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Vol 26, No 2 (2021)
Review paper
Published online: 2021-03-04

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Radiotherapy for cervical cancer: Chilean consensus of the Society of Radiation Oncology

Felipe Carvajal12, Claudia Carvajal1, Tomás Merino34, Verónica López1, Javier Retamales1, Evelyn San Martín5, Freddy Alarcón1, Mónica Cuevas1, Francisca Barahona1, Ignacio Véliz1, Juvenal A. Ríos6, Sergio Becerra7
DOI: 10.5603/RPOR.a2021.0025
Rep Pract Oncol Radiother 2021;26(2):291-302.

Abstract

BACKGROUND: Cervical cancer is a public health problem in Latin America. Radiotherapy plays a fundamental role both as definitive or adjuvant treatment. There are important intra and inter-country differences regarding access and availability of radiotherapy facilities in this region.

The aim of a study was to standardize the basic clinical and technical criteria for the radiation treatment of patients with CC in Chile and provide a guide for Latin American Radiation Oncologists.

MATERIALS AND METHODS: Forty-one expert radiation oncologists from the Chilean Radiation Oncology Society made a consensus using the Delphi methodology.

RESULTS: There was a high degree of agreement for each of the recommendations. Those with the lowest percentage were related to the definition of the conformal 3D technique as the standard for definitive external radiotherapy (81%) and the criteria for extended nodal irradiation (85%).

CONCLUSIONS: These recommendations present an updated guide for radiotherapy treatment of patients with cervical cancer for Latin America. Those should be implemented according to local resources of each institution.

 

