Online Adaptive Radiotherapy Cervical Cancer With Reduced Margin for Cervical Cancer

Prior treatment

• Prior surgery (including pelvic or para-aortic lymph nodes resection, except for tumor biopsy), radiotherapy or chemotherapy to primary tumor or nodes.
• History of previous radiotherapy to the abdomen or pelvis.

Other illness

• Prior malignancy.
• Active inflammatory bowel disease, or history of severe stomach or duodenal ulcer.
• Active infection with fever.
• Any severe disease which may bring unacceptable risk or affect the compliance of the trial, for example, unstable cardiac disease requiring treatment, renal disease, chronic hepatitis, diabetes with poor control, and emotional disturbance.

Other

• With common iliac MLNs.
• Tumor extended to the lower third of the vagina.
• Tumor spread to mucosa of the bladder or rectum.
• Pregnancy or lactation.
• Patients with unacceptable risk that intracavitary brachytherapy can not be conducted.

• Patients must be informed of the investigational nature of this study and give written informed consent before treatment.
• Age ≥18 years and ≤ 75 years.
• Patients with newly histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma, et al.
• No evidence of para-aortic metastatic lymph nodes (MLNs) and inguinal lymph nodes on CT, MRI or positron emission tomograph (PET)/CT.
• No contraindications to CT scanning.
• No evidence of distant metastasis (FIGO stage IVB).
• Adequate marrow: neutrophile granulocyte count ≥1.5\*10\^9/L, hemoglobin ≥ 80 g/L, platelet count ≥100\*10\^9/L.
• Normal liver and kidney function: Creatinine (Cr) \< 1.5 mg/dl, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) \< 2\*upper limit of normal (ULN).