Radiochemotherapy
CERVICAL CANCER
Radiotherapy planning was performed with two computed tomography (CT) scans (full and empty bladder) with an immobilization ProSTEP (ITV, Innsbruck, Austria) device, which aided patient positioning, and a rectal balloon (in 17 of 25 patients). Target volume delineation of the clinical target volume (CTV) and organs-at-risk (OAR) was performed on CT planning image slices with 3 mm thicknesses on full-bladder CT scans and followed RTOG consensus guidelines for endometrial and cervical cancer [Radiotherapy was delivered with a dose of 45–50.4 Gy [relative biological effectiveness (RBE)] in daily fractions of 5–6 × 1.8 Gy (RBE) per week using active raster scanning proton beam radiotherapy and posterior oblique beams with a median of two beams. Proton RBE was based on a fixed RBE relative to high-energy photons of 1.1. Daily orthogonal X-ray-based image guidance and regular CT scan treatment verification was applied. A high-dose-rate brachytherapy boost of 10 Gy using Iridium-192 in two fractions was applied to the upper two thirds of the vaginal cuff and at 5 mm depth to the vaginal mucosa with an intracavitary single vaginal cylinder after the end of proton beam therapy.Chemotherapy was not a mandatory part of the study trial protocol. If indicated, simultaneous weekly cisplatin (40 mg/m