Keywords: uterine cervical neoplasmsradiotherapybrachytherapyconsensus

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References

  1. GLOBOCAN statics. http://gco.iarc.fr/today/home (04/27/2020).
  2. Ministerio de Salud. Guía Clínica AUGE Cáncer Cérvico Uterino. Minsal, Santiago 2015.
  3. Bishr MK, Zaghloul MS. Radiation Therapy Availability in Africa and Latin America: Two Models of Low and Middle Income Countries. Int J Radiat Oncol Biol Phys. 2018; 102(3): 490–498.
    CrossRefPubMed
  4. Zubizarreta EH, Poitevin A, Levin CV. Overview of radiotherapy resources in Latin America: a survey by the International Atomic Energy Agency (IAEA). Radiother Oncol. 2004; 73(1): 97–100.
    CrossRefPubMed
  5. Guedea F, Ventura M, Londres B, et al. Overview of brachytherapy resources in Latin America: a patterns-of-care survey. Brachytherapy. 2011; 10(5): 363–368.
    CrossRefPubMed
  6. Puglisi F, Bisagni G, Ciccarese M, et al. A Delphi consensus and open debate on the role of first-line bevacizumab for HER2-negative metastatic breast cancer. Future Oncol. 2016; 12(22): 2589–2602.
    CrossRefPubMed
  7. Likert R. A technique for the measurement of attitudes. Arch Psychol . 1932; 22(140): 55–55.
  8. Mohile SG, Velarde C, Hurria A, et al. Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts. J Natl Compr Canc Netw. 2015; 13(9): 1120–1130.
    CrossRefPubMed
  9. Manterola C, Asenjo-Lobos C, Otzen T. Jerarquización de la evidencia: Niveles de evidencia y grados de recomendación de uso actual. Rev Chil Infectol. 2014; 31(6): 705–718.
    CrossRef
  10. FIGO Committee on Gynecologic Oncology. FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet. 2014; 125(2): 97–98.
    CrossRefPubMed
  11. Small W, Mell LK, Anderson P, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008; 71(2): 428–434.
    CrossRefPubMed
  12. Lim K, Small W, Portelance L, et al. Gyn IMRT Consortium. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Int J Radiat Oncol Biol Phys. 2011; 79(2): 348–355.
    CrossRefPubMed
  13. Toita T, Ohno T, Kaneyasu Y, et al. JCOG Radiation Therapy Study Group. A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer. Jpn J Clin Oncol. 2011; 41(9): 1119–1126.
    CrossRefPubMed
  14. Small W, Beriwal S, Demanes DJ, et al. American Brachytherapy Society. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012; 11(1): 58–67.
    CrossRefPubMed
  15. Viswanathan AN, Thomadsen B. American Brachytherapy Society Cervical Cancer Recommendations Committee, American Brachytherapy Society. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: general principles. Brachytherapy. 2012; 11(1): 33–46.
    CrossRefPubMed
  16. Haie-Meder C, Pötter R, Van Limbergen E, et al. Gynaecological (GYN) GEC-ESTRO Working Group. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol. 2005; 74(3): 235–245.
    CrossRefPubMed
  17. Dimopoulos JCA, Petrow P, Tanderup K, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol. 2012; 103(1): 113–122.
    CrossRefPubMed
  18. Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer. Virchows Arch. 2018; 472(6): 919–936.
    CrossRefPubMed
  19. Lim MC, Lee M, Shim SH, et al. Practice guidelines for management of cervical cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol. 2017; 28(3): e22.
    CrossRefPubMed
  20. Chopra SJ, Mathew A, Maheshwari A, et al. National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer. J Glob Oncol. 2018; 4: 1–15.
    CrossRefPubMed
  21. Chino J, Annunziata CM, Beriwal S, et al. Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2020; 10(4): 220–234.
    CrossRefPubMed
  22. Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol. 1999; 73(2): 177–183.
    CrossRefPubMed
  23. Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006; 65(1): 169–176.
    CrossRefPubMed
  24. Peters WA, Liu PY, Barrett RJ, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000; 18(8): 1606–1613.
    CrossRefPubMed
  25. Monk BJ, Wang J, Im S, et al. Gynecologic Oncology Group, Southwest Oncology Group, Radiation Therapy Oncology Group. Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. Gynecol Oncol. 2005; 96(3): 721–728.
    CrossRefPubMed
  26. Rogers L, Siu SS, Luesley D, et al. Radiotherapy and chemoradiation after surgery for early cervical cancer. Cochrane Database Syst Rev. 2012(5): CD007583.
