Importance of training in external beam treatment planning for locally advanced cervix cancer: Report from the EMBRACE II dummy run

Yvette Seppenwoolde*, Marianne Sanggaard Assenholt, Epidemiological Study of Familial Breast Cancer (EMBRACE), Dietmar Georg, Remi Nout, Li Tee Tan, Tamara Rumpold, Astrid de Leeuw, Ina Jürgenliemk-Schulz, Christian Kirisits, Richard Pötter, Jacob Christian Lindegaard, Kari Tanderup

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


Background and purpose: The EMBRACE II study combines state-of-the-art Image-Guided Adaptive Brachytherapy in cervix cancer with an advanced protocol for external beam radiotherapy (EBRT) which specifies target volume selection, contouring and treatment planning. In EMBRACE II, well-defined EBRT is an integral part of the overall treatment strategy with the primary aim of improving nodal control and reducing morbidity. The EMBRACE II EBRT planning concept is based on improved conformality through relaxed coverage criteria for all target volumes. For boosting of lymph nodes, a simultaneous integrated boost and coverage probability planning is applied. Before entering EMBRACE II, institutes had to go through accreditation. Material and methods: As part of accreditation, a treatment planning dummy-run included educational blocks and submission of an examination case provided by the study coordinators. Seventy-one centers submitted 123 EBRT dose distributions. Replanning was required if hard constraints were violated or planning concepts were not fully accomplished. Dosimetric parameters of original and revised plans were compared. Results: Only 11 plans violated hard constraints. Twenty-seven centers passed after first submission. 27 needed one and 13 centers needed more revisions. The most common reasons for revisions were low conformality, relatively high OAR doses or insufficient lymph node coverage reduction. Individual feedback on planning concepts improved plan quality considerably, resulting in a median body V43Gy reduction of 158 cm 3 from first plan submission to approved plan. Conclusion: A dummy-run as applied in EMBRACE II, consisting of training and examination cases enabled us to test institutes’ treatment planning capabilities, and improve plan quality.

Original languageEnglish
Pages (from-to)149-155
Number of pages7
JournalRadiotherapy and Oncology
Publication statusPublished - Apr 2019

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Publisher Copyright: © 2019 Elsevier B.V.


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