Image-guided and adaptive radiotherapy for cervical cancer

The established treatment for locally advanced cervical cancer is chemoradiotherapy with external beam radiotherapy (EBRT) and weekly Cisplatin followed by intrauterine brachytherapy. Radiotherapy for cervix cancer is associated with acute and long-term toxicity to adjacent pelvic organs (bladder, bowel, rectum) as they lie in close proximity to the radiotherapy target volume of the cervix, uterus, parametrium and pelvic lymph nodes. Image-guided radiotherapy (IGRT) is the process of frequent imaging during a course of radiotherapy to direct the treatment and improve precision by correcting for variations. It has developed significantly over recent years to include advanced imaging techniques in the radiotherapy planning stage, through to daily cone beam CT (CBCT)-guided radiotherapy delivery, ensuring the planned dose is delivered to the target areas. More recently, offline and online adaptive radiotherapy strategies offer the opportunity to optimise treatment further by utilising the daily imaging to make adaptations to the radiotherapy plan delivered each day, although their implementation is still at an early stage. This article will give an overview of IGRT and adaptive radiotherapy in the treatment of cervical cancer.

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