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The last 2 decades have witnessed the development and broad adoption of image-guided adaptive brachytherapy (IGABT) combined with radiochemotherapy in patients with locally advanced cervical cancer. A variety of brachytherapy techniques and dose/fractionation schedules have been applied, and until recently, there was no strong evidence available for preferring one approach to another. However, large volumes of data have now provided high level clinical evidence for dose-effect relations for both disease and morbidity endpoints. It is therefore now possible to apply evidence based dose planning aims and dose prescription protocols in IGABT for locally advanced cervical cancer. This review gives an overview of targets/organs-at-risk and disease/morbidity endpoints which are relevant in the context of treatment planning and dose prescription in IGABT. The dosimetric and clinical evidence is summarized to support the implementation of dose prescription protocols which include hard and soft constraints for targets and organs at risk. [ABSTRACT FROM AUTHOR]

During the last decade the adoption of image-guided adaptive brachytherapy has dramatically improved local control in patients with locally advanced cervical cancer (LACC) treated with radiotherapy and concomitant chemotherapy; however, nodal failure remains an obstacle. Metastatic lymph nodes can be detected by surgical and imaging approaches with different sensitivities and specificities, that improve the definition of relevant targets for macroscopic and microscopic nodal disease, and that influence our understanding of dose levels of external beam radiotherapy. Systematic use of modern radiotherapy techniques including intensity modulated radiotherapy and simultaneously integrated nodal boosts in combination with daily position verification is emerging as increasingly important for obtaining nodal control in LACC. This review summarizes published and ongoing efforts for optimizing nodal disease treatment in LACC, elaborates the state of the art approach for nodal disease detection, radiotherapy planning and delivery, and discusses future investigational efforts needed for precise optimization. [ABSTRACT FROM AUTHOR]

This study relied on the theory of planned behavior (TPB) to identify the beliefs that influence young people's pro-environmental behavior. High-school students completed a questionnaire regarding the performance of pro-environmental behaviors early in the school year and reported on their behavior toward the end of the year. In addition to the standard TPB constructs, the initial questionnaire assessed descriptive norms, moral norms, sex, and empathic concern. Results revealed an excellent fit for the standard TPB model; attitudes, descriptive subjective norms, and perceptions of control made independent contributions to the prediction of intentions, and intentions together with perceived control predicted behavior. Behavioral, normative, and control beliefs predicted, respectively, attitudes, subjective norms, and perceived behavioral control. Empathic concern influenced intentions and behavior indirectly by its effects on behavioral, normative, and control beliefs. Examination of the effects of specific beliefs revealed important implications for designing effective behavior-change interventions. [ABSTRACT FROM AUTHOR]