Radiotherapy In Treatment Of Cancer Research Articles

Dosimetric comparison of supine versus prone radiotherapy techniques in patients with breast cancer

Early-stage breast cancer patients survive longer so a radiotherapy technique which can reduce late toxicity is important. In this study, we made a dosimetric comparison of supine and prone breast irradiation techniques in patients with left breast cancer. Ten patients scheduled for whole-breast radiotherapy after lumpectomy were included in this study. The patients underwent computed tomography scans in both supine and prone positions on a breast board. The breast was contoured as per standard guidelines. Treatment planning was done for both the positions. A dose of 40 Gy/15#/3 weeks was prescribed. Mean dose to the heart and left lung was calculated for each patient in the supine and prone positions. Dose-volume histograms were generated and compared between the two sets. Paired t test was applied to test the significance of difference between the mean doses received by the heart and left lung for the two techniques. The difference was considered statistically significant if p value was < 0.05. The heart and left lung were better spared in the prone position compared to supine. Mean heart dose in the supine and prone positions was 4.5558 Gy and 2.063 Gy (p = 0.02), respectively. Mean lung dose in the supine and prone positions was 6.5797 Gy and 0.8491 Gy (p = 0.001), respectively. Rotational setup error was noted in 3 and 1 patient in the prone position and supine position, respectively. The prone position for the radiotherapy treatment of left breast cancer was dosimetrically better than the supine position in terms of mean dose to the heart and left lung.

Stability Analysis of Radiotherapy Cancer Treatment Model with Fractional Derivative

This paper presents the condition for uniqueness, the stability analysis, and the bifurcation analysis of a mathematical model that simulates a radiotherapy cancer treatment process. The presented model was the previous cancer treatment model integrated with the Caputo fractional derivative and the Linear-Quadratic with the repopulation model. The metric space analysis was used to establish the conditions for the presence of unique fixed points for the model, which indicated the presence of unique solutions. After establishing uniqueness, the model was used to simulate the fractionated treatment process of six cancer patients treated with radiotherapy. The simulations of the cancer treatment process were done in MATLAB with numerical and radiation parameters. The numerical parameters were obtained from previous literature and the radiation parameters were obtained from reported clinical data. The solutions of the simulations represented the final volumes of tumors and normal cells. Subsequently, the initial values of the model were varied with 200 different values for each patient and the corresponding solutions were recorded. The continuity of the solutions was used to investigate the stability of the solutions with respect to initial values. In addition, the value of the Caputo fractional derivative was chosen as the bifurcation parameter. This parameter was varied with 500 different values to determine the bifurcation values. It was concluded that the solutions are unique and stable, hence the model is well-posed. Therefore, it can be used to simulate a cancer treatment process as well as to predict outcomes of other radiation protocols.

Radiation Treatment of Synchronous Gynaecologic Cancer: a Clinical Case

Introduction. Recent years have witnessed an increased incidence of multiple neoplasms. In multiple combined cancer, the choice of treatment strategy remains challenging, as two or more tumours require treatment in the shortest perspective. However, an intense treatment may induce many and severe complications with co-located organs and systems. No universal protocol or treatment standard for managing multiple primary cancers is accepted in Russia or worldwide.Materials and methods. The clinical case describes radiation treatment of a female patient with synchronous gynaecologic cancer of vagina and endometrium at the “TOOD” medical facility’s radiotherapy unit. Our treatment was designed to maximise the dosage targeting at a minimal off-coverage of healthy tissues. The treatment was conducted in two steps on an Elekta Synergy Platform S instrument, with the total duration of 62 days.Results and discussion. After radiotherapy, the patient had an oncologic and gynaecologic observation for one year. A complete tumour regression in two localities was confirmed visually, cytologically and instrumentally.Conclusion. A treatment strategy in multiple primary cancers should be personalised. With unfeasible “standard therapy”, alternative approaches for the patient’s treatment are to be explored. We report a successful therapy in a woman with synchronous gynaecologic cancer by applying remote conformal radiation in regional uterine cancers with simultaneous integrated boost to the vaginal tumour during the first radiation step. Brachytherapy at the second step was replaced with stereotactic radiation due to vaginal constriction, pain syndrome and unfeasible applicator installation.

