholar 

  129. Chi DS, Mychalczak B, Saigo PE, Rescigno J, Brown CL. The role of whole-pelvic irradiation in the treatment of early-stage uterine carcinosarcoma. Gynecol Oncol. 1997;65(3):493–8. PubMed PMID: 9190981.

    CAS  PubMed  Google Scholar 

  130. Reed NS, Mangioni C, Malmstrom H, Scarfone G, Poveda A, Pecorelli S, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: a European organisation for research and treatment of cancer gynaecological cancer group study (protocol 55874). Eur J Cancer. 2008;44(6):808–18. PubMed PMID: 18378136.

    CAS  PubMed  Google Scholar 

  131. Ayhan A, Tuncer ZS, Tanir M, Yuce K, Ayhan A. Uterine sarcoma: the Hacettepe hospital experience of 88 consecutive patients. Eur J Gynaecol Oncol. 1997;18(2):146–8. PubMed PMID: 9105869.

    CAS  PubMed  Google Scholar 

  132. Echt G, Jepson J, Steel J, Langholz B, Luxton G, Hernandez W, et al. Treatment of uterine sarcomas. Cancer. 1990;66(1):35–9. PubMed PMID: 2354406.

    CAS  PubMed  Google Scholar 

  133. Hornback NB, Omura G, Major FJ. Observations on the use of adjuvant radiation therapy in patients with stage I and II uterine sarcoma. Int J Radiat Oncol Biol Phys. 1986;12(12):2127–30. PubMed PMID: 3793549.

    CAS  PubMed  Google Scholar 

  134. Nickie-Psikuta M, Gawrychowski K. Different types and different prognosis-study of 310 uterine sarcomas. Eur J Gynaecol Oncol. 1993;14:105-13. PubMed PMID: 8200360.

    PubMed  Google Scholar 

  135. Wolfson AH, Brady MF, Rocereto T, Mannel RS, Lee YC, Futoran RJ, et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I–IV carcinosarcoma (CS) of the uterus. Gynecol Oncol. 2007;107(2):177–85. PubMed PMID: 17822748. Pubmed Central PMCID: 2752331.

    PubMed Central  CAS  PubMed  Google Scholar 

  136. Mansi JL, Ramachandra S, Wiltshaw E, Fisher C. Endometrial stromal sarcomas. Gynecol Oncol. 1990;36(1):113–8. PubMed PMID: 2295442.

    CAS  PubMed  Google Scholar 

  137. Salazar OM, Bonfiglio TA, Patten SF, Keller BE, Feldstein M, Dunne ME, et al. Uterine sarcomas: natural history, treatment and prognosis. Cancer. 1978;42(3):1152–60. PubMed PMID: 698910.

    CAS  PubMed  Google Scholar 

  138. Weitmann HD, Knocke TH, Kucera H, Potter R. Radiation therapy in the treatment of endometrial stromal sarcoma. Int J Radiat Oncol Biol Phys. 2001;49(3):739–48. PubMed PMID: 11172957.

    CAS  PubMed  Google Scholar 

  139. Ferrer F, Sabater S, Farrus B, Guedea F, Rovirosa A, Anglada L, et al. Impact of radiotherapy on local control and survival in uterine sarcomas: a retrospective study from the Grup Oncologic Catala-Occita. Int J Radiat Oncol Biol Phys. 1999;44(1):47–52. PubMed PMID: 10219793.

    CAS  PubMed  Google Scholar 

  140. Chauveinc L, Deniaud E, Plancher C, Sastre X, Amsani F, de la Rochefordiere A, et al. Uterine sarcomas: the Curie Institut experience. Prognosis factors and adjuvant treatments. Gynecol Oncol. 1999;72(2):232–7. PubMed PMID: 10021306.

    CAS  PubMed  Google Scholar 

  141. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71–96. PubMed PMID: 18287387.

    PubMed  Google Scholar 

  142. Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006;65(1):169–76. PubMed PMID: 16427212.

    PubMed  Google Scholar 

  143. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 1990;38(3):352–7. PubMed PMID: 2227547.

    CAS  PubMed  Google Scholar 

  144. Garg AK, Jhingran A, Klopp AH, Aggarwal BB, Kunnumakkara AB, Broadus RR, et al. Expression of nuclear transcription factor kappa B in locally advanced human cervical cancer treated with definitive chemoradiation. Int J Radiat Oncol Biol Phys. 2010;78(5):1331–6. PubMed PMID: 20231067.

    CAS  PubMed  Google Scholar 

  145. Eifel PJ, Morris M, Wharton JT, Oswald MJ. The influence of tumor size and morphology on the outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1994;29(1):9–16. PubMed PMID: 8175451.

    CAS  PubMed  Google Scholar 

  146. Green JA, Kirwan JM, Tierney JF, Symonds P, Fresco L, Collingwood M, et al. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet. 2001;358(9284):781–6. PubMed PMID: 11564482.

    CAS  PubMed  Google Scholar 

  147. Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340(15):1154–61. PubMed PMID: 10202166.

    CAS  PubMed  Google Scholar 

  148. Perez CA, Grigsby PW, Castro-Vita H, Lockett MA. Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys. 1995;32(5):1275–88. PubMed PMID: 7635767.

    CAS  PubMed  Google Scholar 

  149. Lanciano RM, Pajak TF, Martz K, Hanks GE. The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys. 1993;25(3):391–7. PubMed PMID: 8436516.

    CAS  PubMed  Google Scholar 

  150. Fyles A, Keane TJ, Barton M, Simm J. The effect of treatment duration in the local control of cervix cancer. Radiother Oncol. 1992;25(4):273–9. PubMed PMID: 1480773.

    CAS  PubMed  Google Scholar 

  151. Girinsky T, Rey A, Roche B, Haie C, Gerbaulet A, Randrianarivello H, et al. Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys. 1993;27(5):1051–6. PubMed PMID: 8262826.

    CAS  PubMed  Google Scholar 

  152. Petereit DG, Sarkaria JN, Chappell R, Fowler JF, Hartmann TJ, Kinsella TJ, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys. 1995;32(5):1301–7. PubMed PMID: 7635769.

