Radiological Treatment of Cervical Cancer

Radiation therapy is a definitive treatment for the uterine cervical cancer, and the treatment results are equivalent to those of surgery in stage IB1-II patients. Radiation therapy is also curative for patients with stage III or more advanced disease for whom surgery is not indicated. In addition, postoperative radiation therapy is performed when risk factors for recurrence are confirmed by histopathological examination after surgery. Concurrent chemoradiotherapy with cisplatin and other drugs is recommended for most patients except in the early stages. Standard radiation therapy is a combination of external beam radiation therapy and brachytherapy. External beam radiation therapy is followed by intracavitary brachytherapy, which is initiated when the primary tumor has shrunk to the extent within the high-dose area of brachytherapy. Postoperative radiation therapy is mainly performed with external beam radiation therapy alone, but intracavitary brachytherapy may be added when vaginal surgical margins are positive. External beam radiation therapy techniques such as intensity-modulated radiation therapy have been introduced, and image-guided brachytherapy has become the standard for brachytherapy. These techniques have made it possible to deliver higher doses that better conform the shape of the tumor and reduce the dose to risk organs and are further improving treatment outcomes.