const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3" x 7.5"
pres.title = "Brachytherapy & Physiotherapy";
pres.author = "Physiotherapy Education";

// ─────────────────────────────────────────────
// COLOUR PALETTE
// Deep teal dominant, slate-navy support, coral accent
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  yellow:     "F5C842",
  green:      "4CAF7D",
  lightBlue:  "7ECFDC",
};

// ─────────────────────────────────────────────
// HELPERS
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function addBg(slide, color) {
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// ─────────────────────────────────────────────
// SLIDE 1 — TITLE SLIDE
{
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}

// SLIDE 2 — TABLE OF CONTENTS
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  const sections = [
    ["01", "What is Brachytherapy?", C.teal],
    ["02", "Types of Brachytherapy", C.teal],
    ["03", "Gynecological Brachytherapy – Indications", C.teal],
    ["04", "Procedure: How It Works", C.coral],
    ["05", "Dose & Technology (IGABT / 3D)", C.coral],
    ["06", "Acute & Late Side Effects", C.coral],
    ["07", "Physio Assessment Post-Brachytherapy", C.yellow],
    ["08", "Post-Treatment Rehabilitation (Pain & Fatigue)", C.yellow],
    ["09", "Pelvic Floor Physiotherapy", C.yellow],
    ["10", "Lymphedema Management", C.green],
    ["11", "Sexual Rehabilitation & Vaginal Health", C.green],
    ["12", "Psychosocial & Exercise Considerations", C.green],
    ["13", "Recent Research Evidence", C.lightBlue],
    ["14", "Key Research Papers (2022–2025)", C.lightBlue],
    ["15", "Summary & Clinical Takeaways", C.silver],
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}

// SLIDE 3 — What is Brachytherapy?
bulletSlide(pres,
  "WHAT IS BRACHYTHERAPY?",
  [
    { text:"Definition", bold:true, color:C.teal },
    "Brachytherapy (Greek: brachys = short distance) is a form of radiotherapy where a radioactive source is placed directly onto or inside the tumour volume.",
    "",
    { text:"Key Physical Principle", bold:true, color:C.teal },
    "Dose follows the inverse square law — radiation drops off sharply with distance, sparing surrounding healthy tissue.",
    "",
    { text:"Advantage Over External Beam RT", bold:true, color:C.teal },
    "Allows very high localised tumour doses (85,000–95,000 cGy) with significantly less exposure to bladder, bowel, and rectum.",
    "",
    { text:"Isotopes Used", bold:true, color:C.teal },
    "Modern HDR: Iridium-192 (192Ir) via afterloader device",
    "LDR prostate seeds: Iodine-125 (125I), 28 keV gamma energy",
    "",
    { text:"Source:", bold:false, color:C.silver, size:12 },
    { text:"Grainger & Allison's Diagnostic Radiology, 6th Ed.; Berek & Novak's Gynecology", bold:false, color:C.silver, size:12 },
  ]
);

// SLIDE 4 — Types of Brachytherapy
twoColSlide(pres,
  "TYPES OF BRACHYTHERAPY",
  "By Dose Rate",
  [
    "LDR (Low Dose Rate): 0.4–2 Gy/hr — inpatient; classic cervix treatment",
    "MDR (Medium Dose Rate): 2–12 Gy/hr",
    "HDR (High Dose Rate): >12 Gy/hr — remote afterloader; most common today",
    "PDR (Pulsed Dose Rate): hourly pulses simulating LDR",
  ],
  "By Placement",
  [
    "Intracavitary: applicator in body cavity (uterus, vagina) — main gynae technique",
    "Intraluminal: placed in hollow tubes (bronchus, oesophagus)",
    "Interstitial: needles/catheters implanted in tissue",
    "Surface/mould: external surface applicator (skin tumours)",
    "Intravascular: coronary artery stenosis prevention",
  ]
);

