Brachytherapy for Locally Advanced Cervix Cancer. Methodical Aspects

Purpose: To increase local control of cervical tumors by developing and introducing into practice the optimization of dose distribution  in the primary tumor  during concomitant  chemoradiation  (CRT) and image-guided adaptive brachytherapy (IGABT) i.e. summing up the maximum dose to the tumor volume of HR-CTV> 85 Gy in the shortest possible period of time by the optimal fractionation regime, without increasing the tolerable doses to the organs of risk (bladder, rectum, sigmoid).

Material and methods: Data of the study was the of clinical observations of patients with locally advanced cervical cancer proven stage IIb–IIIb according to FIGO, treated with curative radiation therapy. After pelvi c ± para-aortic external-beam radiation therapy (2 Gy ×50 Gy with Cisplatin 40 mg/m²  weekly), they received high-dose rate intracavitary brachytherapy or in combination with interstitial component following GEC-ESTRO recommendations.

Results: We managed to achieve maximum dose to the tumor  volume of HR-CTV> 85 Gy without increasing the load on the risk organs. The “Clinical Contouring” at the time of primary diagnosis of cervical cancer and before brachytherapy session based on clinical and diagnostic data using MRI helps to optimize the brachytherapy process, develop patient management tactics and a clear sequence of actions in a complex program of brachytherapy.

Conclusion: The presented clinical cases indicate the prospects of using an individual approach in planning the brachytherapy of patients with locally advanced cervical cancer.

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