Effects of image-guided adaptive brachytherapy on morbidity and quality of life in cervical cancer

Abstract

Image-guided adaptive brachytherapy (IGABT) is a technique now applied in locally advanced cervical cancer. This technique, in which magnetic resonance imaging is used prior to and during brachytherapy application, has led to important advances in gynecological brachytherapy, in terms of both dosimetric and clinical results. The reasons for using IGABT in cervical cancer include capacity of external radiotherapy to significantly shrink tumor prior to brachytherapy, high internal organ motion of cervix due to factors such as filling of urinary bladder, etc., and low local control rate in large tumors using 2-dimensional brachytherapy. In the last 20 years, there has been an increase in the success of treatment of cervical cancer with concomitant chemoradiotherapy and widespread use of IGABT. According to the results of major series using IGABT in cervical cancer, incidence of serious side effects is lower than 10%, and local control is in the range of 79% to 95%. Clinical results of IGABT studies have recommended organ at risk (OAR) dose parameters and limitations, and offered specific OAR (rectum, sigmoid, urinary bladder, bowel, vagina, urethra) toxicity measures and predictive dose-volume parameters. Studies have also provided review of this modality’s impact on quality of life. Cancer patients must be informed about conditions they may confront after therapy and be offered detailed consultation and support regarding how to arrange their business, family, and social lives.