    CAS  PubMed  Google Scholar 

  153. Lovecchio JL, Averette HE, Donato D, Bell J. 5-year survival of patients with periaortic nodal metastases in clinical stage IB and IIA cervical carcinoma. Gynecol Oncol. 1989;34(1):43–5. PubMed PMID: 2737524.

    CAS  PubMed  Google Scholar 

  154. Classe JM, Rauch P, Rodier JF, Morice P, Stoeckle E, Lasry S, et al. Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer). Gynecol Oncol. 2006;102(3):523–9. PubMed PMID: 16504274.

    CAS  PubMed  Google Scholar 

  155. Perez CA, Grigsby PW, Camel HM, Galakatos AE, Mutch D, Lockett MA. Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys. 1995;31(4):703–16. PubMed PMID: 7860381.

    CAS  PubMed  Google Scholar 

  156. Decker MA, Burke JJ 2nd, Gallup DG, Silverio RW, Weems D, Duttenhaver J, et al. Completion hysterectomy after radiation therapy for bulky cervical cancer stages IB, IIA, and IIB: complications and survival rates. Am J Obstet Gynecol. 2004;191(2):654–8 (discussion 8-60). PubMed PMID: 15343258.

    PubMed  Google Scholar 

  157. Eifel PJ, Thoms WW Jr, Smith TL, Morris M, Oswald MJ. The relationship between brachytherapy dose and outcome in patients with bulky endocervical tumors treated with radiation alone. Int J Radiat Oncol Biol Phys. 1994;28(1):113–8. PubMed PMID: 8270431.

    CAS  PubMed  Google Scholar 

  158. Thoms WW Jr, Eifel PJ, Smith TL, Morris M, Delclos L, Wharton JT, et al. Bulky endocervical carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys. 1992;23(3):491–9. PubMed PMID: 1612949.

    PubMed  Google Scholar 

  159. Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF, et al. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the gynecologic oncology group. Gynecol Oncol. 2003;89(3):343–53. PubMed PMID: 12798694.

    PubMed  Google Scholar 

  160. Nijhuis ER, van der Zee AG, in ’t Hout BA, Boomgaard JJ, de Hullu JA, Pras E, et al. Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery. Int J Radiat Oncol Biol Phys. 2006;66(3):699–705. PubMed PMID: 16904839.

    PubMed  Google Scholar 

  161. Sardi JE, Giaroli A, Sananes C, Ferreira M, Soderini A, Bermudez A, et al. Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol. 1997;67(1):61–9. PubMed PMID: 9345358.

    CAS  PubMed  Google Scholar 

  162. Eddy GL, Bundy BN, Creasman WT, Spirtos NM, Mannel RS, Hannigan E, et al. Treatment of (“bulky”) stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of the gynecologic oncology group. Gynecol Oncol. 2007;106(2):362–9. PubMed PMID: 17493669.

    CAS  PubMed  Google Scholar 

  163. Chang TC, Lai CH, Hong JH, Hsueh S, Huang KG, Chou HH, et al. Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer. J Clin Oncol. 2000;18(8):1740–7. PubMed PMID: 10764435.

    CAS  PubMed  Google Scholar 

  164. Katsumata N, Yoshikawa H, Hirakawa T, et al. Phase III randomized trial of neoadjuvant chemotherapy followed by radical hysterectomy (RH) versus RH for bulky stage I/II cervical cancer. J Clin Oncol;24:259s.

    Google Scholar 

  165. Benedetti-Panici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, Giannarelli D, et al. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. J Clin Oncol. 2002;20(1):179–88. PubMed PMID: 11773168.

    CAS  PubMed  Google Scholar 

  166. Rydzewska L, Tierney J, Vale CL, Symonds PR. Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. Cochrane Database Syst Rev. 2012;12:CD007406. PubMed PMID: 23235641.

    PubMed  Google Scholar 

  167. Buda A, Fossati R, Colombo N, Fei F, Floriani I, Gueli Alletti D, et al. Randomized trial of neoadjuvant chemotherapy comparing paclitaxel, ifosfamide, and cisplatin with ifosfamide and cisplatin followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the SNAP01 (Studio Neo-Adjuvante Portio) Italian collaborative study. J Clin Oncol. 2005;23(18):4137–45. PubMed PMID: 15961761.

    CAS  PubMed  Google Scholar 

  168. Cosin JA, Fowler JM, Chen MD, Paley PJ, Carson LF, Twiggs LB. Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking. Cancer. 1998;82(11):2241–8. PubMed PMID: 9610705.

    CAS  PubMed  Google Scholar 

  169. Hacker NF, Wain GV, Nicklin JL. Resection of bulky positive lymph nodes in patients with cervical carcinoma. Int J Gynecol Cancer. 1995;5(4):250–6. PubMed PMID: 11578485.

    PubMed  Google Scholar 

  170. Rutledge TL, Kamelle SA, Tillmanns TD, Gould NS, Wright JD, Cohn DE, et al. A comparison of stages IB1 and IB2 cervical cancers treated with radical hysterectomy. Is size the real difference? Gynecol Oncol. 2004;95(1):70–6. PubMed PMID: 15385112.

    PubMed  Google Scholar 

  171. Allen HH, Nisker JA, Anderson RJ. Primary surgical treatment in one hundred ninety-five cases of stage IB carcinoma of the cervix. Am J Obstet Gynecol. 1982;143(5):581–4. PubMed PMID: 7091229.

    CAS  PubMed  Google Scholar 

  172. Yessaian A, Magistris A, Burger RA, Monk BJ. Radical hysterectomy followed by tailored postoperative therapy in the treatment of stage IB2 cervical cancer: feasibility and indications for adjuvant therapy. Gynecol Oncol. 2004;94(1):61–6. PubMed PMID: 15262120.

    PubMed  Google Scholar 

  173. Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, et al. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001;80(1):3–12. PubMed PMID: 11136561.

    CAS  PubMed  Google Scholar 

  174. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997;350(9077):535–40. PubMed PMID: 9284774.