Dermatologic sequelae of breast cancer: From disease, surgery, and radiation

The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.

Periodic solutions for a model of cell population subjected to general periodic radiation

In this work, we considered models with periodic radiation cancer treatment which describe the dynamics of cell populations in a tumor.This may also be used to consider dynamics of healthy tissue under periodic radiation exposure. We establish the existence of periodic orbits, byusing theory of cooperative systems. We give sufficient conditions for theuniqueness of the periodic solution which then becomes a global attractor.Numerical simulations are performed using specific radiation functions to illustrate our analytical findings.

Dosimetric characteristics of VMAT plans with respect to a different increment of gantry angle size for Ca cervix

AbstractAim:We have investigated the influence in volumetric-modulated arc therapy (VMAT) plans by a sequence of increment of gantry angle (IGA) in definitive radiotherapy treatment for cervical cancer. The plans are quantitatively analysed in terms of conformity index (CI), heterogeneity index (HI), dose–gradient index (DGI), target coverage (TC) by prescription dose, monitor unit (MU) usage, control points (CPs) and dose to organs.Materials and Methods:In this retrospective study, we selected 27 patients with cervical cancer having aged between 54 and 69. All the patients enrolled in this study were at T3N1M0 stage of cervical cancer. The prescription dose to planning target volume (PTV) was 50 Gy and was administered in 2 Gy/fraction through VMAT technique. VMAT plans were optimised by varying the parameter ‘IGA’ as 10, 20, 30 and 40°.Results:Homogenous dose distribution within PTV and TC by prescription dose was significantly enhanced (p &lt; 0·05) with larger IGA. The difference between volume receiving 15 Gy (V15Gy) in bowel was up to 10% with larger IGA (30 and 40°) and V25Gy in femoral head was up to 3% with smaller IGA (10 and 20°). CPs were enhanced and MU usage was reduced with larger IGA (30 and 40°). IGA 40° had reduced the MU usage than IGA 30° but the CI and DGI were compromised due to large MLC field segments.Conclusion:This study recommends that the larger IGA could yield better results when the number of sectors is even, for a cervical cancer patient. However, more data from more patients need to be obtained and analysed to make this an evidence-based hypothesis.

Long-Term Maintenance of Acinar Cells in Human Submandibular Glands After Radiation Therapy

In a combined retrospective and prospective study, human salivary glands were investigated after radiation treatment for head and neck cancers. The aim was to assess acinar cell loss and morphologic changes after radiation therapy and to determine whether irradiated salivary glands have regenerative potential. Irradiated human submandibular and parotid salivary glands were collected from 16 patients at a range of time intervals after completion of radiation therapy (RT). Control samples were collected from 14 patients who had not received radiation treatments. Tissue sections were analyzed using immunohistochemistry to stain for molecular markers. Human submandibular and parotid glands isolated less than 1 year after RT showed a near complete loss of acinar cells. However, acinar units expressing functional secretory markers were observed in all samples isolated at later intervals after RT. Significantly lower acinar cell numbers and increased fibrosis were found in glands treated with combined radiation and chemotherapy, in comparison to glands treated with RT alone. Irradiated samples showed increased staining for duct cell keratin markers, as well as many cells coexpressing acinar- and duct cell-specific markers, in comparison to nonirradiated control samples. After RT, acinar cell clusters are maintained in human submandibular glands for years. The surviving acinar cells retain proliferative potential, although significant regeneration does not occur. Persistent DNA damage, increased fibrosis, and altered cell identity suggest mechanisms that may impair regeneration.

