Image-guided brachytherapy in cervical cancer including fractionation

• Published in: International journal of gynecological cancer Vol. 32; no. 3; pp. 273 - 280
• Main Authors: Sturdza, Alina Emiliana, Knoth, Johannes
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.03.2022; BMJ Publishing Group LTD
• Subjects: Bladder; Brachytherapy - methods; Cancer therapies; Cervical cancer; Cervix; cervix uteri; Clinical medicine; Female; Gynecology; Humans; image-guided; interventional; Lymphatic system; Organs at Risk; Prospective Studies; Radiation therapy; radiology; radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Image-Guided - methods; Review; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - radiotherapy; Vagina; radiotherapy; radiotherapy dosage; cervix uteri; interventional; radiology; image-guided
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1136/ijgc-2021-003056

Image-guided brachytherapy in cervical cancer has been developed to be a feasible and very efficient component of the treatment of locally advanced cervical cancer in addition to concurrent chemoradiation treatment. This technique allows effective dose coverage of the target while sparing the organs at risk through adjustment of the implants (intracavitary and interstitial needles) and multi-pararametric three-dimensional treatment planning. Emerging evidence from prospective studies shows a high rate of local control throughout all stages, superior to two-dimensional brachytherapy, with limited toxicity for each organ site. This is associated with a high rate of pelvic control and overall survival. Based on clinical evidence, there is a dose–effect relationship for both disease and morbidity endpoints from which clear dose constraints for the target and organs at risk were derived. This review gives an overview of the major milestones that occurred in the development of image-guided adaptive brachytherapy in the last two decades, including outcome data and a summary of the hard and soft dose constraints recommended for targets and organs at risk.