// SLIDE 5 — Gynecological Indications
bulletSlide(pres,
  "GYNECOLOGICAL BRACHYTHERAPY — INDICATIONS",
  [
    { text:"Primary Indications", bold:true, color:C.coral },
    "Cervical Cancer (Stage IB–IVA): Combined with external beam RT ± chemotherapy — curative intent",
    "Endometrial (Uterine) Cancer: Adjuvant vaginal vault brachytherapy post-hysterectomy",
    "Vaginal Cancer: Primary or adjuvant intracavitary / interstitial treatment",
    "Vulvar Cancer: Interstitial implants for localised disease",
    "",
    { text:"Why Brachytherapy is Essential for Cervical Cancer", bold:true, color:C.coral },
    "Local control rate: 91% at 5 years (RetroEMBRACE study, n=731 patients, 12 centres)",
    "Pelvic control: 87% | Overall survival: 74% | Cancer-specific survival: 79%",
    "3D Image-Guided Adaptive BT (IGABT) halves toxicity vs 2D approach (STIC trial, n=705)",
    "",
    { text:"Guideline Recommendation", bold:true, color:C.coral },
    "GEC-ESTRO / ABS: High-risk CTV D90 cumulative dose = 85–95 Gy (EQD2)",
    "",
    { text:"Source: Berek & Novak's Gynecology", bold:false, color:C.silver, size:12 },
  ]
);

// SLIDE 6 — Procedure
bulletSlide(pres,
  "THE BRACHYTHERAPY PROCEDURE — HOW IT WORKS",
  [
    { text:"Step 1 — Applicator Placement", bold:true, color:C.yellow },
    "Hollow tubes/applicators placed inside uterine cavity and vaginal fornices under US or MRI guidance",
    "Ring applicators, Fletcher-Suit tandems, Vienna applicators — patient under anaesthesia/sedation",
    "",
    { text:"Step 2 — 3D Imaging (MRI/CT)", bold:true, color:C.yellow },
    "MRI preferred: tumour, bladder, rectum, sigmoid bowel delineated precisely",
    "Allows individualised dose planning matching patient's anatomy",
    "",
    { text:"Step 3 — Treatment Planning", bold:true, color:C.yellow },
    "Physicist calculates dwell times at 5 mm intervals along applicator",
    "GTV, CTV, OAR (organs at risk) contoured for optimal dose distribution",
    "",
    { text:"Step 4 — Remote Afterloading", bold:true, color:C.yellow },
    "Patient in shielded room; afterloader remotely advances 192Ir source",
    "HDR: Treatment ~10–20 minutes; 5–6 fractions total",
    "No radiation exposure to healthcare staff after applicator placement",
    "",
    { text:"Source: Grainger & Allison's Diagnostic Radiology; Berek & Novak's Gynecology", bold:false, color:C.silver, size:12 },
  ]
);

// SLIDE 7 — IGABT Technology
bulletSlide(pres,
  "IMAGE-GUIDED ADAPTIVE BRACHYTHERAPY (IGABT)",
  [
    { text:"Evolution from 2D to 3D", bold:true, color:C.lightBlue },
    "Classical 2D: Generic 'Point A' dosing via X-ray — same dose regardless of tumour size",
    "3D IGABT: Individualised volumetric dose based on MRI/CT tumour geometry",
    "",
    { text:"Clinical Evidence", bold:true, color:C.lightBlue },
    "RetroEMBRACE (n=731): 91% local control with MR-guided IGABT",
    "STIC trial (n=705): 3D brachytherapy → HALF the toxicity vs 2D",
    "Improved coverage of high-risk CTV while reducing dose to bladder & rectum",
    "",
    { text:"Standard Doses (3D IGABT)", bold:true, color:C.lightBlue },
    "High-risk CTV D90: 85–95 Gy (EQD2) — GEC-ESTRO standard",
    "Organs at risk limits: Bladder D2cc <90 Gy; Rectum D2cc <70–75 Gy",
    "",
    { text:"Fractionation", bold:true, color:C.lightBlue },
    "HDR: 4–6 fractions; LDR: continuous implant over 48–96 hours",
    "Combined with external pelvic EBRT (45–50 Gy) ± concurrent cisplatin",
    "",
    { text:"Source: Berek & Novak's Gynecology; Grainger & Allison's Diagnostic Radiology", bold:false, color:C.silver, size:12 },
  ]
);

// SLIDE 8 — Side Effects (two-column)
twoColSlide(pres,
  "ACUTE & LATE SIDE EFFECTS — THE PHYSIO'S CONCERN",
  "Acute Effects (During & Weeks After)",
  [
    "Pelvic pain / cramping during applicator insertion",
    "Urinary frequency, dysuria, haematuria",
    "Bowel urgency, diarrhoea, rectal discomfort",
    "Vaginal discharge, spotting",
    "Fatigue (acute cancer-related fatigue)",
    "Anxiety & psychological distress",
    "Anaesthesia-related effects (nausea, weakness)",
  ],
  "Late Effects (Months to Years After)",
  [
    "Vaginal fibrosis & stenosis (key PT target)",
    "Pelvic floor dysfunction / pain",
    "Bladder: atony, fistulas (1–2%)",
    "Bowel: radiation fibrosis, strictures (6–8%)",
    "Lymphedema (lower limb / genital)",
    "Sexual dysfunction (dyspareunia, dryness)",
    "Osteoporosis (premature menopause post-radiation)",
    "Chronic fatigue & deconditioning",
  ]
);

