Radiochemotherapy is the standard treatment for patients with locally advanced cervical cancer. The radiotherapy is delivered as a combination of external beam radiotherapy (EBRT) and brachytherapy (BT). There has been a significant development of sophisticated irradiation techniques for EBRT the last two decades. Intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) utilizes treatment beams of varying intensity allowing the high-dose region to be conformed to the shape of the tumour volume. With a highly conformal dose distribution a key element is to localize the target volume with high precision. Nowadays, both MR (anatomical and dynamic) and PET imaging is used additional to CT for this purpose. Another important aspect is the internal movement of the target, e.g. the position of the uterus is highly depending of the bladder filling. Concepts for daily adaptation to minimize the consequences of such uncertainties have been developed.
Traditional brachytherapy has been based on sources placed in catheters (applicators) in a standardized pattern and used a 2-dimentional (2D) concept based on x-ray imaging. The last decade MR-based treatment planning has been developed giving the opportunity to individualize the treatment at every fraction. Additional, the development of new applicators facilitating a combination of intracavitary and interstitial brachytherapy offers the possibility to also give high dose to large tumours.
Evidence is eventually coming up that these developments have improved local control and survival for this group of patients.