Brachytherapy Technique from 2D to 3D in Cervical Cancer – Short Overview

Abstract

Brachytherapy (BT) is a type of radiation therapy which is treating cancer patients. BT treatment is given in different type of malignancies: gynecological cancer, prostate cancer, head and neck, rectal cancer, anal cancer, breast cancer, penile glans, esophageal, endobronchial tumors and pediatric rhabdomyosarcoma. Since 1960 when first paper was published low dose rate (LDR) BT in the treatment of gynecologic malignancies, BT has been considered an integral part of the cervical cancers treatment (1-4). The comparison with pelvic external beam radiotherapy (EBRT) alone and in association with BT in cervical cancer patients, was shown that BT reduce local recurrence and improve overall survival (OS) (5-9). Standard treatment for locally advanced cervical cancer (stage IB2-IVA) relies on EBRT with concurrent chemotherapy, followed by intracavitary brachytherapy. In the last decade, brachytherapy has progressed from two-dimensional (2D) to three-dimensional (3D) brachytherapy. In 2015 was published level I - IV recommendations in the report of the International Commission on Radiation Units and Measurements (ICRU)/ European Group of Brachytherapy (GEC) and the European Radiotherapy Society (ESTRO) 88. 3D BT is superior to 2D BT planning for cervical cancer, adding clinical advantages: placement of the applicator, optimization of the treatment planning and decreased dose to OAR without compromising target coverage (4-11). Our aim is to make an overview of the progression made in brachytherapy technique from 2D, treatment based on radiography (simple X-ray) to 3D where the treatment is guided on magnetic resonance imaging (MRI).