3D image-guided interstitial brachytherapy for primary vaginal cancer: A multi-institutional experience

Purpose/objectivesHigh dose rate (HDR) interstitial brachytherapy (ISBT) boost is integral for definitive radiation treatment of primary vaginal cancer. Technological advances with CT or MRI guidance provide improved precision and ability to treat more extensively invasive tumors over historical techniques, but reported experience is limited. We sought to provide updated outcome and toxicity data for women with primary vaginal cancer undergoing treatment with a modern ISBT technique. Material/methodsDatabases of primary vaginal carcinoma patients treated at two Canadian academic cancer institutions were combined including patient, tumor and treatment characteristics, and survival outcomes and toxicity data. Descriptive statistics, survival estimates based on the Kaplan-Meier method, and univariable/multivariable Cox proportional hazards regression analyses are reported. ResultsBetween 2002 and 2017, 67 women with primary vaginal cancer were treated with 3D HDR ISBT. FIGO stage distribution was I (22.4%), II (50.8%), III (17.9%), IVa (9.0%). All patients received external beam radiotherapy and HDR ISBT of 500–750 cGy per fraction over 2–4 fractions. Median follow-up was 2.68 years (95% confidence interval: 2.04–6.04). Cumulative rate of grade 3–4 genitourinary/gastrointestinal toxicity was 10.4%. Four patients developed vaginal fistula. Progression-free survival at 2 and 3 years was 73.5% and 66.4% for all patients, 78.3% and 75.0% for stage I-II and 61.6% and 46.2% for stage III-IVa, respectively (log-rank p = 0.252). ConclusionsUse of 3D image-guided HDR ISBT boost was safe and resulted in improved survival outcomes compared to historical rates in this series of primary vaginal cancer patients. Prospective study is warranted to better define clinical and dosimetric predictors of local control.

Anatomically-adaptive multi-modal image registration for image-guided external-beam radiotherapy

Image-guided radiotherapy (IGRT) allows observation of the location and shape of the tumor and organs-at-risk (OAR) over the course of a radiation cancer treatment. Such information may in turn be used for reducing geometric uncertainties during therapeutic planning, dose delivery and response assessment. However, given the multiple imaging modalities and/or contrasts potentially included within the imaging protocol over the course of the treatment, the current manual approach to determining tissue displacement may become time-consuming and error prone. In this context, variational multi-modal deformable image registration (DIR) algorithms allow automatic estimation of tumor and OAR deformations across the acquired images. In addition, they require short computational times and a low number of input parameters, which is particularly beneficial for online adaptive applications, which require on-the-fly adaptions with the patient on the treatment table.However, the majority of such DIR algorithms assume that all structures across the entire field-of-view (FOV) undergo a similar deformation pattern. Given that various anatomical structures may behave considerably different, this may lead to the estimation of anatomically implausible deformations at some locations, thus limiting their validity. Therefore, in this paper we propose an anatomically-adaptive variational multi-modal DIR algorithm, which employs a regionalized registration model in accordance with the local underlying anatomy. The algorithm was compared against two existing methods which employ global assumptions on the estimated deformations patterns.Compared to the existing approaches, the proposed method has demonstrated an improved anatomical plausibility of the estimated deformations over the entire FOV as well as displaying overall higher accuracy. Moreover, despite the more complex registration model, the proposed approach is very fast and thus suitable for online scenarios. Therefore, future adaptive IGRT workflows may benefit from an anatomically-adaptive registration model for precise contour propagation and dose accumulation, in areas showcasing considerable variations in anatomical properties.

SP-0266: Scheduling radiotherapy and drug treatments for pancreatic cancer

SP-0266: Scheduling radiotherapy and drug treatments for pancreatic cancer

PO-1101: Intensity-modulated radiotherapy treatment of anal cancer: single-institution outcomes

PO-1101: Intensity-modulated radiotherapy treatment of anal cancer: single-institution outcomes

PH-0163: Harmonization of breast cancer radiotherapy treatment planning in the Netherlands

PH-0163: Harmonization of breast cancer radiotherapy treatment planning in the Netherlands

A Prospective Randomized Trial of the Influence of Music on Anxiety in Patients Starting Radiation Therapy for Cancer