    CAS  PubMed  Google Scholar 

  175. Monk BJ, Cha DS, Walker JL, Burger RA, Ramsinghani NS, Manetta A, et al. Extent of disease as an indication for pelvic radiation following radical hysterectomy and bilateral pelvic lymph node dissection in the treatment of stage IB and IIA cervical carcinoma. Gynecol Oncol. 1994;54(1):4–9. PubMed PMID: 8020837.

    CAS  PubMed  Google Scholar 

  176. Rotman M, Pajak TF, Choi K, Clery M, Marcial V, Grigsby PW, et al. Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA. 1995;274(5):387–93. PubMed PMID: 7616634.

    CAS  PubMed  Google Scholar 

  177. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecol Oncol. 1999;73(2):177–83. PubMed PMID: 10329031.

    CAS  PubMed  Google Scholar 

  178. Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606–13. PubMed PMID: 10764420.

    CAS  PubMed  Google Scholar 

  179. Committee on Practice B-G. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas, number 35, May 2002. Obstet Gynecol. 2002;99(5 Pt 1):855–67. PubMed PMID: 11978302.

    Google Scholar 

  180. Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004;22(5):872–80. PubMed PMID: 14990643.

    PubMed  Google Scholar 

  181. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340(15):1137–43. PubMed PMID: 10202164.

    CAS  PubMed  Google Scholar 

  182. Pearcey R, Brundage M, Drouin P, Jeffrey J, Johnston D, Lukka H, et al. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol. 2002;20(4):966–72. PubMed PMID: 11844818.

    CAS  PubMed  Google Scholar 

  183. Leitao MM Jr, Chi DS. Recurrent cervical cancer. Curr Treat Options Oncol. 2002;3(2):105–11. PubMed PMID: 12057073.

    PubMed  Google Scholar 

  184. Singh N, Arif S. Histopathologic parameters of prognosis in cervical cancer-a review. Int J Gynecol Cancer. 2004;14(5):741–50. PubMed PMID: 15361180.

    CAS  PubMed  Google Scholar 

  185. Pilleron JP, Durand JC, Hamelin JP. Prognostic value of node metastasis in cancer of the uterine cervix. Am J Obstet Gynecol. 1974;119(4):458–62. PubMed PMID: 4842590.

    CAS  PubMed  Google Scholar 

  186. Metcalf KS, Johnson N, Calvert S, Peel KR. Site specific lymph node metastasis in carcinoma of the cervix: is there a sentinel node? Int J Gynecol Cancer. 2000;10(5):411–6. PubMed PMID: 11240707.

    PubMed  Google Scholar 

  187. Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W, Deavers M, et al. Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. J Clin Oncol. 2002;20(3):688–93. PubMed PMID: 11821449.

    PubMed  Google Scholar 

  188. Bader AA, Winter R, Haas J, Tamussino KF. Where to look for the sentinel lymph node in cervical cancer. Am J Obstet Gynecol. 2007;197(6):678.e1–7. PubMed PMID: 18060980.

    PubMed  Google Scholar 

  189. Sevin BU, Nadji M, Averette HE, Hilsenbeck S, Smith D, Lampe B. Microinvasive carcinoma of the cervix. Cancer. 1992;70(8):2121–8. PubMed PMID: 1394041.

    CAS  PubMed  Google Scholar 

  190. Lee YN, Wang KL, Lin MH, Liu CH, Wang KG, Lan CC, et al. Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases. Gynecol Oncol. 1989;32(2):135–42. PubMed PMID: 2910773.

    CAS  PubMed  Google Scholar 

  191. Arends MJ, Buckley CH, Wells M. Aetiology, pathogenesis, and pathology of cervical neoplasia. J Clini Pathol. 1998;51(2):96–103. PubMed PMID: 9602680. Pubmed Central PMCID: 500501.

    CAS  Google Scholar 

  192. Leblanc E, Narducci F, Frumovitz M, Lesoin A, Castelain B, Baranzelli MC, et al. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol. 2007;105(2):304–11. PubMed PMID: 17258799.

    PubMed  Google Scholar 

  193. Vidaurreta J, Bermudez A, di Paola G, Sardi J. Laparoscopic staging in locally advanced cervical carcinoma: a new possible philosophy? Gynecol Oncol. 1999;75(3):366–71. PubMed PMID: 10600291.

    CAS  PubMed  Google Scholar 

  194. Sonoda Y, Leblanc E, Querleu D, Castelain B, Papageorgiou TH, Lambaudie E, et al. Prospective evaluation of surgical staging of advanced cervical cancer via a laparoscopic extraperitoneal approach. Gynecol Oncol. 2003;91(2):326–31. PubMed PMID: 14599862.

    CAS  PubMed  Google Scholar 

  195. Hasenburg A, Salama JK, Van TJ, Amosson C, Chiu JK, Kieback DG. Evaluation of patients after extraperitoneal lymph node dissection and subsequent radiotherapy for cervical cancer. Gynecol Oncol. 2002;84(2):321–6. PubMed PMID: 11812094.

    PubMed  Google Scholar 

  196. Denschlag D, Gabriel B, Mueller-Lantzsch C, Tempfer C, Henne K, Gitsch G, et al. Evaluation of patients after extraperitoneal lymph node dissection for cervical cancer. Gynecol Oncol. 2005;96(3):658–64. PubMed PMID: 15721408.

    CAS  PubMed  Google Scholar 

  197. Marnitz S, Kohler C, Roth C, Fuller J, Hinkelbein W, Schneider A. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005;99(3):536–44. PubMed PMID: 16126259.

    PubMed  Google Scholar 

  198. Kim PY, Monk BJ, Chabra S, Burger RA, Vasilev SA, Manetta A, et al. Cervical cancer with paraaortic metastases: significance of residual paraaortic disease after surgical staging. Gynecol Oncol. 1998;69(3):243–7. PubMed PMID: 9648595.

