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The use of modern imaging technologies in radiation therapy of cervical cancer

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Journal of Radiation Oncology

Abstract

Over the past century, definitive management of unresectable cervical cancer has evolved and currently employs high-dose radiation treatment with teletherapy and intracavitary brachytherapy (ICBT) components, combined with concurrent chemotherapy. Reflecting high disease prevalence among developing nations, the International Federation of Gynecology and Obstetrics (FIGO) staging of cervical cancer relies on clinical assessment, with limited radiographic studies. However, multiple clinicopathologic analyses describe suboptimal correlation between clinical examination findings and pathologic stage. Over the past two decades, systematic evaluation of volumetric and functional imaging modalities including CT, MRI, and PET-CT has refined our ability to define disease extent and provide posttreatment surveillance. Similarly, traditional ICBT techniques relied on two-dimensional (2D) data for evaluation of target dose coverage and offered limited assessment of exposure to critical structures including the bladder, rectum, and sigmoid colon. During the last several years, investigators at leading European centers have enhanced the capabilities of existing ICBT techniques through dose optimization [high-dose rate (HDR) and pulsed dose rate (PDR)] and by incorporating volumetric imaging methods. Early results are encouraging, from both toxicity and tumor control perspectives. These techniques are currently being adopted in multiple centers. Pertinent aspects are summarized in the body of this report.

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Acknowledgments

The authors thank Laura Riojas for her help in preparation of this manuscript.

Conflict of interest

Angel I. Blanco, Larissa A. Meyer, Verghese George, Bin S. Teh, Adan Rios, Kara Ferachi, Matthew Rodriguez, Anneliese Gonzalez, and John Dalrymple declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Radiation Therapy Services, Memorial Hermann Cancer Center, Memorial Hermann Medical Plaza, 6400 Fannin, Ste #220, Houston, TX, 77030, USA

    Angel I. Blanco

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Houston, TX, USA

    Larissa A. Meyer & John Dalrymple

  3. Section of Abdominal Imaging, Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX, USA

    Verghese George

  4. Department of Radiation Oncology, The Methodist Hospital, Cancer Center and Research Institute, Houston, TX, USA

    Bin S. Teh

  5. Internal Medicine Department, Division of Oncology, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Adan Rios

  6. Landauer Medical Physics, 2 Science Road, Glenwood, IL, 60425, USA

    Kara Ferachi & Matthew Rodriguez

  7. Internal Medicine Department, Division of Oncology, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Anneliese Gonzalez

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  1. Angel I. Blanco
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Blanco, A.I., Meyer, L.A., George, V. et al. The use of modern imaging technologies in radiation therapy of cervical cancer. J Radiat Oncol 4, 1–10 (2015). https://doi.org/10.1007/s13566-014-0178-z

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