One of the most downloaded articles in 2017 from the International Journal of Radiation Oncology, Biology, and Physics was a study suggesting that music therapy during radiation therapy (RT) simulation substantially reduces anxiety. To further evaluate the potential of music's clinical efficacy in the context of radiation therapy, we conducted a randomized trial evaluating the influence of genre-based music chosen by the study participant on anxiety during the first RT treatment session with a method that is applicable to routine clinical practice. We conducted a prospective randomized trial of music versus no music during the first RT treatment for cancer. We limited the study to women because prior studies document a higher rate of anxiety in female patients with cancer. Anxiety was evaluated before and after the first RT treatment using the State-Trait Anxiety Inventory (STAI) and Symptom Distress Thermometer (SDT). Patients randomized to music had their preferred genre of music played from a web-based application while in the treatment vault. In the study, 102 females were enrolled (51 with and 51 without music). Baseline high anxiety score before RT was recorded in 48% of patients using the STAI and 58% using the SDT. The percent decrease in mean STAI score was 16% with music versus 10% without music (P = .2197). The mean SDT percent changes were a 13% decrease with music versus a 2% increase without music (P = .3298). This study documents that high anxiety is common in women receiving RT for cancer and that music, as used in this study, does not reduce anxiety to a meaningful degree.

Cardiorespiratory Fitness is a Strong, Independent Predictor of Radiation Induced Fatigue in Breast Cancer

Fatigue is among the most common but most poorly understood toxicities of patients undergoing radiation treatment for primary breast cancer, predisposing to poor quality of life, treatment non-compliance and comorbidity. In this prospective study, we sought to investigate whether an integrative measure of cardiopulmonary function under exercise conditions (cardiorespiratory fitness as evaluated by peak oxygen consumption, VO2peak) predicted fatigue in patients with early stage breast cancer undergoing radiation treatment. Patients with stage Tis-T2N0M0 breast cancer undergoing radiation to the breast performed a symptom-limited cardiopulmonary exercise test (CPET) on an electronic motorized treadmill test with 12-lead ECG monitoring (Mac® 5000, GE Healthcare) to assess cardiorespiratory fitness (VO2peak; ml O2.kg-1.min-1) according to standard procedures. Fatigue was assessed by the FACIT fatigue scale survey. Both assessments were performed during or after radiation therapy (typically within 30 days). To isolate the effects of radiation on fatigue and VO2peak, patients who received cytotoxic chemotherapy were excluded. All patients were treated with an opposed tangent technique to a dose of 4240 cGy in 16 fractions +/- a lumpectomy bed boost of 1000 cGy in 4 fractions. Twenty-eight patients (median age: 51.5, range 31-71) successfully performed both CPET and the FACIT surveys. The mean VO2 peak was 26.7 ml O2.kg-1.min-1(range 16.7- 41.7). The mean fatigue score was 38.6 (range 10-52, lower values indicating more fatigue). In age-adjusted analysis, lower VO2peak was a significant predictor of fatigue (r (25) = 0.49, n = 28, p = 0.009). Radiation-induced fatigue appears to be driven by a decrease in global cardiopulmonary function. Larger prospective studies are needed to further investigate this novel finding.

Chemotherapy combined with radiotherapy for successful treatment of angioimmunoblastic T-cell lymphoma: a case report

BackgroundThe incidence of angioimmunoblastic T-cell lymphoma is rare worldwide, and it has a poor prognosis. There is no proven or standard first-line therapy that works for the majority of patients with angioimmunoblastic T-cell lymphoma because of the rarity of this disease. The treatment and management are challenging for clinicians.Case presentationThis report presents the diagnosis and treatment of a 65-year-old Chinese man who presented with cough and lymph node swellings in the left axillary region. The patient was diagnosed with angioimmunoblastic T-cell lymphoma. He underwent eight cycles of chemotherapy with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) followed by TOMO radiotherapy (helical tomotherapy, a kind of radiotherapy for cancer treatment using spiral computed tomographic scanning). After treatment, the therapeutic effects were evaluated by magnetic resonance imaging and computed tomography about every 3 months. The patient recovered well with no sign of tumor recurrence and no obvious severe treatment-related adverse effects.ConclusionThis treatment experience indicates an essential role for the combination of radiation therapy with CHOP, which may have a better prognosis than treatments without radiation therapy. But challenges warrant further validation in prospective studies.

