Point: Parametrial irradiation in locally advanced cervix cancer can be achieved effectively with a variety of external beam techniques

Abstract

Parametrial extension is a poor prognostic factor in cervical cancer. A locally invasive phenotype is driven by adverse tumor biology, particularly hypoxia (1, 2), which is also involved in radioresistance, angiogenesis, and metastasis (3). Tumor breach of the cervical stroma gives access to lymphatic and, to a lesser extent, hematogenous means of dissemination, leading to impaired regional and systemic disease control. Nevertheless, there is clinical evidence that pelvic dose escalation can overcome these adverse factors to achieve improved local control and overall survival (4).