Surekha Goyal, Surya Prakash Vankina, Geeta S Narayanan

AN AUDIT OF AORTIC BIFURCATION LEVEL IN PATIENTS WITH CERVIX CANCER – IMPLICATIONS FOR RADIATION THERAPY PLANNING

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OBJECTIVES : To assess the level of aortic bifurcation concerning lumbar vertebra in patients with carcinoma cervix and to discuss the implications for radiation therapy planning for target coverage, toxicity, and treatment techniques. In this retrospective observational METHODS: study (n=1004), vertebral level of aortic bifurcation in patients diagnosed (histological) to have carcinoma cervix as been measured on radiation planning CT scan and categorised into those occurring at interspace and at the level of the vertebral body. Aortic bifurcation occurred RESULTS: above L4-5 interspace in 83% of patients. The commonest site of bifurcation was observed opposite the body of the L4 vertebra (68 %) followed by L4-L5 interspace (12%) and L3-L4 interspace (9.4%). Of note, one (0.1%) patient had a very high level of bifurcation at the level of L2-L3 interspace. In conclusion, L4-L5 as the superior border of the radiation eld increase CONCLUSION: s the risk of nodal failure in the common iliac region. The radiation eld should encompass the aortic bifurcation with a sufcient margin for setup error and beam penumbra. An increase in GI toxicity as a result of a higher bifurcation level should be mitigated by the use of conformal techniques

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