Preparation and Evaluation of Rebamipide Colloidal Nanoparticles Obtained by Cogrinding in Ternary Ground Mixtures

Aphthous stomatitis is one of the side effects of chemotherapy and radiotherapy in cancer treatment. Rebamipide (RB) mouthwash for stomatitis acts as a radical scavenger. However, RB is poorly soluble in water, which leads to aggregation and precipitation of the dispersoid. The particle size of the drug needs to be less than 100 nm for the particles to reach the mucus layer in the oral cavity. In this study, we attempted to prepare nanoparticles of RB by cogrinding with polyvinylpyrrolidone (PVP) or hydroxypropyl cellulose (HPC) and sodium dodecyl sulfate (SDS) using a mixer ball mill, and evaluated the physicochemical properties of RB nanoparticles, the stability of dispersion in water, and permeation of the mucus layer in vitro. By cogrinding, the particle size decreased to around 110 nm, and powder X-ray diffraction (PXRD) of the particles showed totally broad halo patterns, which suggested a decreased crystalline region. Furthermore, the solubility of RB nanoparticles increased by approximately fourfold compared with RB crystals, and the water dispersibility and permeation of the mucus layer were improved. The results suggest that in a ternary ground mixture of RB, PVP or HPC, and SDS, the RB nanoparticles obtained can be applied as a formulation for stomatitis.

Genetically-regulated transcriptomics & copy number variation of proctitis points to altered mitochondrial and DNA repair mechanisms in individuals of European ancestry

BackgroundProctitis is an inflammation of the rectum and may be induced by radiation treatment for cancer. The genetic heritability of developing radiotoxicity and prior role of genetic variants as being associated with side-effects of radiotherapy necessitates further investigation for underlying molecular mechanisms. In this study, we investigated gene expression regulated by genetic variants, and copy number variation in prostate cancer survivors with radiotoxicity.MethodsWe investigated proctitis as a radiotoxic endpoint in prostate cancer patients who received radiotherapy (n = 222). We analyzed the copy number variation and genetically regulated gene expression profiles of whole-blood and prostate tissue associated with proctitis. The SNP and copy number data were genotyped on Affymetrix® Genome-wide Human SNP Array 6.0. Following QC measures, the genotypes were used to obtain gene expression by leveraging GTEx, a reference dataset for gene expression association based on genotype and RNA-seq information for prostate (n = 132) and whole-blood tissue (n = 369).ResultsIn prostate tissue, 62 genes were significantly associated with proctitis, and 98 genes in whole-blood tissue. Six genes - CABLES2, ATP6AP1L, IFIT5, ATRIP, TELO2, and PARD6G were common to both tissues. The copy number analysis identified seven regions associated with proctitis, one of which (ALG1L2) was also associated with proctitis based on transcriptomic profiles in the whole-blood tissue. The genes identified via transcriptomics and copy number variation association were further investigated for enriched pathways and gene ontology. Some of the enriched processes were DNA repair, mitochondrial apoptosis regulation, cell-to-cell signaling interaction processes for renal and urological system, and organismal injury.ConclusionsWe report gene expression changes based on genetic polymorphisms. Integrating gene-network information identified these genes to relate to canonical DNA repair genes and processes. This investigation highlights genes involved in DNA repair processes and mitochondrial malfunction possibly via inflammation. Therefore, it is suggested that larger studies will provide more power to infer the extent of underlying genetic contribution for an individual’s susceptibility to developing radiotoxicity.

Gene Expression Profiling Identifies Akt as a Target for Radiosensitization in Gastric Cancer Cells.

BackgroundDespite the important role of radiotherapy in cancer treatment, a subset of patients responds poorly to treatment majorly due to radioresistance. Particularly the role of radiotherapy has not been established in gastric cancer (GC). Herein, we aimed to identify a radiosensitivity gene signature and to discover relevant targets to enhance radiosensitivity in GC cells.MethodsAn oligonucleotide microarray (containing 22,740 probes) was performed in 12 GC cell lines prior to radiation. A clonogenic assay was performed to evaluate the survival fraction at 2 Gy (SF2) as a surrogate marker for radiosensitivity. Genes differentially expressed (fold change > 6, q-value < 0.025) were identified between radiosensitive and radioresistant cell lines, and quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) was performed for validation. Gene set and pathway analyses were performed using Ingenuity Pathway Analysis (IPA).ResultsRadiosensitive (SF2 < 0.4) and radioresistant cell lines (SF2 ≥ 0.6) exhibited a marked difference in gene expression. We identified 68 genes that are differentially expressed between radiosensitive and radioresistant cell lines. The identified genes showed interactions via AKT, HIF1A, TGFB1, and TP53, and their functions were associated with the genetic networks associated with cellular growth and proliferation, cellular movement, and cell cycle. The Akt signaling pathway exhibited the highest association with radiosensitivity. Combinatorial treatment with MK-2206, an allosteric Akt inhibitor, and radiotherapy significantly increased cell death compared with radiotherapy alone in two radioresistant cell lines (YCC-2 and YCC-16).ConclusionWe identified a GC-specific radiosensitivity gene signature and suggest that the Akt signaling pathway could serve as a therapeutic target for GC radiosensitization.

