Radiation Therapy for Cervical Cancer

  • Kathryn E. Dusenbery
  • Bruce J. Gerbi
Part of the Medical Radiology book series (MEDRAD)


Carcinoma of the uterine cervix is a highly curable malignancy. Surgery is often used for early stages. For patients with more advanced disease the combination of external beam therapy with radiosensitizing chemotherapy combined with intracavitary radiotherapy offers excellent local control and disease free survival but requires meticulous attention to detail to ensure low complication rates


Cervical Cancer External Beam Figo Stage Radical Hysterectomy Uterosacral Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adcock LL et al (1984) Carcinoma of the cervix, FIGO Stage IB treatment failures. Gynecol Oncol 18:218–225PubMedCrossRefGoogle Scholar
  2. Au WW, Sierra-Torres CH, Tyring SK (2003) Acquired and genetic susceptibility to cervical cancer. Mutation Res 544:361–364PubMedCrossRefGoogle Scholar
  3. Beadle BM, Jhingran A, Yom S, Ramirez PT, Eifel PJ (2009) Patterns of regional recurrence after definitive radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 76:1396–1403PubMedCrossRefGoogle Scholar
  4. Belinson JL, Doherty M, McDay JB (1984) A new technique for ovarian transposition. Surg Gynecol Obstet 159:157–160PubMedGoogle Scholar
  5. Bhatnagar JP, Kaplan C, Specht R (1980) A rule of thumb for dose rate at point A for the Fletcher–Suit applicator. Br J Radiol 53:511–512PubMedCrossRefGoogle Scholar
  6. Chen RJ et al (1999) Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan. Gynecol Oncol 73:184–190PubMedCrossRefGoogle Scholar
  7. Coia L et al (1990) The patterns of care outcome study for cancer of the uterine cervix. Results of the second national practice survey. Cancer 66:2451–2456PubMedCrossRefGoogle Scholar
  8. Cosin JA et al (1998) Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking. Cancer 82:2241–2248PubMedCrossRefGoogle Scholar
  9. Crook JM et al (1987) Dose–volume analysis and the prevention of radiation sequelae in cervical cancer. Radiother Oncol 8:321–332PubMedCrossRefGoogle Scholar
  10. Deore SM et al (1991) The severity of late rectal and recto-sigmoid complications related to fraction size in irradiation treatment of carcinoma cervix stage III B. Strahlenther Onkol 167:638–642PubMedGoogle Scholar
  11. Dunleavey R (2004) Incidence, pathophysiology and treatment of cervical cancer. Nursing Times 100:38–41PubMedGoogle Scholar
  12. Dunst J et al (2003) Anemia in cervical cancers: impact on survival, patterns of relapse, and association with hypoxia and angiogenesis. Int J Radiat Oncol Biol Phys 56:778–787PubMedCrossRefGoogle Scholar
  13. Eifel PJ et al (1990) Adenocarcinoma of the uterine cervix. Prognosis and patterns of failure in 367 cases. Cancer 65:2507–2514PubMedCrossRefGoogle Scholar
  14. Eifel PJ et al (1995) Time course and incidence of late complications in patients treated with radiation therapy for FIGO stage IB carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 32:1289–1300PubMedCrossRefGoogle Scholar
  15. el-Baradie M, Inoue T, Inoue T, Murayama S, Tang JT, Yamazaki H et al (1997) HDR and MDR intracavitary treatment for carcinoma of the uterine cervix. A prospective randomized study. Strahlenthera Onkol 173:155–162CrossRefGoogle Scholar
  16. Erridge SC et al (2002) The effect of overall treatment time on the survival and toxicity of radical radiotherapy for cervical carcinoma. Radiother Oncol 63:59–66PubMedCrossRefGoogle Scholar
  17. Esche BA et al (1987) Reference volume, milligram-hours and external irradiation for the Fletcher applicator. Radiother Oncol 9:255–261PubMedCrossRefGoogle Scholar