// SLIDE 9 — Physio Assessment
bulletSlide(pres,
  "PHYSIOTHERAPY ASSESSMENT POST-BRACHYTHERAPY",
  [
    { text:"Subjective Assessment", bold:true, color:C.green },
    "Pain history: pelvic, perineal, lower back, lower limb — use VAS/NRS",
    "Fatigue severity: FACIT-Fatigue scale or Brief Fatigue Inventory",
    "Bowel/bladder dysfunction: frequency, urgency, incontinence",
    "Sexual health history (if patient comfortable): dyspareunia, vaginal dryness",
    "Lymphedema symptoms: limb heaviness, swelling",
    "Psychological screening: anxiety, depression (PHQ-9, GAD-7)",
    "",
    { text:"Objective Assessment", bold:true, color:C.green },
    "Posture & movement screen: antalgic gait, lumbo-pelvic alignment",
    "Pelvic floor muscle function: tone, tenderness, strength (if indicated)",
    "Lymphoedema: limb circumference or water displacement, skin integrity",
    "Functional capacity: 6-Minute Walk Test, sit-to-stand, grip strength",
    "Scar/tissue mobility: abdominal/perineal scar assessment post-surgery",
    "",
    { text:"Timing: Begin within 4–6 weeks post-treatment; screen at each oncology review", bold:false, color:C.yellow },
  ]
);

// SLIDE 10 — Pain & Fatigue Management
bulletSlide(pres,
  "POST-TREATMENT REHABILITATION: PAIN & FATIGUE",
  [
    { text:"Pain Management", bold:true, color:C.coral },
    "TENS (Transcutaneous Electrical Nerve Stimulation): Evidence for pelvic pain in cancer survivors (Mathias & Pattanshetty, 2022 — TENS + stabilization exercises reduced pelvic pain)",
    "Soft tissue mobilisation, trigger point therapy for pelvic floor hypertonicity",
    "Graded mobilisation and postural correction for low back pain",
    "Heat/cold modalities for symptom relief (avoid directly over irradiated areas)",
    "Acupressure: RCT (Duzova et al., 2025) — significantly reduced anxiety, depression & pain in gynae brachytherapy patients",
    "",
    { text:"Cancer-Related Fatigue (CRF) — Exercise is the Gold Standard", bold:true, color:C.coral },
    "ASCO-SIO Guideline 2024 (Bower et al.): Exercise is the most evidence-based CRF intervention",
    "Aerobic training: 30 min, moderate intensity, 3–5×/week — best evidence",
    "Network meta-analysis (Dong et al., JOSPT 2023): Aerobic + resistance training most effective",
    "Systematic review (Herranz-Gómez et al., APMR 2023): All exercise models reduce CRF during chemo-RT",
    "",
    { text:"Hand Massage (RCT, Efe Arslan et al., 2024): Reduced fatigue in women receiving brachytherapy", bold:false, color:C.yellow },
  ]
);

// SLIDE 11 — Pelvic Floor Physiotherapy
bulletSlide(pres,
  "PELVIC FLOOR PHYSIOTHERAPY",
  [
    { text:"Why Radiation Damages the Pelvic Floor", bold:true, color:C.teal },
    "Radiation fibrosis → tissue hypoxia, collagen crosslinking → reduced elasticity",
    "Vaginal stenosis develops in up to 88% without intervention",
    "Pelvic floor hypertonicity/spasm is common → contributes to pain & dysfunction",
    "",
    { text:"Vaginal Rehabilitation Protocol", bold:true, color:C.teal },
    "Vaginal dilator therapy: Begin 6–8 weeks post-brachytherapy",
    "Graduated sizes; 3×/week for at least 1 year",
    "Reduces vaginal stenosis and maintains sexual function",
    "Lubricant use essential; water-based preferred",
    "",
    { text:"Pelvic Floor Muscle Training (PFMT)", bold:true, color:C.teal },
    "Relaxation / down-training for hypertonic pelvic floor (most common post-RT pattern)",
    "Kegel exercises for hypotonicity / incontinence",
    "Biofeedback to train voluntary control",
    "Photobiomodulation (LLLT) + PFMT: Emerging evidence for urinary incontinence (da Silva et al., 2023)",
    "",
    { text:"Goal: Restore pelvic floor function, prevent long-term disability, improve QoL", bold:false, color:C.yellow },
  ]
);

