Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer

J Mayadev,L.K Mell,C.W Williamson,H.C Liu

doi:10.1016/j.clon.2021.06.012

J Mayadev, L.K Mell + Show 2 more

Open Access

https://doi.org/10.1016/j.clon.2021.06.012

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Journal: Clinical Oncology	Publication Date: Jul 12, 2021
Citations: 15	License type: cc-by

Affiliation: University of California, San Diego

Abstract

The standard of care for the definitive treatment of locoregionally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost. Historically, EBRT was delivered via a two-dimensional technique based primarily on bony landmarks. This gave way to three-dimensional conformal radiation therapy, which allows for dose calculation and adjustment based on individual tumour and patient anatomy. Further technological advances have established intensity-modulated radiation therapy (IMRT) as a standard treatment modality, given the ability to maintain tumoricidal doses to target volumes while reducing unwanted radiation dose to nearby critical structures, thereby reducing toxicity. Routine image guidance allows for increased confidence in patient alignment prior to treatment, and the ability to visualise the daily position of the targets and organs at risk has been instrumental in allowing safe reductions in treated volumes. Additional EBRT technologies, including proton therapy and stereotactic body radiation therapy, may further improve the therapeutic index. In the realm of brachytherapy, a shift from point-based dose planning to image-guided brachytherapy has been associated with improved local control and reduced toxicity, with additional refinement ongoing. Here we will discuss these advances, the supporting data and future directions.

Highlights

Cervical cancer is the second most common malignancy by incidence and the third deadliest form of cancer for women worldwide, with developing nations bearing a disproportionate burden [1]
Standard treatment for the definitive management of locoregionally advanced cervical cancers includes external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost [5]
intensity-modulated radiation therapy (IMRT) associated with significantly smaller decline in patient-reported bowel and urinary symptom score, less frequent or constant diarrhoea, and fewer IMRT patients required anti-diarrhoeal medications 4 or more times daily IMRT associated with significantly less grade 2 anaemia, grade 3 gastrointestinal, and grade 2 bladder toxicity compared with 3D-CRT

Summary

Introduction

Cervical cancer is the second most common malignancy by incidence and the third deadliest form of cancer for women worldwide, with developing nations bearing a disproportionate burden [1]. The TIME-C trial enrolled 289 postoperative patients with cervical and endometrial cancer and randomised women to adjuvant standard radiation therapy versus IMRT, with a primary end point of change in patient-reported acute gastrointestinal toxicity from baseline to the end of radiation therapy using standardised quality of life instruments [21]. This trial found statistically significant improvements in Expanded Prostate Cancer Index Composite bowel and urinary scores together with patient-reported diarrhoea metrics.

Design Phase III RCT

Key findings

Design

Conclusions

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Conflicts of interest