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Abstract
The current standard of radical treatment for locally advanced cervical cancer is remote radiotherapy (RRT) with concurrent chemotherapy followed by focal dose escalation with brachytherapy. At the same time, technological advances introduced into clinical practice over time have made intensity-modulated radiotherapy (IMRT) the standard treatment for this onco-gynaecological pathology. Subsequently, the advent of regular image guidance has increased confidence in the alignment of the patient prior to irradiation. The ability to visualize the daily position of the volume to be irradiated and the organs at risk of exposure played an important role in ensuring the likely optimal and safe reduction of tissue exposed to radiation. Meanwhile, additional RRT technologies, including proton therapy and stereotactic body radiotherapy (SBRT), have further improved the therapeutic index. At the same time, in the field of brachytherapy, the transition from point dose planning to image-guided brachytherapy has been associated with an improvement in local control of the tumor and a reduction in the overall toxicity of the combined special treatment. However, in recent years there have been reports of a decline in the use of brachytherapy to consolidate the effects of ongoing special treatment in women with cervical cancer. This phenomenon is mainly due to certain technological advances in the application of advanced RRT techniques, such as intensity-modulated radiation therapy (IMRT), rotational radiation techniques with volumetric-modulated arc therapy (VMAT), helical TomoTherapy, stereotactic body radiotherapy (SBRT) and magnetic resonance image-guided radiotherapy (MRIg-RT). In this article, we have attempted to summarize the status of brachytherapy in the antitumor treatment of locally advanced cervical cancer and to highlight possible negative aspects associated with the replacement of brachytherapy by cutting-edge methods of remote radiotherapy, which to some extent confirms the prematurity of this postulate in clinical practice.
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