  18. Falkenberg E, Kim RY, Meleth S, De Los Santos J, Spencer S (2006) Lowdose-rate vs. high-dose-rate intracavitary brachytherapy for carcinoma of the cervix: The University of Alabamaat Birmingham (UAB) experience. Brachytherapy 5:49–55PubMedCrossRefGoogle Scholar
  19. Ferrigno R, Nishimoto IN, Novaes PE, Pellizzon AC, Maia MA, Fogarolli RC et al (2005) Comparison of low and high dose rate brachytherapy in the treatment of uterine cervix cancer. Retrospective analysis of two sequential series. Int J Radiat Oncol Biol Phys 62:1108–1116PubMedCrossRefGoogle Scholar
  20. Fey MC, Beal MW (2004) Role of human papilloma virus testing in cervical cancer prevention. J Midwifery Women’s Health 49:4–13CrossRefGoogle Scholar
  21. Fletcher GH (1973) Female pelvis: squamous cell carcinoma of the uterine cervix. In: Fletcher GH (ed) Textbook of radiotherapy. Saunders, London, p 620Google Scholar
  22. Gasinska A et al (2002) Prognostic significance of intratumour microvessel density and haemoglobin level in carcinoma of the uterine cervix. Acta Oncol 41:437–443PubMedCrossRefGoogle Scholar
  23. Gerbaulet AL et al (1992) Combined radiotherapy and surgery: local control and complications in early carcinoma of the uterine cervix—the Villejuif experience, 1975–1984. Radiother Oncol 23:66–73PubMedCrossRefGoogle Scholar
  24. Ghosh K et al (2001) Using a belly board device to reduce the small bowel volume within pelvic radiation fields in women with postoperatively treated cervical carcinoma. Gynecol Oncol 83:271–275PubMedCrossRefGoogle Scholar
  25. Greer BE, Koh WJ, Abu-Rustum NR, Apte SM, Campos SM, Chan J, Cho KR, Copeland L, Crispens MA, Dupont N, Eifel PJ, Gaffney DK, Huh WK, Kapp DS, Lurain JR III, Martin L, Morgan MA, Morgan RJ Jr, Mutch D, Remmenga SW, Reynolds RK, Small W Jr, Teng N, Valea FA (2010) Cervical cancer. Natl Compr Canc Network 8:1388–1416Google Scholar
  26. Greven K et al (1999) Current developments in the treatment of newly diagnosed cervical cancer. Hematol Oncol Clin North Am 13:275–303PubMedCrossRefGoogle Scholar
  27. Grinsky T, Rey A, Roche B et al (1993) Overall treatment time in advanced cervical carcinoma: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys 27:1051–1056CrossRefGoogle Scholar
  28. Grigsby PW, Siegel BA, Dehdashti F (2001a) Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 19:3745–3749Google Scholar
  29. Grigsby PW et al (2001b) Long-term follow-up of RTOG 92–10: cervical cancer with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 51:982–987CrossRefGoogle Scholar
  30. Grigsby PW et al (2004) Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome. J Clin Oncol 22:2167–2171PubMedCrossRefGoogle Scholar
  31. Hanks GE, Herring DF, Kramer S (1983) Patterns of care outcome studies. Results of the national practice in cancer of the cervix. Cancer 51:959–967PubMedCrossRefGoogle Scholar
  32. Haie-Meder C, Potter R, Van Limbergen E et al (2005) Recommendations from Gynae-cological (GYN) GEC-ESTRO Working Group (I) Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 74:235–245PubMedCrossRefGoogle Scholar
  33. Harima Y et al (2002) Human papilloma virus (HPV) DNA associated with prognosis of cervical cancer after radiotherapy. Int J Radiat Oncol Biol Phys 52:1345–1351PubMedCrossRefGoogle Scholar
  34. Hernandez-Hernandez DM et al (2003) Association between high-risk human papillomavirus DNA load and precursor lesions of cervical cancer in Mexican women. Gynecol Oncol 90:310–317PubMedCrossRefGoogle Scholar
  35. Herzog TJ (2003) New approaches for the management of cervical cancer. Gynecol Oncol 90:S22–S27PubMedCrossRefGoogle Scholar
  36. Horiot JC et al (1988) Radiotherapy alone in carcinoma of the intact uterine cervix according to G.H. Fletcher guidelines: a French cooperative study of 1383 cases. Int J Radiat Oncol Biol Phys 14:605–611CrossRefGoogle Scholar