    CAS  PubMed  Google Scholar 

  199. Gold MA, Tian C, Whitney CW, Rose PG, Lanciano R. Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a gynecologic oncology group study. Cancer. 2008;112(9):1954–63. PubMed PMID: 18338811.

    PubMed  Google Scholar 

  200. Heller PB, Maletano JH, Bundy BN, Barnhill DR, Okagaki T. Clinical-pathologic study of stage IIB, III, and IVA carcinoma of the cervix: extended diagnostic evaluation for paraaortic node metastasis—A gynecologic oncology group study. Gynecol Oncol. 1990;38(3):425–30. PubMed PMID: 2227556.

    CAS  PubMed  Google Scholar 

  201. Scheidler J, Hricak H, Yu KK, Subak L, Segal MR. Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA. 1997;278(13):1096–101. PubMed PMID: 9315770.

    CAS  PubMed  Google Scholar 

  202. Malur S, Krause N, Kohler C, Schneider A. Sentinel lymph node detection in patients with cervical cancer. Gynecol Oncol. 2001;80(2):254–7. PubMed PMID: 11161868.

    CAS  PubMed  Google Scholar 

  203. Chung HH, Lee S, Sim JS, Kim JY, Seo SS, Park SY, et al. Pretreatment laparoscopic surgical staging in locally advanced cervical cancer: preliminary results in Korea. Gynecol Oncol. 2005;97(2):468–75. PubMed PMID: 15863146.

    PubMed  Google Scholar 

  204. Choi HJ, Roh JW, Seo SS, Lee S, Kim JY, Kim SK, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer. 2006;106(4):914–22. PubMed PMID: 16411226.

    PubMed  Google Scholar 

  205. Odunsi KO, Lele S, Ghamande S, Seago P, Driscoll DL. The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer. Eur J Gynaecol Oncol. 2001;22(5):325–30. PubMed PMID: 11766731.

    CAS  PubMed  Google Scholar 

  206. Roh JW, Seo SS, Lee S, Kang KW, Kim SK, Sim JS, et al. Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study. Eur J Cancer. 2005;41(14):2086–92. PubMed PMID: 16125928.

    PubMed  Google Scholar 

  207. Narayan K, Hicks RJ, Jobling T, Bernshaw D, McKenzie AF. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: potential impact on treatment. Int J Gynecol Cancer. 2001;11(4):263–71. PubMed PMID: 11520363.

    CAS  PubMed  Google Scholar 

  208. Lin WC, Hung YC, Yeh LS, Kao CH, Yen RF, Shen YY. Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings. Gynecol Oncol. 2003;89(1):73–6. PubMed PMID: 12694656.

    PubMed  Google Scholar 

  209. Haie C, Pejovic MH, Gerbaulet A, Horiot JC, Pourquier H, Delouche J, et al. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol. 1988;11(2):101–12. PubMed PMID: 3281186.

    CAS  PubMed  Google Scholar 

  210. Grigsby PW, Lu JD, Mutch DG, Kim RY, Eifel PJ. Twice-daily fractionation of external irradiation with brachytherapy and chemotherapy in carcinoma of the cervix with positive para-aortic lymph nodes: phase II study of the Radiation Therapy Oncology group 92-10. Int J Radiat Oncol Biol Phys. 1998;41(4):817–22. PubMed PMID: 9652843.

    CAS  PubMed  Google Scholar 

  211. Grigsby PW, Heydon K, Mutch DG, Kim RY, Eifel P. Long-term follow-up of RTOG 92-10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys. 2001;51(4):982–7. PubMed PMID: 11704321.

    CAS  PubMed  Google Scholar 

  212. Small W Jr, Winter K, Levenback C, Iyer R, Gaffney D, Asbell S, et al. Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of ARM 1 of RTOG 0116. Int J Radiat Oncol Biol Phys. 2007;68(4):1081–7. PubMed PMID: 17398031.

    CAS  PubMed  Google Scholar 

  213. Small W Jr, Winter K, Levenback C, Iyer R, Hymes SR, Jhingran A, et al. Extended-field irradiation and intracavitary brachytherapy combined with cisplatin and amifostine for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of arm II of Radiation Therapy Oncology Group (RTOG) 0116. Int J Gynecol Cancer. 2011;21(7):1266–75. PubMed PMID: 21892091.

    PubMed  Google Scholar 

  214. Varia MA, Bundy BN, Deppe G, Mannel R, Averette HE, Rose PG, et al. Cervical carcinoma metastatic to para-aortic nodes: extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 1998;42(5):1015–23. PubMed PMID: 9869224.

    CAS  PubMed  Google Scholar 

  215. Ahmed RS, Kim RY, Duan J, Meleth S, De Los Santos JF, Fiveash JB. 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. Int J Radiat Oncol Biol Phys. 2004;60(2):505–12. PubMed PMID: 15380585.

    PubMed  Google Scholar 

  216. Esthappan J, Chaudhari S, Santanam L, Mutic S, Olsen J, Macdonald DM, et al. Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys. 2008;72(4):1134–9. PubMed PMID: 18472358.

    PubMed  Google Scholar 

  217. Gerszten K, Colonello K, Heron DE, Lalonde RJ, Fitian ID, Comerci JT, et al. Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix. Gynecol Oncol. 2006;102(2):182–8. PubMed PMID: 16516281.

    CAS  PubMed  Google Scholar 

  218. Beriwal S, Gan GN, Heron DE, Selvaraj RN, Kim H, Lalonde R, et al. Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2007;68(1):166–71. PubMed PMID: 17321070.

    PubMed  Google Scholar 

  219. Marnitz S, Lukarski D, Kohler C, Wlodarczyk W, Ebert A, Budach V, et al. Helical tomotherapy versus conventional intensity-modulated radiation therapy for primary chemoradiation in cervical cancer patients: an intraindividual comparison. Int J Radiat Oncol Biol Phys. 2011;81(2):424–30. PubMed PMID: 20864270.

    PubMed  Google Scholar 

  220. Milby AB, Both S, Ingram M, Lin LL. Dosimetric comparison of combined intensity-modulated radiotherapy (IMRT) and proton therapy versus IMRT alone for pelvic and para-aortic radiotherapy in gynecologic malignancies. Int J Radiat Oncol Biol Phys. 2012;82(3):e477–84. PubMed PMID: 22177626.