    CrossRefPubMed
  27. Klopp AH, Yeung AR, Deshmukh S, et al. Patient-Reported Toxicity During Pelvic Intensity-Modulated Radiation Therapy: NRG Oncology-RTOG 1203. J Clin Oncol. 2018; 36(24): 2538–2544.
    CrossRefPubMed
  28. Yeung AR, Pugh S, Klopp AH, et al. IMRT Improves Late Toxicity Compared to Conventional RT: An Update on NRG Oncology-RTOG 1203. Int J Radiat Oncol Biol Phys. 2019; 105(1): S50.
    CrossRef
  29. Song S, Song C, Kim HJ, et al. 20 year experience of postoperative radiotherapy in IB-IIA cervical cancer patients with intermediate risk factors: impact of treatment period and concurrent chemotherapy. Gynecol Oncol. 2012; 124(1): 63–67.
    CrossRefPubMed
  30. Hong JH, Tsai CS, Lai CH, et al. Postoperative low-pelvic irradiation for stage I–IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis. Int J Radiat Oncol Biol Phys. 2002; 53(5): 1284–1290.
    CrossRefPubMed
  31. Soisson AP, Soper JT, Clarke-Pearson DL, et al. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer. Gynecol Oncol. 1990; 37(3): 390–395.
    CrossRefPubMed
  32. Kim D, Ki Y, Kim W, et al. Adjuvant external beam radiation and brachytherapy for vaginal resection margin positive cervical cancer. Radiat Oncol J. 2018; 36(2): 147–152.
    CrossRefPubMed
  33. Landoni F, Colombo A, Milani R, et al. Randomized study between radical surgery and radiotherapy for the treatment of stage IB-IIA cervical cancer: 20-year update. J Gynecol Oncol. 2017; 28(3): e34.
    CrossRefPubMed
  34. Landoni F, Maneo A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997; 350(9077): 535–540.
    CrossRefPubMed
  35. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999; 340(15): 1144–1153.
    CrossRefPubMed
  36. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999; 340(15): 1154–1161.
    CrossRefPubMed
  37. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999; 340(15): 1137–1143.
    CrossRefPubMed
  38. Whitney CW, Sause W, Bundy BN, et al. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999; 17(5): 1339–1348.
    CrossRefPubMed
  39. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008; 26(35): 5802–5812.
    CrossRefPubMed
  40. Du Xl, Tao J, Sheng Xg, et al. Intensity-modulated radiation therapy for advanced cervical cancer: a comparison of dosimetric and clinical outcomes with conventional radiotherapy. Gynecol Oncol. 2012; 125(1): 151–157.
    CrossRefPubMed
  41. Chen SW, Liang JA, Hung YC, et al. Does initial 45Gy of pelvic intensity-modulated radiotherapy reduce late complications in patients with locally advanced cervical cancer? A cohort control study using definitive chemoradiotherapy with high-dose rate brachytherapy. Radiol Oncol. 2013; 47(2): 176–184.
    CrossRefPubMed
  42. Wu MH, Chen JH, Tai HC, et al. Intensity-Modulated Radiotherapy with Concurrent Chemotherapy for Elder Cervical Cancers: A Comparison of Clinical Outcomes with Conventional Radiotherapy. Int J Gerontol. 2016; 10(3): 159–163.
    CrossRef
  43. Naik A, Gurjar OP, Gupta KL, et al. Comparison of dosimetric parameters and acute toxicity of intensity-modulated and three-dimensional radiotherapy in patients with cervix carcinoma: A randomized prospective study. Cancer Radiother. 2016; 20(5): 370–376.
    CrossRefPubMed
  44. Gandhi AK, Sharma DN, Rath GK, et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013; 87(3): 542–548.
    CrossRefPubMed
  45. Kidd EA, Siegel BA, Dehdashti F, et al. Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2010; 77(4): 1085–1091.
    CrossRefPubMed
  46. Lin Y, Chen K, Lu Z, et al. Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis. Radiat Oncol. 2018; 13(1): 177.
    CrossRefPubMed
  47. Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiother Oncol. 2018; 127(3): 404–416.
    CrossRefPubMed
  48. Dimopoulos JCA, Schirl G, Baldinger A, et al. MRI assessment of cervical cancer for adaptive radiotherapy. Strahlenther Onkol. 2009; 185(5): 282–287.
    CrossRefPubMed
  49. Mazeron R, Petit C, Rivin E, et al. 45 or 50 Gy, Which is the Optimal Radiotherapy Pelvic Dose in Locally Advanced Cervical Cancer in the Perspective of Reaching Magnetic Resonance Image-guided Adaptive Brachytherapy Planning Aims? Clin Oncol (R Coll Radiol). 2016; 28(3): 171–177.