// SLIDE 12 — Lymphedema
bulletSlide(pres,
  "LOWER LIMB LYMPHEDEMA MANAGEMENT",
  [
    { text:"Why Lymphedema Occurs Post-Brachytherapy/RT", bold:true, color:C.lightBlue },
    "Pelvic irradiation + lymph node dissection disrupt lymphatic drainage",
    "Combined chemoradiation increases risk further",
    "Incidence: 10–30% in gynecological cancer survivors",
    "",
    { text:"Assessment", bold:true, color:C.lightBlue },
    "Limb circumference at standardised points (10 cm above/below patella)",
    "Stemmer sign, skin changes, pitting vs fibrotic oedema",
    "Bioimpedance spectroscopy (where available)",
    "",
    { text:"Complete Decongestive Therapy (CDT) — First-Line", bold:true, color:C.lightBlue },
    "Manual Lymphatic Drainage (MLD): 45–60 min sessions, proximal-to-distal technique",
    "Multi-layer compression bandaging during intensive phase",
    "Compression garments (Class II/III): Long-term daily use",
    "Therapeutic exercise: Decongestive exercises with garment",
    "Skin care: Daily moisturiser, avoid trauma/infection",
    "",
    { text:"Education: Avoid prolonged sitting, air travel precautions, temperature extremes", bold:false, color:C.yellow },
  ]
);

// SLIDE 13 — Sexual Rehabilitation
bulletSlide(pres,
  "SEXUAL REHABILITATION & VAGINAL HEALTH",
  [
    { text:"Impact of Brachytherapy on Sexual Function", bold:true, color:C.coral },
    "Cervical brachytherapy significantly impairs sexual function: dyspareunia, decreased libido, vaginal dryness, orgasmic dysfunction",
    "Review (Chin & Damast, Brachytherapy 2023): Brachytherapy is a key independent contributor to sexual morbidity",
    "RCT (González-Alcorta et al., Front Med 2025): Sexual dysfunction and QoL impaired post-LDR brachytherapy, especially at 6 months",
    "",
    { text:"Physiotherapy Role", bold:true, color:C.coral },
    "Pelvic floor rehabilitation → reduces vaginismus, dyspareunia",
    "Vaginal dilator programme + lubrication education",
    "Non-ablative radiofrequency: Emerging — RCT (Grossi et al., J Sex Med 2025) vs promestriene for genitourinary syndrome in cervical cancer survivors",
    "Mindfulness-based interventions and psychosexual counselling referral",
    "",
    { text:"Timing & Sensitivity", bold:true, color:C.coral },
    "Introduce topic tactfully at 6–8 week post-treatment review",
    "Use validated tools: FSFI (Female Sexual Function Index), FSDS",
    "Multidisciplinary approach: Physio + gynae-oncologist + psychologist",
  ]
);

// SLIDE 14 — Psychosocial + Exercise
twoColSlide(pres,
  "PSYCHOSOCIAL WELLBEING & THERAPEUTIC EXERCISE",
  "Psychosocial Considerations for Physio",
  [
    "Screen for anxiety & depression at every session",
    "Acupressure (Duzova et al., RCT 2025): ↓ anxiety & depression in brachytherapy patients",
    "Mindfulness & relaxation: breathing exercises, body scan",
    "Peer support referrals; address fear of recurrence",
    "Goal-setting using SMART goals for rehab",
    "Maintain open communication about sexual health concerns",
  ],
  "Exercise Prescription (Post-Brachytherapy)",
  [
    "Phase 1 (0–6 wks): Gentle walking 15–20 min daily, breathing exercises",
    "Phase 2 (6–12 wks): Aerobic training, core stability, PFMT",
    "Phase 3 (3–6 mo): Progressive resistance training, yoga/pilates",
    "ASCO 2024 Guideline: Aerobic + resistance combo best for fatigue",
    "Hypopressive exercises (Berríos-Contreras et al., RCT protocol 2024): For urinary incontinence & fatigue in gynae cancer",
    "Avoid: High-impact exercise until 3 months post-treatment",
  ]
);

