Image-guided adaptive brachytherapy in the treatment of patients with cervix cancer

Deep modifications have occurred these last years in the brachytherapy use in patients with cervix cancer. Imaging allowed a more precise definition of the volumes of interest linked to the tumour and its extension as well as a better visualization of organs at risk. Recommendations on delineation modalities were published in 2005, leading to definition homogeneity, even if large variations are still observed among centres, in terms of techniques and doses. These new definitions also served as basis for new applicators development, allowing a combination of interstitial and endocavitary techniques. Results from centres using image-guided brachytherapy (MRI in particular) evidenced local control improvement, without increase in complications. Retrospective and prospective studies are currently under evaluation. These studies will likely be able to determine dose required to sterilize tumours, as a function of stage and size, as well as dose limits for organs at risk. (C) 2013 Published by Elsevier Masson SAS on behalf of the Societe francaise de radiotherapie oncologique (SFRO).