High dose rate brachytherapy in cervical cancer: an update
Affiliation and adress for correspondence

1 Zakład Brachyterapii, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie, ul. Roentgena 5, 02-781 Warszawa
2 Zakład Teleradioterapii, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie, ul. Roentgena 5, 02-781 Warszawa
Kierownik Centrum Onkologii: Prof. dr hab. n. med. Marian Reinfuss
Adres do korespondencji: Agnieszka Żółciak-Siwińska, Zakład Brachyterapii, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie w Warszawie, ul. Roentgena 5, 02-781 Warszawa, tel.: 506 063 633, e-mail: agnieszka.zolciak@wp.pl
Source of financing: Department own sources

CURR. GYNECOL. ONCOL. 2011, 9 (4), p. 264-271
ABSTRACT

Selection of optimal treatment modality in a patient with cervical cancer depends on FIGO clinical stage. At stages IB2-IVA, the cornerstone of treatment is radiochemotherapy. As first step, patients undergo irradiation from external fields combined with chemotherapy (cisplatin, 40 mg/m2, QW). Brachytherapy is used as second-line treatment – an essential component thereof – enabling delivery of high dose of radiation to both genital organs and tumor. Quality of this treatment directly correlates with local control of the disease, long-term overall survival and quality of life of patients after completion of therapy. The paper presents current principles of high dose rate (HDR) brachytherapy in cervical cancer patients. Discussed are principles of two-dimensional (2D) planning, used to date in about 50% of brachytherapy centers worldwide, as well as three-dimensional (3D) magnetic resonance (MR)-based planning. As availability of MR in ours and many other oncology centers is limited, a computed tomography-based modification of gynecologic recommendations GIN GEC ESTRO has been suggested. Therapeutic areas are defined: high-risk clinical target volume (HR CTV) and intermediate risk clinical target volume (IR CTV) which may be safely contoured based on clinical exam and CT study, when no MRI is available. Acceptable doses for critical organs are listed. Based on own experience, indications and limitations for use of intraparenchymal (interstitial) and intracavitary applications were developed.

Keywords: cervical cancer, HDR brachytherapy, principles of treatment, 3D planning, computed tomographye treatment, allogeneic hematopoietic stem cell transplantation, mesenchymal stem cells, extracorporeal photopheresis