  37. Husseinzadeh N et al (1984) The preservation of ovarian function in young women undergoing pelvic radiation therapy. Gynecol Oncol 18:373–379PubMedCrossRefGoogle Scholar
  38. ICRU (1985) Dose and volume specification for reporting intracavitary therapy in gynecology. ICRU Report 38:1Google Scholar
  39. Jhingran A, Eifel PJ (2000) Perioperative and postoperative complications of intracavitary radiation for FIGO stage I–III carcinoma of the cervix. Int J Radiat Oncol Biol Phys 46:1177–1183PubMedCrossRefGoogle Scholar
  40. Karolewski K et al (1999) Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone. Acta Oncol 38:461–468PubMedCrossRefGoogle Scholar
  41. Katz A, Eifel PJ (2000) Quantification of intracavitary brachytherapy parameters and correlation with outcome in patients with carcinoma of the cervix (see comment). Int J Radiat Oncol Biol Phys 48:1417–1425PubMedCrossRefGoogle Scholar
  42. Keys HM et al (1999) Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 340:1154–1161PubMedCrossRefGoogle Scholar
  43. Kim RY et al (1989) Radiation alone in the treatment of cancer of the uterine cervix: analysis of pelvic failure and dose response relationship. Int J Radiat Oncol Biol Phys 17:973–978PubMedCrossRefGoogle Scholar
  44. Kim WC, Kim GE, Suh CO, Loh JJ (2001) High versus low dose rate intracavitary irradiation for adenocarcinoma of the uterine cervix. Jpn J Clin Oncol 31(9):432–437PubMedCrossRefGoogle Scholar
  45. Kramer C et al (1989) Radiation treatment of FIGO stage IVA carcinoma of the cervix. Gynecol Oncol 32:323–326PubMedCrossRefGoogle Scholar
  46. Kucera H et al (1986) Prognosis of primary radiotherapy of cervix cancer in younger females (in German). Geburtshilfe Frauenheilkd 46:800–803PubMedCrossRefGoogle Scholar
  47. Kucera H et al (1987) The influence of nicotine abuse and diabetes mellitus on the results of primary irradiation in the treatment of carcinoma of the cervix. Cancer 60:1–4PubMedCrossRefGoogle Scholar
  48. Kucera H, Potter R, Knocke TH, Baldass M, Kucera E (2001) High-dose versus low-dose rate brachytherapy in definitive radiotherapy of cervical cancer. Wien Klin Wochenschr 113:58–62PubMedGoogle Scholar
  49. Kutcher GJ et al (1994) Comprehensive QA for radiation oncology: report of AAPM Radiation Therapy Committee Task Group 40. Med Phys 21:581–618PubMedCrossRefGoogle Scholar
  50. Landoni F et al (1997) Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer (see comment). Lancet 350:535–540PubMedCrossRefGoogle Scholar
  51. Leibel S et al (1987) Radiotherapy with or without misonidazole for patients with stage IIIB or stage IVA squamous cell carcinoma of the uterine cervix: preliminary report of a Radiation Therapy Oncology Group randomized trial. Int J Radiat Oncol Biol Phys 13:541–549PubMedCrossRefGoogle Scholar
  52. Lieu D (1996) The Papanicolaou smear: its value and limitations (see comment). J Fam Pract 42:391–399PubMedGoogle Scholar
  53. Lukka H et al (2002) Concurrent cisplatin-based chemotherapy plus radiotherapy for cervical cancer—a meta-analysis (see comment). Clin Oncol (Royal College of Radiologists) 14:203–212CrossRefGoogle Scholar
  54. Mashburn J, Scharbo-DeHaan M (1997) A clinician’s guide to Pap smear interpretation (see comment). Nurse Pract 22:115–118PubMedCrossRefGoogle Scholar
  55. Mendenhall WM et al (1984) Prognostic and treatment factors affecting pelvic control of Stage IB and IIA-B carcinoma of the intact uterine cervix treated with radiation therapy alone. Cancer 53:2649–2654PubMedCrossRefGoogle Scholar
  56. Montana GS, Fowler WC (1989) Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complications. Int J Radiat Oncol Biol Phys 16:95–100PubMedCrossRefGoogle Scholar