    PubMed  Google Scholar 

  221. Chen SW, Liang JA, Yeh LS, Yang SN, Shiau AC, Lin FJ. Comparative study of reference points by dosimetric analyses for late complications after uniform external radiotherapy and high-dose-rate brachytherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2004;60(2):663–71. PubMed PMID: 15380604.

    PubMed  Google Scholar 

  222. Grigsby PW, Williamson JF, Clifford Chao KS, Perez CA. Cervical tumor control evaluated with ICRU 38 reference volumes and integrated reference air kerma. Radiother Oncol. 2001;58(1):19–23. PubMed PMID: 11165677.

    CAS  PubMed  Google Scholar 

  223. Potter R, Van Limbergen E, Gerstner N, Wambersie A. Survey of the use of the ICRU 38 in recording and reporting cervical cancer brachytherapy. Radiother Oncol. 2001;58(1):11–8. PubMed PMID: 11165676.

    CAS  PubMed  Google Scholar 

  224. Purdy JA. Advances in three-dimensional treatment planning and conformal dose delivery. Semin Oncol. 1997;24(6):655–71. PubMed PMID: 9422262.

    CAS  PubMed  Google Scholar 

  225. Erickson B. CT guidance assists brachytherapy for gynecologic disease. Diag Imaging. 2000;22(11):167-71, 91. PubMed PMID: 11148961.

    CAS  Google Scholar 

  226. Erickson B. MRI and ultrasound guide gynecologic brachytherapy. Diag Imaging. 2000;22(12):78–83. PubMed PMID: 11146805.

    CAS  Google Scholar 

  227. Barillot I, Horiot JC, Maingon P, Bone-Lepinoy MC, Vaillant D, Feutray S. Maximum and mean bladder dose defined from ultrasonography. Comparison with the ICRU reference in gynaecological brachytherapy. Radiother Oncol. 1994;30(3):231–8. PubMed PMID: 8209007.

    CAS  PubMed  Google Scholar 

  228. Weitmann HD, Knocke TH, Waldhausl C, Potter R. Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma. Strahlenther Onkol. 2006;182(2):86–95. PubMed PMID: 16447015.

    PubMed  Google Scholar 

  229. Stock RG, Chan K, Terk M, Dewyngaert JK, Stone NN, Dottino P. A new technique for performing Syed-Neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance. Int J Radiat Oncol Biol Phys. 1997;37(4):819–25. PubMed PMID: 9128957.

    CAS  PubMed  Google Scholar 

  230. Nag S, Martinez-Monge R, Ellis R, Lewandowski G, Vacarello L, Boutselis JG, et al. The use of fluoroscopy to guide needle placement in interstitial gynecological brachytherapy. Int J Radiat Oncol Biol Phys. 1998;40(2):415–20. PubMed PMID: 9457830.

    CAS  PubMed  Google Scholar 

  231. Stuecklschweiger GF, Arian-Schad KS, Poier E, Poschauko J, Hackl A. Bladder and rectal dose of gynecologic high-dose-rate implants: comparison of orthogonal radiographic measurements with in vivo and CT-assisted measurements. Radiology. 1991;181(3):889–94. PubMed PMID: 1947116.

    CAS  PubMed  Google Scholar 

  232. Kapp KS, Stuecklschweiger GF, Kapp DS, Hackl AG. Dosimetry of intracavitary placements for uterine and cervical carcinoma: results of orthogonal film, TLD, and CT-assisted techniques. Radiother Oncol. 1992;24(3):137–46. PubMed PMID: 1410567.

    CAS  PubMed  Google Scholar 

  233. Coltart RS, Nethersell AB, Thomas S, Dixon AK. A CT based dosimetry system for intracavitary therapy in carcinoma of the cervix. Radiother Oncol. 1987;10(4):295–305. PubMed PMID: 3444907.

    CAS  PubMed  Google Scholar 

  234. Lee KR, Mansfield CM, Dwyer SJ 3rd, Cox HL, Levine E, Templeton AW. CT for intracavitary radiotherapy planning. AJR Am J Roentgenol. 1980;135(4):809–13. PubMed PMID: 6778118.

    CAS  PubMed  Google Scholar 

  235. Schoeppel SL, Fraass BA, Hopkins MP, La Vigne ML, Lichter AS, McShan DL, et al. A CT-compatible version of the Fletcher system intracavitary applicator: clinical application and 3-dimensional treatment planning. Int J Radiat Oncol Biol Phys. 1989;17(5):1103–9. PubMed PMID: 2808045.

    CAS  PubMed  Google Scholar 

  236. Schoeppel SL, LaVigne ML, Martel MK, McShan DL, Fraass BA, Roberts JA. Three-dimensional treatment planning of intracavitary gynecologic implants: analysis of ten cases and implications for dose specification. Int J Radiat Oncol Biol Phys. 1994;28(1):277–83. PubMed PMID: 8270452.

    CAS  PubMed  Google Scholar 

  237. Mai J, Rownd J, Erickson B. CT-guided high-dose-rate dose prescription for cervical carcinoma: the importance of uterine wall thickness. Brachytherapy. 2002;1(1):27–35. PubMed PMID: 15062184.

    PubMed  Google Scholar 

  238. Coia L, Won M, Lanciano R, Marcial VA, Martz K, Hanks G. The patterns of care outcome study for cancer of the uterine cervix. Results of the second national practice survey. Cancer. 1990;66(12):2451–6. PubMed PMID: 2249184.

    CAS  PubMed  Google Scholar 

  239. Heron DE, Gerszten K, Selvaraj RN, King GC, Sonnik D, Gallion H, et al. Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose-volume histograms. Gynecol Oncol. 2003;91(1):39–45. PubMed PMID: 14529660.

