Improvement in radiation techniques for locally advanced cervical cancer during the last two decades

Abstract

Since the National Cancer Institute (NCI) alert of concurrent chemoradiotherapy, radiotherapy has been changed from external beam radiotherapy plus brachytherapy to platinum-based concurrent chemoradiotherapy. Therefore, concurrent chemoradiotherapy plus brachytherapy has become a standard treatment for locally advanced cervical cancer. Simultaneously, definitive radiotherapy has been changed gradually from external beam radiotherapy plus low-dose-rate intracavitary brachytherapy to external beam radiotherapy plus high-dose-rate intracavitary brachytherapy. Cervix cancer is uncommon in developed countries; hence, international collaborations have been critical in large-scale clinical trials. The Cervical Cancer Research Network (CCRN), created from the Gynecologic Cancer InterGroup (GCIG), has investigated various concurrent chemotherapy regimens and sequential methods of radiation and chemotherapy. Most recently, many clinical trials of combining immune checkpoint inhibitors with radiotherapy have been ongoing for sequential or concurrent settings. During the last decade, the method of standard radiation therapy has changed from three-dimensional conformal radiation therapy to intensity-modulated radiation therapy for external beam radiotherapy and from two-dimensional to three-dimensional image-guided approaches for brachytherapy. Recent improvements include stereotactic ablative body radiotherapy and MRI-guided linear accelerator (MRI-LINAC) using adaptive radiotherapy. Here we review the current progress of radiation therapy during the last two decades.

Evolving standards and future directions for systemic therapies in cervical cancer

“…Owing to RT quality assurance across trial centers, high proportions of patients received protocol-mandated external beam RT and brachytherapy, and median overall RT duration was 45 days. RT techniques had improved over that decade [ 11 12 13 ] and 3-dimensional image-guided adaptive brachytherapy was encouraged within this trial.…”

Investigating the Use of a Liquid Immunogenic Fiducial Eluter Biomaterial in Cervical Cancer Treatment

“…Common treatment options for patients with cervical cancer include surgery if diagnosed in its early stages [ 10 , 11 , 12 ]. Radiation therapy and chemotherapy, separately or in combination, are used for patients with advanced stages of cervical cancer [ 13 , 14 , 15 , 16 ]. External beam and internally delivered radiation (brachytherapy) are often used in the radiotherapy of cervical cancer [ 17 , 18 ].…”