Image-Guided Radiotherapy and -Brachytherapy for Cervical Cancer

Abstract

Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT), and 2-dimensional intracavitary brachytherapy. Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron-emission tomography and magnetic resonance imaging has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT) may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT), allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer.

Rationale, indications, techniques and applications of interstitial brachytherapy for carcinoma cervix

“…The possible disadvantages of brachytherapy include that it is invasive, resource intensive, can be technically challenging, and is ideally performed in women who have a good performance status. [7,35] Few studies are there citing comparison between brachytherapy and few of the probable options for the alternatives such as EBRT boost using intensity modulated radiotherapy (IMRT), image-guided radiotherapy, volumetric modulated arc therapy, and stereotactic body radiotherapy. [36][37][38] In a study, volumes receiving 60 Gy (EQD2) were approximately twice as large for IMRT compared with brachytherapy, and the high central tumor dose was lower than that seen by brachytherapy.…”

Cervical cancer: what's new?

“…The existing studies that adopt historical controls for comparison show improved local control and survival, especially in the treatment of advanced tumors (stage IIIB). [38][39][40][41][42] But there are no prospective studies confirming these results. Moreover, the application of these radiotherapy techniques almost quadruples the time spent with each patient, making it difficult to use in most public services, where there are patients awaiting radiotherapy for a considerable time.…”

Acute radiation toxicity during and after concurrent chemoradiotherapy in patients with localy advanced cervical cancer

“…In a therapeutic setting, the cervix tolerates high radiation dose, and for this reason, the total dose delivered is increased by concomitant use of external beam RT and brachytherapy. There are different modalities of brachytherapy such as high-dose-rate (HDR) brachytherapy, low-doserate, middle-dose-rate, and pulse-dose-rate 18,19,20 . However, HDR is currently the most commonly used, because treatment time is the shortest and the most comfortable for the patients, compared to other modalities.…”