Patricia J. Eifel

Brachytherapy plays a critical role in the curative management of locally advanced cervical cancers. Although the ability to cure even very advanced cancers is in part thanks to the tendency of HPV-related cancers to remain loco-regionally confined and to the introduction of effective concurrent chemotherapy, the ability to use the uterus as a container for radioactive sources has been recognized for more than 100 years as a key factor in the effectiveness of radiation therapy. Although the basic geometric arrangements used for placement of radiation sources in the uterus and vagina have not changed greatly since the 1930s, the development of remote afterloading techniques, image guidance and other technological advances have resulted in marked improvements in our ability to optimize brachytherapy dose to tumor and critical structures. However, the huge volume of locally advanced cervical cancer cases in medically underserved countries and the rarity in more developed countries pose particular challenges to the radiation oncologists who treat these cases. Factors that should be considered in the selection of brachytherapy applicators, methods, doses, and integration with external chemoradiotherapy will be discussed.

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