The role of brachytherapy in the treatment of locally advanced cervical cancer

04/2021

MUDr. Radovan Vojtíšek, Ph.D.

Onkologická a radioterapeutická klinika LF UK a FN Plzeň           

SUMMARY

Brachytherapy is indicated for the treatment of all locally advanced cervical cancers. Conventional planning based on two orthogonal X rays does not take into account the response to external beam radiotherapy (EBRT) and is thus not consistent with the current individual tumor extent. The concept, which takes into account the change in tumor size and the topography of organs at risk at the end of initial EBRT, is image guided adaptive brachytherapy (IGABT). It also allows the dose from brachytherapy to be increased to the newly defined target volumes according to the risk of recurrence. Image guided adaptive brachytherapy has a positive effect on locoregional control and on the reduction of late postradiation toxicity. The gold standard in IGABT planning of cervical tumors is the use of magnetic resonance imaging. Current treatment recommendations are based on repeated evaluation of the tumor by clinical examination and imaging methods, optimally by magnetic resonance imaging, with subsequent adaptation of dose prescription and target volumes according to response and risk of recurrence.

Key words

brachytherapy, cervical cancer, adaptive radiotherapy, uterovaginal brachytherapy, 3 D planning, magnetic resonance imaging