  57. Montana GS et al (1983) Carcinoma of the cervix stage IB: results of treatment with radiation therapy. Int J Radiat Oncol Biol Phys 9:45–49PubMedCrossRefGoogle Scholar
  58. Montana GS et al (1985) Analysis of results of radiation therapy for stage II carcinoma of the cervix. Cancer 55:956–962PubMedCrossRefGoogle Scholar
  59. Montana GS et al (1986) Carcinoma of the cervix, stage III. results of radiation therapy. Cancer 57:148–154PubMedCrossRefGoogle Scholar
  60. Montana GS et al (1987) Analysis of results of radiation therapy for stage IB carcinoma of the cervix. Cancer 60:2195–2200PubMedCrossRefGoogle Scholar
  61. Montana GS, Martz KL, Hanks GE (1991) Patterns and sites of failure in cervix cancer treated in the U.S.A. in 1978. Int J Radiat Oncol Biol Phys 20:87–93PubMedCrossRefGoogle Scholar
  62. Mundt AJ, Lujan AE, Rotmensch J et al (2002) Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 52:1330–1337PubMedCrossRefGoogle Scholar
  63. Mutic S et al (2003) PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes—a dose-escalation treatment planning study. Int J Radiat Oncol Biol Phys 55:28–35PubMedCrossRefGoogle Scholar
  64. Nag S et al (1999) The American brachytherapy society survey of brachytherapy practice for carcinoma of the cervix in the United States. Gynecol Oncol 73:111–118PubMedCrossRefGoogle Scholar
  65. Nag S et al (2002) The American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix (see comment). Int J Radiat Oncol Biol Phys 52:33–48 (erratum 52:1157)PubMedCrossRefGoogle Scholar
  66. Nag S, Cardenes H, Chang S et al (2004) Proposed guidelines for image-based intracavitary brachytherapy for cervical carcinoma: report from image-guided brachytherapy group. Int J Radiat Oncol Biol Phys 60:1160–1172PubMedCrossRefGoogle Scholar
  67. Okkan S, Atkovar G, Sahinler I, Oner Dincbas F, Koca A, Koksal S et al (2003) Results and complications of high dose rate and low dose rate brachytherapy in carcinoma of the cervix: cerrahpaÅŸa experience. Radiother Oncol 67:97–105PubMedCrossRefGoogle Scholar
  68. Orton CG, Seyedsadr M, Somnay A (1991) Comparisons of high and low dose rate remote afterloading for cervix cancer and the importance of fractionation. Int J Radiat Oncol Biol Phys 21:1425–1434PubMedCrossRefGoogle Scholar
  69. Perez CA et al (1984) Radiation therapy alone in the treatment of carcinoma of the uterine cervix. II. analysis of complications. Cancer 54:235–246PubMedCrossRefGoogle Scholar
  70. Perez CA et al (1998) Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys 41:307–317PubMedCrossRefGoogle Scholar
  71. Perez CA et al (1999) Radiation therapy morbidity in carcinoma of the uterine cervix: dosimetric and clinical correlation. Int J Radiat Oncol Biol Phys 44:855–866PubMedCrossRefGoogle Scholar
  72. Perlman SE (1999) Pap smears: screening, interpretation, treatment. Adolescent Medicine State Art Rev 10:243–254Google Scholar
  73. Petereit DG, Sarkaria JN, Potter DM, Schink JC (1999) High-dose-rate versus low-dose-rate brachytherapy in the treatment of cervical cancer: analysis of tumor recurrence—the University of Wisconsin experience. Int J Radiat Oncol Biol Phys 45:1267–1274PubMedCrossRefGoogle Scholar
  74. Peters WA III et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18:1606–1613PubMedGoogle Scholar
  75. Portelance L, Chao KS, Grigsby PW et al (2001) Intensity-modulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 51:261–266PubMedCrossRefGoogle Scholar
  76. Potish RA, Deibel FC Jr, Khan FM (1982) The relationship between milligram-hours and dose to point A in carcinoma of the cervix. Radiology 145:479–483PubMedGoogle Scholar