    CrossRefPubMed
  50. Pötter R, Tanderup K, Kirisits C, et al. EMBRACE Collaborative Group. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018; 9: 48–60.
    CrossRefPubMed
  51. EMBRACE. https://www.embracestudy.dk/Public/Default.aspx?ReturnUrl=%2f (11/07/2019).
  52. Perez CA, Grigsby PW, Castro-Vita H, et al. Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys. 1995; 32(5): 1275–1288.
    CrossRefPubMed
  53. Petereit DG, Sarkaria JN, Chappell R, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys. 1995; 32(5): 1301–1307.
    CrossRefPubMed
  54. Lanciano RM, Pajak TF, Martz K, et al. The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: a patterns-of-care study. Int J Radiat Oncol Biol Phys. 1993; 25(3): 391–397.
    CrossRefPubMed
  55. Girinsky T, Rey A, Roche B, et al. Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys. 1993; 27(5): 1051–1056.
    CrossRefPubMed
  56. Tanderup K, Fokdal LU, Sturdza A, et al. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol. 2016; 120(3): 441–446.
    CrossRefPubMed
  57. Fenkell L, Assenholt M, Nielsen SK, et al. Parametrial boost using midline shielding results in an unpredictable dose to tumor and organs at risk in combined external beam radiotherapy and brachytherapy for locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2011; 79(5): 1572–1579.
    CrossRefPubMed
  58. Rajasooriyar C, Van Dyk S, Lindawati M, et al. Reviewing the role of parametrial boost in patients with cervical cancer with clinically involved parametria and staged with positron emission tomography. Int J Gynecol Cancer. 2012; 22(9): 1532–1537.
    CrossRefPubMed
  59. Tewari KS, Monk BJ. Chapter 3 — Invasive Cervical Cancer. In: Di Saia PJ, Creasman W. ed. Clinical Gynecologic Oncology. 8th ed. Mosby, Philadelphia 2012: 51–119.
  60. Patel CN, Nazir SA, Khan Z, et al. 18F-FDG PET/CT of cervical carcinoma. AJR Am J Roentgenol. 2011; 196(5): 1225–1233.
    CrossRefPubMed
  61. Marth C, Landoni F, Mahner S, et al. ESMO Guidelines Committee. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28(suppl_4): iv72–iv83.
    CrossRefPubMed
  62. Rotman M, Pajak TF, Choi K, et al. Prophylactic extended-field irradiation of para-aortic lymph nodes in stages IIB and bulky IB and IIA cervical carcinomas. Ten-year treatment results of RTOG 79-20. JAMA. 1995; 274(5): 387–393.
    PubMed
  63. Rotman M, Choi K, Guse C, et al. Prophylactic irradiation of the para-aortic lymph node chain in stage IIB and bulky stage IB carcinoma of the cervix, initial treatment results of RTOG 7920. Int J Radiat Oncol Biol Phys. 1990; 19(3): 513–521.
    CrossRefPubMed
  64. Wang W, Liu X, Meng Q, et al. Prophylactic Extended-Field Irradiation for Patients With Cervical Cancer Treated With Concurrent Chemoradiotherapy: A Propensity-Score Matching Analysis. Int J Gynecol Cancer. 2018; 28(8): 1584–1591.
    CrossRefPubMed
  65. Haie C, Pejovic MH, Gerbaulet A, et al. Is prophylactic para-aortic irradiation worthwhile in the treatment of advanced cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol. 1988; 11(2): 101–112.
    CrossRefPubMed
  66. Eifel PJ, Winter K, Morris M, et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004; 22(5): 872–880.
    CrossRefPubMed
  67. Osborne EM, Klopp AH, Jhingran A, et al. Definitive Extended-Field Radiation Therapy for Cervical Cancer Patients With Para-Aortic Lymph Node Metastases. Int J Radiat Oncol Biol Phys. 2015; 93(3): S202–S203.
    CrossRef
  68. Vargo JA, Kim H, Choi S, et al. Extended field intensity modulated radiation therapy with concomitant boost for lymph node-positive cervical cancer: analysis of regional control and recurrence patterns in the positron emission tomography/computed tomography era. Int J Radiat Oncol Biol Phys. 2014; 90(5): 1091–1098.
    CrossRefPubMed
  69. Bacorro W, Dumas I, Escande A, et al. Dose-volume effects in pathologic lymph nodes in locally advanced cervical cancer. Gynecol Oncol. 2018; 148(3): 461–467.
    CrossRefPubMed
  70. Grigsby PW, Singh AK, Siegel BA, et al. Lymph node control in cervical cancer. Int J Radiat Oncol Biol Phys. 2004; 59(3): 706–712.
    CrossRefPubMed
  71. Wakatsuki M, Ohno T, Kato S, et al. Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer. J Radiat Res. 2014; 55(1): 139–145.
