Original Research Article
Year: 2020 | Month: July-September | Volume: 5 | Issue: 3 | Pages: 278-280
Evaluation of Aortic Bifurcation in Cervical Cancer Patients
Shilpa Kaushal1, Muninder Negi2, Neha Bhardwaj3
1Medical Officer, Department of Radiotherapy and Oncology, Dr. RPGMC, Kangra at Tanda, Himachal Pradesh, India
2Professor, Department of Radiotherapy and Oncology, Dr. RPGMC, Kangra at Tanda, Himachal Pradesh, India
3Medical Officer (Anaesthesia), Health & Family Welfare Department, Himachal Pradesh, India
Corresponding Author: Neha Bhardwaj
ABSTRACT
Background: Cervical cancer is the second most common cancer in Indian women.
External Beam Radiotherapy (EBRT) and brachytherapy play an important role in the management of carcinoma cervix. EBRT treatment portals are designed to adequately cover the areas of gross and microscopic disease. The superior border of radiation portal is placed at L4-L5 intervertebral space to cover common iliac nodes, which lie caudal to the aortic bifurcation. The present study was done to evaluate the level of aortic bifurcation in relation to lumbar vertebrae in cervical cancer patients to reconsider the level of superior border of radiation portal while radiotherapy (RT) planning.
Methods: This retrospective study included cervical cancer patients who received EBRT from March 2019 to June 2020. Evaluation of level of aortic bifurcation was done on treatment planning system using computed tomography (CT) simulation images of the patients.
Results: We observed that aortic bifurcation occurred above the L4–L5 intervertebral space in 81.3% of the patients. The most common site of aortic bifurcation was at the level of L4 vertebral body i.e. in 64.1% of cases.
Conclusions: It is highly recommended to use CT based RT planning where the superior border of RT treatment portal should be placed considering individual patient anatomy. With conventional X-ray based planning, the superior border of RT portal may be shifted upwards at the level of L3-L4 intervertebral space to adequately cover the common iliac lymph node region. However, the benefit of extending the border must be weighed against the toxicities.
Keywords: Cervical cancer, aortic bifurcation, radiotherapy, treatment portal