A therapy protocol, applicator guided intensity modulated radiation therapy (AGIMRT), is proposed for locally advanced cervical cancers (LACC). This novel radiation therapy modality can provide highly conformal and accurately localized external beam therapy as an alternative to high-dose rate (HDR) brachytherapy treatments. A brachytherapy applicator substitute is designed which provides an accurate, reproducible method for determining the tumor and critical structure locations relative to the applicator. Magnetic resonance imaging techniques will be modified to minimize spatial distortions and used to accurately map the applicator and surrounding soft tissues. The applicator substitute allows alignment of the tumor and organs to an IMRT treatment device, which can generate dose distributions superior to those produced using sealed-source intracavitary brachytherapy. AGIMRT treatment plans will have customized concave dose distributions that simultaneously deliver optimal tumor coverage and critical structure sparing. Two multidimensional dosimeters, Radiochromic film and BANG (Bis, Acrylamide, Nitrogen, and Gelatin) gel, will be benchmarked and calibrated to measure the expected steep dose gradients of AGIMRT dose distributions. We believe this novel LACC treatment modality offers the radiation oncologist unparalleled flexibility in dose distribution design, leading to the potential for significant improvement in local control.
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