    CrossRefPubMed
  72. Orton C, Seyedsadr M, Somnay A. Comparison of high and low dose rate remote afterloading for cervix cancer and the importance of fractionation. Int J Radiat Oncol Biol Phys. 1991; 21(6): 1425–1434.
    CrossRefPubMed
  73. Patel FD, Sharma SC, Negi PS, et al. Low dose rate vs. high dose rate brachytherapy in the treatment of carcinoma of the uterine cervix: a clinical trial. Int J Radiat Oncol Biol Phys. 1994; 28(2): 335–341.
    CrossRefPubMed
  74. Kim H, Rajagopalan MS, Beriwal S, et al. Cost-effectiveness analysis of 3D image-guided brachytherapy compared with 2D brachytherapy in the treatment of locally advanced cervical cancer. Brachytherapy. 2015; 14(1): 29–36.
    CrossRefPubMed
  75. Pelloski CE, Palmer M, Chronowski GM, et al. Comparison between CT-based volumetric calculations and ICRU reference-point estimates of radiation doses delivered to bladder and rectum during intracavitary radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2005; 62(1): 131–137.
    CrossRefPubMed
  76. Lee KK, Lee JY, Nam JMo, et al. High-dose-rate vs. low-dose-rate intracavitary brachytherapy for carcinoma of the uterine cervix: Systematic review and meta-analysis. Brachytherapy. 2015; 14(4): 449–457.
    CrossRefPubMed
  77. The Transition from 2-D Brachytherapy to 3-D High Dose Rate Brachytherapy: Training Material. Thttps://www.iaea.org/publications/10982/the-transition-from-2-d-brachytherapy-to-3-d-high-dose-rate-brachytherapy-training-material (04/27/2020).
  78. Charra-Brunaud C, Harter V, Delannes M, et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol. 2012; 103(3): 305–313.
    CrossRefPubMed
  79. Tanderup K, Lindegaard JC, Kirisits C, et al. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome. Radiother Oncol. 2016; 120(3): 365–369.
    CrossRefPubMed
  80. Tanderup K, Georg D, Pötter R, et al. Adaptive management of cervical cancer radiotherapy. Semin Radiat Oncol. 2010; 20(2): 121–129.
    CrossRefPubMed
  81. Tanderup K, Viswanathan AN, Kirisits C, et al. Magnetic resonance image guided brachytherapy. Semin Radiat Oncol. 2014; 24(3): 181–191.
    CrossRefPubMed
  82. Serban M, Kirisits C, de Leeuw A, et al. EMBRACE Collaborative Group. Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study. Int J Radiat Oncol Biol Phys. 2020; 106(5): 1052–1062.
    CrossRefPubMed
  83. Kashihara T, Kobayashi K, Iijima K, et al. A case report of a patient with bulky uterine cervical neoplasm who achieved complete response with "intentional internal high-dose policy" high-dose-rate interstitial brachytherapy. Medicine (Baltimore). 2020; 99(27): e20860.
    CrossRefPubMed
  84. Fokdal L, Sturdza A, Mazeron R, et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol. 2016; 120(3): 434–440.
    CrossRefPubMed
  85. Smolic M, Sombroek C, Bloemers MC, et al. Prediction of optimal needle configuration in the first fraction of cervix brachytherapy. Phys Imaging Radiat Oncol. 2019; 10: 14–18.
    CrossRefPubMed
  86. Wachter-Gerstner N, Wachter S, Reinstadler E, et al. The impact of sectional imaging on dose escalation in endocavitary HDR-brachytherapy of cervical cancer: results of a prospective comparative trial. Radiother Oncol. 2003; 68(1): 51–59.
    CrossRefPubMed
  87. Wachter S, Gerstner N, Lefaza D, et al. 6The impact of MRI on the delineation of gross tumour volume in cervical cancer treatment planning: An interobserver analysis. Radiother Oncol. 2001; 60: S2–S3.
    CrossRef
  88. Viswanathan AN, Erickson B, Gaffney DK, et al. Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2014; 90(2): 320–328.
    CrossRefPubMed
  89. Kamran SC, Manuel MM, Cho LP, et al. Comparison of outcomes for MR-guided versus CT-guided high-dose-rate interstitial brachytherapy in women with locally advanced carcinoma of the cervix. Gynecol Oncol. 2017; 145(2): 284–290.
    CrossRefPubMed
  90. Mahantshetty U, Naga Ch P, Khadanga CR, et al. A Prospective Comparison of Computed Tomography with Transrectal Ultrasonography Assistance and Magnetic Resonance Imaging-Based Target-Volume Definition During Image Guided Adaptive Brachytherapy for Cervical Cancers. Int J Radiat Oncol Biol Phys. 2018; 102(5): 1448–1456.
    CrossRefPubMed

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