    CAS  PubMed  Google Scholar 

  240. Komaki R, Brickner TJ, Hanlon AL, Owen JB, Hanks GE. Long-term results of treatment of cervical carcinoma in the United States in 1973, 1978, and 1983: patterns of Care Study (PCS). Int J Radiat Oncol Biol Phys. 1995;31(4):973–82. PubMed PMID: 7860414.

    CAS  PubMed  Google Scholar 

  241. Logsdon MD, Eifel PJ. Figo IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy. Int J Radiat Oncol Biol Phys. 1999;43(4):763–75. PubMed PMID: 10098431.

    CAS  PubMed  Google Scholar 

  242. Eifel PJ, Moughan J, Owen J, Katz A, Mahon I, Hanks GE. Patterns of radiotherapy practice for patients with squamous carcinoma of the uterine cervix: patterns of care study. Int J Radiat Oncol Biol Phys. 1999;43(2):351–8. PubMed PMID: 10030261.

    CAS  PubMed  Google Scholar 

  243. Han K, Milosevic M, Fyles A, Pintilie M, Viswanathan AN. Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys. 2013;87(1):111–9. PubMed PMID: 23849695.

    PubMed  Google Scholar 

  244. Hareyama M, Sakata K, Oouchi A, Nagakura H, Shido M, Someya M, et al. High-dose-rate versus low-dose-rate intracavitary therapy for carcinoma of the uterine cervix: a randomized trial. Cancer. 2002;94(1):117–24. PubMed PMID: 11815967.

    PubMed  Google Scholar 

  245. Petereit DG, Sarkaria JN, Potter DM, Schink JC. High-dose-rate versus low-dose-rate brachytherapy in the treatment of cervical cancer: analysis of tumor recurrence—The University of Wisconsin experience. Int J Radiat Oncol Biol Phys. 1999;45(5):1267–74. PubMed PMID: 10613322.

    CAS  PubMed  Google Scholar 

  246. Lorvidhaya V, Tonusin A, Changwiwit W, Chitapanarux I, Srisomboon J, Wanwilairat S, et al. High-dose-rate afterloading brachytherapy in carcinoma of the cervix: an experience of 1992 patients. Int J Radiat Oncol Biol Phys. 2000;46(5):1185–91. PubMed PMID: 10725630.

    CAS  PubMed  Google Scholar 

  247. International Commission on Radiation Units and Measurements. ICRU Report 38: Dose and volume specification for reporting intracavitary therapy in gynecology. Bethesda: International Commission on Radiation Units and Measurements; 1985.

    Google Scholar 

  248. Brenner DJ, Hall EJ. Fractionated high dose rate versus low dose rate regimens for intracavitary brachytherapy of the cervix. I. General considerations based on radiobiology. Br J Radiol. 1991;64(758):133–41. PubMed PMID: 2004204.

    CAS  PubMed  Google Scholar 

  249. Erickson B, Eifel P, Moughan J, Rownd J, Iarocci T, Owen J. Patterns of brachytherapy practice for patients with carcinoma of the cervix (1996–1999): a patterns of care study. Int J Radiat Oncol Biol Phys. 2005;63(4):1083–92. PubMed PMID: 16099599.

    PubMed  Google Scholar 

  250. Bastin K, Buchler D, Stitt J, Shanahan T, Pola Y, Paliwal B, et al. Resource utilization. High dose rate versus low dose rate brachytherapy for gynecologic cancer. Am J Clin Oncol. 1993;16(3):256–63. PubMed PMID: 8338060.

    CAS  PubMed  Google Scholar 

  251. Sminia P, Schneider CJ, Koedooder K, van Tienhoven G, Blank LE, Gonzalez DG. Pulse frequency in pulsed brachytherapy based on tissue repair kinetics. Int J Radiat Oncol Biol Phys. 1998;41(1):139–50. PubMed PMID: 9588929.

    CAS  PubMed  Google Scholar 

  252. Kwekkeboom KL, Dendaas NR, Straub M, Bradley KA. Patterns of pain and distress during high-dose-rate intracavity brachytherapy for cervical cancer. J Support Oncol. 2009;7(3):108–14. PubMed PMID: 19507459.

    PubMed  Google Scholar 

  253. Houdek PV, Schwade JG, Abitbol AA, Pisciotta V, Wu XD, Serago CF, et al. Optimization of high dose-rate cervix brachytherapy; Part I: dose distribution. Int J Radiat Oncol Biol Phys. 1991;21(6):1621–5. PubMed PMID: 1938572.

    CAS  PubMed  Google Scholar 

  254. Falkenberg E, Kim RY, Meleth S, De Los Santos J, Spencer S. Low-dose-rate vs. high-dose-rate intracavitary brachytherapy for carcinoma of the cervix: the University of Alabama at Birmingham (UAB) experience. Brachytherapy. 2006;5(1):49–55. PubMed PMID: 16563997.

    PubMed  Google Scholar 

  255. Parker K, Gallop-Evans E, Hanna L, Adams M. Five years’experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-dose-rate brachytherapy: results from a single institution. Int J Radiat Oncol Biol Phys. 2009;74(1):140–6. PubMed PMID: 18922646.

    PubMed  Google Scholar 

  256. Wang X, Liu R, Ma B, Yang K, Tian J, Jiang L, et al. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev. 2010;7(7):CD007563. PubMed PMID: 20614461.

    PubMed  Google Scholar 

  257. Brenner DJ, Hall EJ, Huang Y, Sachs RK. Potential reduced late effects for pulsed brachytherapy compared with conventional LDR. Int J Radiat Oncol Biol Phys. 1995;31(1):201–2. PubMed PMID: 7995755.

    CAS  PubMed  Google Scholar 

  258. Charra-Brunaud C, Harter V, Delannes M, Haie-Meder C, Quetin P, Kerr C, et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol. 2012;103(3):305–13. PubMed PMID: 22633469.

    PubMed  Google Scholar 

  259. Refaat T, Nickers P, Lartigau E. Volume-based pulsed-dose-rate brachytherapy boosting concurrent chemoradiation as a definitive treatment modality in cervical cancer. Brachytherapy. 2014;13(1):80–7. PubMed PMID: 24246857.

