Abstract
Radiation therapy is a definitive treatment for the uterine cervical cancer, and the treatment results are equivalent to those of surgery in stage IB1-II patients. Radiation therapy is also curative for patients with stage III or more advanced disease for whom surgery is not indicated. In addition, postoperative radiation therapy is performed when risk factors for recurrence are confirmed by histopathological examination after surgery. Concurrent chemoradiotherapy with cisplatin and other drugs is recommended for most patients except in the early stages. Standard radiation therapy is a combination of external beam radiation therapy and brachytherapy. External beam radiation therapy is followed by intracavitary brachytherapy, which is initiated when the primary tumor has shrunk to the extent within the high-dose area of brachytherapy. Postoperative radiation therapy is mainly performed with external beam radiation therapy alone, but intracavitary brachytherapy may be added when vaginal surgical margins are positive. External beam radiation therapy techniques such as intensity-modulated radiation therapy have been introduced, and image-guided brachytherapy has become the standard for brachytherapy. These techniques have made it possible to deliver higher doses that better conform the shape of the tumor and reduce the dose to risk organs and are further improving treatment outcomes.
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References
NCCN guidelines version 1.2023 cervical cancer. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed 30 Jan 2023.
Toita T, Kato S, Niibe Y, et al. Prospective multi-institutional study of definitive radiotherapy with high-dose-rate intracavitary brachytherapy in patients with nonbulky (<4-cm) stage I and II uterine cervical cancer (JAROG0401/JROSG04-2). Int J Radiat Oncol Biol Phys. 2012;82:e49–56. https://doi.org/10.1016/j.ijrobp.2011.01.022.
Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12.
Peters WA III, Liu PY, Barrett RJ II, et al. 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. 2000;18:1606–0613. https://doi.org/10.1200/JCO.2000.18.8.1606.
Shirvastava S, Mahantshetty U, Engineer R, et al. Cisplatin chemoradiotherapy vs radiotherapy in FIGO stage IIIB squamous cell carcinoma of the uterine cervix: a randomized clinical trial. JAMA Oncol. 2018;4:506–13; https://jamanetwork.com/journals/jamaoncology/fullarticle/2671607.
Gill BS, Lin JF, Krivak TC, et al. National cancer data base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys. 2014;90:1083–90. https://doi.org/10.1016/j.ijrobp.2014.07.017.
Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56:1354–60. https://doi.org/10.1016/S0360-3016(03)00325-0.
Ahamad A, D’Souza W, Salehpour M, et al. Intensity-modulated radiation therapy after hysterectomy: comparison with conventional treatment and sensitivity of the normal-tissue- sparing effect to margin size. Int J Radiat Oncol Biol Phys. 2005;62:1117–24. https://doi.org/10.1016/j.ijrobp.2004.12.029.
Lin AJ, Kidd E, Dehdashti F, et al. Intensity modulated radiation therapy and image-guided adapted brachytherapy for cervix cancer. Int J Radiat Oncol Biol Phys. 2019;103:1088–97. https://doi.org/10.1016/j.ijrobp.2018.11.012.
Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018;9:48–60. https://doi.org/10.1016/j.ctro.2018.01.001.
Small W Jr, Bosch WR, Harkenrider MM, et al. NRG oncology/RTOG consensus guidelines for delineation of clinical target volume for intensity modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer: an update. Int J Radiat Oncol Biol Phys. 2022;109:413–24. https://doi.org/10.1016/j.ijrobp.2020.08.061.
International Commission on Radiation Units and Measurement. Dose and volume specification for reporting intracavitary therapy in gynecology. Bethesda, MD: ICRU Report 38; 1985.
Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (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. 2005;74:235–45. https://doi.org/10.1016/j.radonc.2004.12.015.
Syed AM, Feder BH. Technique of after-loading interstitial implants. Radiol Clin. 1977;46:458–75.
Martinez A, Edmundson GK, Cox RS, et al. Combination of external beam irradiation and multiple-site perineal applicator (MUPIT) for treatment of locally advanced or recurrent prostatic, anorectal, and gynecological malignancies. Int J Radiat Oncol Biol Phys. 1985;11:391–8. https://doi.org/10.1016/0360-3016(85)90163-4.
Sturdza A, Pötter R, Fokdal LU, et al. Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol. 2016;120:428–33. https://doi.org/10.1016/j.radonc.2016.03.011.
Mazeron R, Fokdal LU, Kirchheiner K, et al. Dose-volume effect relationships for late rectal morbidity in patients treated with chemoradiation and MRI-guided adaptive brachytherapy for locally advanced cervical cancer: results from the prospective multicenter EMBRACE study. Radiother Oncol. 2016;120:412–9. https://doi.org/10.1016/j.radonc.2016.06.006.
Okazaki S, Murata K, Noda S, et al. Dose-volume parameters and local tumor control in cervical cancer treated with central-shielding external-beam radiotherapy and CT-based image-guided brachytherapy. J Radiat Res. 2019;60:490–500. https://doi.org/10.1093/jrr/rrz023.
Toita T, Kitagawa R, Hamano T, et al. Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: efficacy and toxicity of a low cumulative radiation dose schedule. Gynecol Oncol. 2012;126:211–6. https://doi.org/10.1016/j.ygyno.2012.04.036.
Fokdal L, Sturdza A, Mazeron R, et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: analysis from the retroEMBRACE study. Radiother Oncol. 2016;120:434–40. https://doi.org/10.1016/j.radonc.2016.03.020.
Ohno T, Noda SE, Okonogi N, et al. In-room computed tomography–based brachytherapy for uterine cervical cancer: results of a 5-year retrospective study. J Radiat Res. 2017;58:543–51. https://doi.org/10.1093/jrr/rrw121.
Takada A, Yokota H, Watanabe Nemoto M, et al. A multi-scanner study of MRI radiomics in uterine cervical cancer: prediction of in-field tumor control after definitive radiotherapy based on a machine learning method including peritumoral regions. Jpn J Radiol. 2020;38:265–73. https://doi.org/10.1007/s11604-019-00917-0.
Ikushima H, Haga A, Ando K, et al. Prediction of out-of-field recurrence after chemoradiotherapy for cervical cancer using a combination model of clinical parameters and magnetic resonance imaging radiomics: a multi-institutional study of the Japanese radiation oncology study group. J Radiat Res. 2022;63:98–106. https://doi.org/10.1093/jrr/rrab104.
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Uno, T. (2024). Radiological Treatment of Cervical Cancer. In: Aoki, D. (eds) Recent Topics on Prevention, Diagnosis, and Clinical Management of Cervical Cancer. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-99-9396-3_12
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