Radiation therapy of cervical cancer: Current status in Korea and recent developments

Huh, Seung Jae

Abstract

Brachytherapy is an essential part of the radiotherapy for uterine cervical cancer. Since 1979, high dose rate (HDR) brachytherapy has been used for the treatment of uterine cervical cancer in Korea; the number of institutions employing HDR has been increasing. At 40 radiation oncology departments out of 53 in Korea, HDR brachytherapy was practiced in 2004. Approximately in 1,000 of patients, brachytherapy was done annually and among these, HDR proportions were 75-80%. In Korea, treatment results for HDR are comparable with the low dose rate (LDR) system series and appear to be a safe and effective alternative to LDR for the treatment of cervical carcinoma. The studies from the major centers report the five-year survival rate of cervical cancer as, 78-86% for Stage I, 68-85% for stage II, and 38-56% for Stage III. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiation dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. Recently a three-dimensional conformal radiotherapy (3DCRT) or an intensity-modulated radiotherapy (IMRT), which allow for a high degree of conformity to the target volume have been used for the uterine cervical cancer. Several studies have reported the superiority of IMRT, over the conventional technique, in reducing the small bowel dose. The author will introduce the small bowel displacement system (SBDS)-assisted IMRT for cervical cancer patients. Positional changes of the uterus during radiotherapy, which can degrade the accuracy of 3DCRT and IMRT, will be discussed.