Table 8.

Target volume definitions for image guided brachytherapy⁸¹

Volume	Components	Dose goals
GTV	Gross tumor at the time of brachytherapy, determined by imaging or examination	At a minimum, dose should be ≥8000 cGy
HR-CTV	GTV, the entire cervix, and regions of indeterminate T2-weighted MRI signal (ie, gray zones)	D90 ≥8000 cGy, with consideration of escalation for advanced disease or poor response to initial therapy
IR-CTV	HR-CTV with an asymmetrical expansion,* not extending into OARs, and including sites of initial disease involvement	Optional: D90 ≥6000 cGy, with consideration of escalation for advanced disease

Abbreviations: GTV = gross tumor volume; HR-CTV = high-risk target volume; IR-CTV = intermediate-risk target volume; MRI = magnetic resonance imaging; OARs = organs at risk.

^*The IR-CTV expansion is 0.5–1.0 cm globally with an additional 0.5 cm superiorly into the uterus, inferiorly into the vagina, and laterally in bilateral paracervical tissues.