    PubMed  Google Scholar 

  260. Kim SH, Choi BI, Lee HP, Kang SB, Choi YM, Han MC, et al. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology. 1990;175(1):45–51. PubMed PMID: 2315503.

    CAS  PubMed  Google Scholar 

  261. Erickson B, Albano K, Gillin M. CT-guided interstitial implantation of gynecologic malignancies. Int J Radiat Oncol Biol Phys. 1996;36(3):699–709. PubMed PMID: 8948356.

    CAS  PubMed  Google Scholar 

  262. Subak LL, Hricak H, Powell CB, Azizi L, Stern JL. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol. 1995;86(1):43–50. PubMed PMID: 7784021.

    CAS  PubMed  Google Scholar 

  263. Hricak H, Yu KK. Radiology in invasive cervical cancer. AJR Am J Roentgenol. 1996;167(5):1101–8. PubMed PMID: 8911159.

    CAS  PubMed  Google Scholar 

  264. Haie-Meder C, Potter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, et al. Recommendations from gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol. 2005;74(3):235–45. PubMed PMID: 15763303.

    PubMed  Google Scholar 

  265. Potter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol. 2006;78(1):67–77. PubMed PMID: 16403584.

    PubMed  Google Scholar 

  266. Nag S, Cardenes H, Chang S, Das IJ, Erickson B, Ibbott GS, et al. Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma: report from Image—Guided brachytherapy working group. Int J Radiat Oncol Biol Phys. 2004;60(4):1160–72. PubMed PMID: 15519788.

    PubMed  Google Scholar 

  267. Potter R, Dimopoulos J, Georg P, Lang S, Waldhausl C, Wachter-Gerstner N, et al. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer. Radiother Oncol. 2007;83(2):148–55. PubMed PMID: 17531904.

    PubMed  Google Scholar 

  268. Krempien RC, Daeuber S, Hensley FW, Wannenmacher M, Harms W. Image fusion of CT and MRI data enables improved target volume definition in 3D-brachytherapy treatment planning. Brachytherapy. 2003;2(3):164–71. PubMed PMID: 15062139.

    PubMed  Google Scholar 

  269. Al-Booz H, Boiangiu I, Appleby H, French C, Coomber H, Humphery P, et al. Sigmoid colon is an unexpected organ at risk in brachytherapy for cervix cancer. J Egypt Natl Canc Inst. 2006;18(2):156–60. PubMed PMID: 17496941.

    PubMed  Google Scholar 

  270. Kirisits C, Lang S, Dimopoulos J, Oechs K, Georg D, Potter R. Uncertainties when using only one MRI-based treatment plan for subsequent high-dose-rate tandem and ring applications in brachytherapy of cervix cancer. Radiother Oncol. 2006;81(3):269–75. PubMed PMID: 17126938.

    PubMed  Google Scholar 

  271. Lang S, Nesvacil N, Kirisits C, Georg P, Dimopoulos JC, Federico M, et al. Uncertainty analysis for 3D image-based cervix cancer brachytherapy by repetitive MR imaging: assessment of DVH-variations between two HDR fractions within one applicator insertion and their clinical relevance. Radiother Oncol. 2013;107(1):26–31. PubMed PMID: 23541645.

    PubMed  Google Scholar 

  272. Brooks S, Bownes P, Lowe G, Bryant L, Hoskin PJ. Cervical brachytherapy utilizing ring applicator: comparison of standard and conformal loading. Int J Radiat Oncol Biol Phys. 2005;63(3):934–9. PubMed PMID: 16199322.

    PubMed  Google Scholar 

  273. Koom WS, Sohn DK, Kim JY, Kim JW, Shin KH, Yoon SM, et al. Computed tomography-based high-dose-rate intracavitary brachytherapy for uterine cervical cancer: preliminary demonstration of correlation between dose-volume parameters and rectal mucosal changes observed by flexible sigmoidoscopy. Int J Radiat Oncol Biol Phys. 2007;68(5):1446–54. PubMed PMID: 17482766.

    PubMed  Google Scholar 

  274. Viswanathan AN, Dimopoulos J, Kirisits C, Berger D, Potter R. Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardized contours. Int J Radiat Oncol Biol Phys. 2007;68(2):491–8. PubMed PMID: 17331668.

    PubMed  Google Scholar 

  275. Nakamoto Y, Eisbruch A, Achtyes ED, Sugawara Y, Reynolds KR, Johnston CM, et al. Prognostic value of positron emission tomography using F-18-fluorodeoxyglucose in patients with cervical cancer undergoing radiotherapy. Gynecol Oncol. 2002;84(2):289–95. PubMed PMID: 11812089.

    PubMed  Google Scholar 

  276. Kirisits C, Potter R, Lang S, Dimopoulos J, Wachter-Gerstner N, Georg D. Dose and volume parameters for MRI-based treatment planning in intracavitary brachytherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2005;62(3):901–11. PubMed PMID: 15936576.

    PubMed  Google Scholar 

  277. Potter R, Georg P, Dimopoulos JC, Grimm M, Berger D, Nesvacil N, et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol. 2011;100(1):116–23. PubMed PMID: 21821305. Pubmed Central PMCID: 3165100.

    PubMed Central  PubMed  Google Scholar 

  278. De Hullu JA,H, Burger MP, et al. Vulvar carcinoma. The price of less radical surgery. Cancer. 2002;95(11):2331–8. PubMed PMID: 12436439.

    PubMed  Google Scholar 

  279. Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. 1990;38(3):309–14. PubMed PMID: 2227541.

    CAS  PubMed  Google Scholar 

  280. Rouzier R, Haddad B, Plantier F, Dubois P, Pelisse M, Paniel BJ. Local relapse in patients treated for squamous cell vulvar carcinoma: incidence and prognostic value. Obstet Gynecol. 2002;100(6):1159–67. PubMed PMID: 12468158.