Effects of Low Dose Radiation on Biological Processes in Peri-tumoral and Tumoral Areas n Squamous Cell Skin Cancer

Very low dose ionizing radiation (LDR) may have paradoxically beneficial effects via an adaptive response. This adaptive response can mitigate against the potential adverse effects of high-dose radiation therapy and chemotherapy. In this study we aimed to:1.identify the specific molecular details behind the adaptive response to LDR and2.integrate the LDR adaptive response into clinical practice. Our aim was to determine how low dose radiation modifies genetic expression in both healthy and tumor tissue. To determine this, a human clinical trial (n=8) was conducted in 2018 to ascertain the biological effects of integrating 0.1Gy of LDR into standard radiotherapy (2Gy fractions) over the first two weeks of radiation treatment for epidermoid skin cancers. RNA was obtained from skin biopsies and processed for genetic expression using Affymetrix Human gene chips Clarion-D (138K genes). 8 patients with squamous skin cancer, were studied according to the experimental design showed in Figure 1. Biopsy samples were collected and total RNA preparation (100 ng), labeled cRNA synthesis, hybridization, scanning, and image analysis were performed. Changes in biological response were measured using Affymetrix microarrays. Experiments 17F1 and 17F2 were performed in duplicate, and experiments 18F3 and 18F4 were performed in triplicate. Pathway analysis was performed using the Affymetrix Transcriptome Analysis Console software and the Wikipaths database. Comparisons were performed as noted in Table 1. The difference in gene expression in healthy tissues due to LDR exposure is quite low (only 325 genes, mostly downregulated) as noted in Figures 2A and 3A and Tables 2 and 3. The 20 most important biological processes enriched are shown in Figure 4 and include Senescence and Autophagy in malignant cells, and the Genotoxicity Pathway (both downregulated). The difference in gene expression in tumor tissue due to LDR exposure is significantly more pronounced (5,651 genes, mostly upregulated) as noted in Figures 2C and 3C. The 20 most important biological processes enriched are shown in Figures 5 and 6 and Tables 4-6, and include the Allograft rejection pathway in skin cancer (upregulated). Our results suggest that very low doses of radiation (0.1Gy) have a narrow effect on gene expression when applied in the healthy peritumoral area. Down regulated genes predominate, and DNA repair mechanisms are stimulated by the first low dose in healthy tissue.

Acute chemoradiotherapy toxicity in cervical cancer patients.

During radiotherapy treatment for cervical cancer, up to 84% of patients exhibit some form of acute radiation toxicity (ART). The primary aim of this clinical study is to determine the impact of angiotensin-converting enzyme (ACE) inhibitors, β-blockers and other risk factors such as the patient’s anatomical characteristics on ART emergence in patients with locally advanced cervical cancer treated by chemoradiotherapy. This is a combination of two nested case–control studies within the cohort of patients with locally advanced cervical cancer based on the analysis of potential risk factors for the onset of ART in patients treated with 3D conformal radiotherapy (3D-CRT) and 2D conventional radiotherapy (2D-RT), prospectively followed up from January 2017 to September 2018 in a tertiary care hospital. The ACE inhibitors and bladder volume were identified as factors that significantly affect the occurrence of ART in patients treated with 3D-CRT. In patients treated with 2D-RT, the factors that significantly affect the occurrence of ART were ACE inhibitors, body mass index (BMI), brachytherapy rectal and bladder dose. This study has shown that BMI, radiation dose received by the bladder and rectum are of exceptional importance for the occurrence of the ART and also that therapy with ACE inhibitors was associated with the decreased chances of the ART.