// SLIDE 15 — Recent Research Papers
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    { num:"01", year:"2023", tier:"Systematic Review", title:"Effectiveness of Therapeutic Exercise on Cancer-Related Fatigue (Herranz-Gómez et al.)", journal:"Arch Phys Med Rehabil", color:C.green },
    { num:"02", year:"2023", tier:"Network Meta-Analysis", title:"Which Exercise Approaches Work for Relieving CRF? (Dong et al.)", journal:"J Orthop Sports Phys Ther", color:C.green },
    { num:"03", year:"2024", tier:"Practice Guideline", title:"Management of Fatigue in Adult Cancer Survivors — ASCO-SIO Guideline Update (Bower et al.)", journal:"J Clin Oncol", color:C.coral },
    { num:"04", year:"2023", tier:"Review", title:"Brachytherapy Impacts on Sexual Function in Cervical Cancer (Chin & Damast)", journal:"Brachytherapy", color:C.teal },
    { num:"05", year:"2025", tier:"RCT", title:"Acupressure on Anxiety, Depression & Pain in Gynae Brachytherapy (Duzova et al.)", journal:"Support Care Cancer", color:C.yellow },
    { num:"06", year:"2024", tier:"RCT", title:"Hand Massage Effect on Fatigue in Women Receiving Brachytherapy (Efe Arslan et al.)", journal:"Support Care Cancer", color:C.yellow },
    { num:"07", year:"2022", tier:"Clinical Trial", title:"TENS & Stabilisation Exercises for Pelvic Pain in Cancer Survivors (Mathias & Pattanshetty)", journal:"J Cancer Res Ther", color:C.teal },
    { num:"08", year:"2025", tier:"RCT", title:"Non-ablative RF vs Promestriene for Genitourinary Syndrome in Cervical Cancer (Grossi et al.)", journal:"J Sex Med", color:C.coral },
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// SLIDE 16 — Research Insights (PMID details)
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  "RECENT EVIDENCE: KEY INSIGHTS FOR PHYSIOTHERAPISTS",
  [
    { text:"Exercise for Cancer-Related Fatigue (CRF)", bold:true, color:C.green },
    "ASCO-SIO 2024 Guideline: Exercise + psychological interventions = RECOMMENDED for all cancer survivors with fatigue",
    "Aerobic training (moderate-intensity, ≥150 min/week) + resistance training = most effective combination (PMID: 38754041)",
    "Benefit seen both during and after treatment (Malveiro et al., Sys Rev 2023)",
    "",
    { text:"Brachytherapy-Specific PT Interventions", bold:true, color:C.teal },
    "Acupressure (Duzova et al., RCT 2025, PMID: 40679634): Significantly reduced anxiety (p<0.05), depression and pain scores in patients receiving gynecological brachytherapy",
    "Hand Massage (Efe Arslan et al., RCT 2024, PMID: 39625640): Significantly reduced fatigue levels in women undergoing brachytherapy",
    "TENS + Core Stabilisation (Mathias & Pattanshetty, 2022, PMID: 36149171): Reduced pelvic pain post multimodal cancer treatment",
    "",
    { text:"Sexual Function Post-Brachytherapy", bold:true, color:C.coral },
    "Vaginal dilator therapy + pelvic floor PT = cornerstone for preventing stenosis",
    "Non-ablative radiofrequency shows promise for genitourinary syndrome (Grossi et al., RCT 2025)",
    "Sexual dysfunction affects majority of cervical cancer survivors — requires proactive screening",
  ]
);

// SLIDE 17 — MDT Role
twoColSlide(pres,
  "THE PHYSIOTHERAPIST IN THE MDT — YOUR UNIQUE ROLE",
  "During Treatment Phase",
  [
    "Patient education: what to expect, self-care",
    "Breathing & relaxation techniques for procedure anxiety",
    "Gentle mobility to prevent deconditioning",
    "Fatigue management education",
    "Bladder/bowel diary and advice",
    "Early lymphedema screening",
  ],
  "Post-Treatment Phase",
  [
    "Comprehensive pelvic floor assessment",
    "Vaginal dilator programme supervision",
    "Progressive exercise rehabilitation",
    "Lymphedema CDT (MLD + compression)",
    "Pain management (TENS, manual therapy)",
    "Sexual health rehabilitation",
    "Return-to-activity guidance & occupational advice",
    "Psychosocial support & MDT communication",
  ]
);

