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Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer
Clinical Oncology ( IF 3.4 ) Pub Date : 2021-07-12 , DOI: 10.1016/j.clon.2021.06.012
C W Williamson 1 , H C Liu 2 , J Mayadev 1 , L K Mell 3
Affiliation  

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.



中文翻译:

宫颈癌外束放射治疗及近距离放射治疗进展

局部晚期宫颈癌根治性治疗的护理标准是外照射放射治疗 (EBRT) 和同步化疗,然后是近距离放射治疗。从历史上看,EBRT 是通过主要基于骨性标志的二维技术进行的。这让位于三维适形放射治疗,允许根据个体肿瘤和患者解剖结构进行剂量计算和调整。进一步的技术进步已将调强放射治疗 (IMRT) 确立为标准治疗方式,因为它能够将杀瘤剂量保持在目标体积,同时减少对附近关键结构的不需要的辐射剂量,从而降低毒性。常规图像引导可提高治疗前对患者对齐的信心,并且可视化目标和处于危险中的器官的日常位置的能力有助于安全减少治疗量。额外的 EBRT 技术,包括质子治疗和立体定向放射治疗,可能会进一步提高治疗指数。在近距离放射治疗领域,从基于点的剂量计划到图像引导的近距离放射治疗的转变与改善局部控制和降低毒性有关,并且正在进行进一步的改进。在这里,我们将讨论这些进展、支持数据和未来方向。在近距离放射治疗领域,从基于点的剂量计划到图像引导的近距离放射治疗的转变与改善局部控制和降低毒性有关,并且正在进行进一步的改进。在这里,我们将讨论这些进展、支持数据和未来方向。在近距离放射治疗领域,从基于点的剂量计划到图像引导的近距离放射治疗的转变与改善局部控制和降低毒性有关,并且正在进行进一步的改进。在这里,我们将讨论这些进展、支持数据和未来方向。

更新日期:2021-08-03
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