  77. Potish RA et al (1984) The utility and limitations of decision theory in the utilization of surgical staging and extended field radiotherapy in cervical cancer. Obstet Gynecol Surv 39:555–562PubMedCrossRefGoogle Scholar
  78. Potish RA, Gerbi BJ (1986) Role of point A in the era of computerized dosimetry. Radiology 158:827–831PubMedGoogle Scholar
  79. Potish RA et al (1989) The role of surgical debulking in cancer of the uterine cervix. Int J Radiat Oncol Biol Phys 17:979–984PubMedCrossRefGoogle Scholar
  80. Potish RA (1992) Cervix cancer. In: Levitt SH (ed) Technological basis of radiation therapy. Lea & Febiger, Philadelphia, p 289Google Scholar
  81. Pourquier H et al (1987) A quantified approach to the analysis and prevention of urinary complications in radiotherapeutic treatment of cancer of the cervix. Int J Radiat Oncol Biol Phys 13:1025–1033PubMedCrossRefGoogle Scholar
  82. Randall ME, Ibbott GS (2006) Intensity-modulated radiation therapy for gynecologix cancers: pitfalls, hazards, and cautions to be considered. Semin Rad Onc 16(3):138–143CrossRefGoogle Scholar
  83. Reinhardt MJ, Ehritt-Braun C, Vogelgesang D et al (2001) Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology 218:776–782PubMedGoogle Scholar
  84. Rose PG et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340:1144–1153PubMedCrossRefGoogle Scholar
  85. Sarkaria JN, Petereit DG, Stitt JA, Hartman T, Chappell R, Thomadsen BR et al (1994) A comparison of the efficacy and complication rates of low dose-rate versus high dose-rate brachytherapy in the treatment of uterine cervical carcinoma. Int J Radiat Oncol Biol Phys 30:75–82PubMedCrossRefGoogle Scholar
  86. Sasaoka M et al (2001) Patterns of failure in carcinoma of the uterine cervix treated with definitive radiotherapy alone. Am J Clin Oncol 24:586–590PubMedCrossRefGoogle Scholar
  87. Sedlis A et al (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study (see comment). Gynecol Oncol 73:177–183PubMedCrossRefGoogle Scholar
  88. Singh AK et al (2003) FDG-PET lymph node staging and survival of patients with FIGO stage IIIb cervical carcinoma. Int J Radiat Oncol Biol Phys 56:489–493PubMedCrossRefGoogle Scholar
  89. Sommers GM et al (1989) Outcome of recurrent cervical carcinoma following definitive irradiation. Gynecol Oncol 35:150–155PubMedCrossRefGoogle Scholar
  90. Thoms WW Jr et al (1992) Bulky endocervical carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys 23:491–499PubMedCrossRefGoogle Scholar
  91. Tsai CS et al (2004) Preliminary report of using FDG-PET to detect extrapelvic lesions in cervical cancer patients with enlarged pelvic lymph nodes on MRI/CT. Int J Radiat Oncol Biol Phys 58:1506–1512PubMedCrossRefGoogle Scholar
  92. Unal A et al (1981) An analysis of the severe complications of irradiation of carcinoma of the uterine cervix: treatment with intracavitary radium and parametrial irradiation. Int J Radiat Oncol Biol Phys 7:999–1004PubMedCrossRefGoogle Scholar
  93. Waggoner SE (2003) Cervical cancer. Lancet 361:2217–2225PubMedCrossRefGoogle Scholar
  94. Wang X, Liu R, Ma B, Yang K, Tian J, Jiang L, Bai ZG, Hao XY, Wang J, Li J, Sun SL, Yin H (2010) High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer (Review). Cochrane Dadabase Syst Rev (7):CD007563Google Scholar
  95. Whitney CW et al (1999) Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 17:1339–1348PubMedGoogle Scholar
  96. Willen H et al (1985) Invasive squamous cell carcinoma of the uterine cervix. VIII. survival and malignancy grading in patients treated by irradiation in Lund 1969–1970. Acta Radiol Oncol 24:41–50PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  1. 1.Department of Therapeutic Radiology-Radiation OncologyUniversity of Minnesota Medical SchoolMinneapolisUSA

Personalised recommendations