    PubMed  Google Scholar 

  281. Farias-Eisner R, Cirisano FD, Grouse D, Leuchter RS, Karlan BY, Lagasse LD, et al. Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1-2N0-1M0) disease. Gynecol Oncol. 1994;53(1):55–8. PubMed PMID: 8175023.

    CAS  PubMed  Google Scholar 

  282. Chan JK, Sugiyama V, Pham H, Gu M, Rutgers J, Osann K, et al. Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis. Gynecol Oncol. 2007;104(3):636–41. PubMed PMID: 17095080.

    PubMed  Google Scholar 

  283. Montana GS, Thomas GM, Moore DH, Saxer A, Mangan CE, Lentz SS, et al. Preoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2000;48(4):1007–13. PubMed PMID: 11072157.

    CAS  PubMed  Google Scholar 

  284. Moore DH, Ali S, Koh WJ, Michael H, Barnes MN, McCourt CK, et al. A phase II trial of radiation therapy and weekly cisplatin chemotherapy for the treatment of locally-advanced squamous cell carcinoma of the vulva: a gynecologic oncology group study. Gynecol Oncol. 2012;124(3):529–33. PubMed PMID: 22079361.

    CAS  PubMed  Google Scholar 

  285. Balat O, Edwards CL, Verschraegen C, Delclos L. The long term results of radiotherapy with or without surgery in management of advanced vulvar cancer: report of 76 patients. Eur J Gynaecol Oncol. 2000;21(4):426–9. PubMed PMID: 11055502.

    CAS  PubMed  Google Scholar 

  286. Hacker NF, Berek JS, Juillard GJ, Lagasse LD. Preoperative radiation therapy for locally advanced vulvar cancer. Cancer. 1984;54(10):2056–61. PubMed PMID: 6488136.

    CAS  PubMed  Google Scholar 

  287. Rotmensch J, Rubin SJ, Sutton HG, Javaheri G, Halpern HJ, Schwartz JL, et al. Preoperative radiotherapy followed by radical vulvectomy with inguinal lymphadenectomy for advanced vulvar carcinomas. Gynecol Oncol. 1990;36(2):181–4. PubMed PMID: 2298406.

    CAS  PubMed  Google Scholar 

  288. Homesley HD, Bundy BN, Sedlis A, Adcock L. Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol. 1986;68(6):733–40. PubMed PMID: 3785783.

    CAS  PubMed  Google Scholar 

  289. Parthasarathy A, Cheung MK, Osann K, Husain A, Teng NN, Berek JS, et al. The benefit of adjuvant radiation therapy in single-node-positive squamous cell vulvar carcinoma. Gynecol Oncol. 2006;103(3):1095–9. PubMed PMID: 16889821.

    PubMed  Google Scholar 

  290. Kunos C, Simpkins F, Gibbons H, Tian C, Homesley H. Radiation therapy compared with pelvic node resection for node-positive vulvar cancer: a randomized controlled trial. Obstet Gynecol. 2009;114(3):537–46. PubMed PMID: 19701032.

    PubMed  Google Scholar 

  291. Dunn LJ, Napier JG. Primary carcinoma of the vagina. Am J Obstet Gynecol. 1966;96(8):1112–6. PubMed PMID: 5928467.

    CAS  PubMed  Google Scholar 

  292. Bergman F. Carcinoma of the ovary. A clinicopathological study of 86 autopsied cases with special reference to mode of spread. Acta Obstet Gynecol Scand. 1966;45(2):211–31. PubMed PMID: 4287500.

    CAS  PubMed  Google Scholar 

  293. Way S. Vaginal metastases of carcinoma of the body of the uterus. J Obstet Gynaecol Br Emp. 1951;58(4):558–72. PubMed PMID: 14880973.

    CAS  PubMed  Google Scholar 

  294. Tewari KS, Cappuccini F, Puthawala AA, Kuo JV, Burger RA, Monk BJ, et al. Primary invasive carcinoma of the vagina: treatment with interstitial brachytherapy. Cancer. 2001;91(4):758–70. PubMed PMID: 11241244.

    CAS  PubMed  Google Scholar 

  295. Frank SJ, Jhingran A, Levenback C, Eifel PJ. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005;62(1):138–47. PubMed PMID: 15850914.

    PubMed  Google Scholar 

  296. Reddy S, Saxena VS, Reddy S, Lee MS, Yordan EL, Graham JE, et al. Results of radiotherapeutic management of primary carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 1991;21(4):1041–4. PubMed PMID: 1917600.

    CAS  PubMed  Google Scholar 

  297. Spirtos NM, Doshi BP, Kapp DS, Teng N. Radiation therapy for primary squamous cell carcinoma of the vagina: Stanford University experience. Gynecol Oncol. 1989;35(1):20–6. PubMed PMID: 2792898.

    CAS  PubMed  Google Scholar 

  298. Perez CA, Grigsby PW, Garipagaoglu M, Mutch DG, Lockett MA. Factors affecting long-term outcome of irradiation in carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 1999;44(1):37–45. PubMed PMID: 10219792.

    CAS  PubMed  Google Scholar 

  299. Tran PT, Su Z, Lee P, Lavori P, Husain A, Teng N, et al. Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol. 2007;105(3):641–9. PubMed PMID: 17363046.

    PubMed  Google Scholar 

  300. Stock RG, Mychalczak B, Armstrong JG, Curtin JP, Harrison LB. The importance of brachytherapy technique in the management of primary carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 1992;24(4):747–53. PubMed PMID: 1429100.

    CAS  PubMed  Google Scholar 

  301. Rai B, Bansal A, Patel FD, Sharma SC. Radiotherapy for ovarian cancers—redefining the role. Asian Pac J Cancer Prev. 2014;15(12):4759–63. PubMed PMID: 24998538.

    PubMed  Google Scholar 

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Correspondence to William Small Jr. MD, FACRO, FACR, FASTRO .

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Refaat, T., Small, W. (2015). The Role of Radiation Therapy in the Treatment of Malignant Gynecological Tumors. In: Ehrenpreis, E., Marsh, R., Small Jr., W. (eds) Radiation Therapy for Pelvic Malignancy and its Consequences. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2217-8_1

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