// SLIDE 18 — Clinical Pathways
bulletSlide(pres,
  "PHYSIOTHERAPY CARE PATHWAY — GYNAE BRACHYTHERAPY",
  [
    { text:"Pre-Treatment (if accessible)", bold:true, color:C.yellow },
    "Baseline assessment: Pelvic floor, functional capacity, lymphedema risk screening",
    "Education about expected side effects, dilator therapy, pelvic floor exercises",
    "",
    { text:"Acute Phase (0–6 weeks post-treatment)", bold:true, color:C.yellow },
    "Rest-activity balance; fatigue diary; gentle walking programme",
    "Bladder/bowel symptom management; breathing exercises",
    "TENS for pain as needed; gentle pelvic floor relaxation",
    "",
    { text:"Sub-acute Phase (6 weeks – 3 months)", bold:true, color:C.teal },
    "Pelvic floor rehabilitation: Dilators commence at 6–8 weeks",
    "Progressive aerobic exercise: Build to 30 min moderate intensity 3–5×/week",
    "Lymphedema: MLD if indicated; garment fitting; skin care education",
    "Sexual rehabilitation assessment and programme initiation",
    "",
    { text:"Long-term Maintenance (3 months +)", bold:true, color:C.teal },
    "Annual review: Pelvic floor, lymphedema, bone health, psychosocial",
    "Maintain exercise programme; refer for osteoporosis management if premature menopause",
    "Continue dilator therapy for at least 12–24 months",
  ]
);

// SLIDE 19 — Summary & Key Takeaways
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    { icon:"✦", text:"3D IGABT (Image-Guided Adaptive BT) is the modern gold standard for cervical cancer — improved outcomes, half the toxicity of 2D.", color:C.lightBlue },
    { icon:"✦", text:"Key physio targets: Cancer-related fatigue, pelvic floor dysfunction, vaginal stenosis, lymphedema, sexual rehabilitation, and psychological wellbeing.", color:C.green },
    { icon:"✦", text:"Exercise (aerobic + resistance) is the strongest evidence-based intervention for CRF — ASCO 2024 Guideline.", color:C.yellow },
    { icon:"✦", text:"Acupressure & hand massage have Level 1 RCT evidence for anxiety, pain and fatigue reduction specifically in brachytherapy patients.", color:C.coral },
    { icon:"✦", text:"Vaginal dilator therapy + pelvic floor PT should begin at 6–8 weeks post-treatment and continue for 1–2 years.", color:C.teal },
    { icon:"✦", text:"Physiotherapists play an irreplaceable MDT role: from pre-treatment education through long-term survivorship care.", color:C.green },
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// SLIDE 20 — References
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  "REFERENCES",
  [
    { text:"Textbooks", bold:true, color:C.teal },
    "Berek & Novak's Gynecology — Cervical Cancer: Brachytherapy (pp. 2253–2260)",
    "Grainger & Allison's Diagnostic Radiology 7th Ed. — Chapter 67: Radiotherapy Principles",
    "",
    { text:"Clinical Guidelines", bold:true, color:C.teal },
    "GEC-ESTRO Recommendations for Image-Guided Brachytherapy in Cervical Cancer",
    "ASCO-SIO Guideline: Management of Fatigue in Adult Survivors of Cancer (2024)",
    "",
    { text:"Recent Research Papers (PubMed-Verified)", bold:true, color:C.teal },
    "Bower et al. (2024). Fatigue guideline update. J Clin Oncol. PMID: 38754041",
    "Herranz-Gómez et al. (2023). Exercise for CRF. Arch Phys Med Rehabil. PMID: 36736602",
    "Dong et al. (2023). Exercise for CRF, network meta-analysis. JOSPT. PMID: 36947532",
    "Duzova et al. (2025). Acupressure in gynae brachytherapy. Support Care Cancer. PMID: 40679634",
    "Efe Arslan et al. (2024). Hand massage for fatigue. Support Care Cancer. PMID: 39625640",
    "Mathias & Pattanshetty (2022). TENS for pelvic pain. J Cancer Res Ther. PMID: 36149171",
    "Chin & Damast (2023). Brachytherapy & sexual function. Brachytherapy. PMID: 36567175",
    "Grossi et al. (2025). RF for genitourinary syndrome. J Sex Med. PMID: 40312849",
    "Malveiro et al. (2023). Exercise in neoadjuvant treatment. J Sci Med Sport. PMID: 37696693",
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