In your practice, what is your goal dose for boosting positive PA nodes in either the adjuvant or definitive treatment for cervical cancer?

The dose of RT is based on the risk of tumor recurrence tempered by normal tissue constraints. In general, known or suspected gross nodal disease is treated to 60 Gy; higher doses of 62-66 Gy may be used for large nodes that are not immediately adjacent to the duodenum, particularly if a portion of the boost is integrated with the CTV treatment. If the nodal disease has been resected without evidence of ECE and without evidence of residual nodal disease on postop scans, we typically treat to 45 Gy. If there was evidence of ECE, we treat a high-risk CTV to 55-60 Gy, depending on the location and the amount of perinodal infiltration.

The most important dose-limiting structure beyond kidney and spinal cord tends to be the duodenum, which cross...