3D brachytherapy for cervical cancer: New optimization ways.

Brachytherapy has known major improvements in recent decades. It represents an essential component of local treatment of cervix cancers. One major breakthrough was the advent of 3D imaging for image-guided brachytherapy. Doses could be prescribed to volumes. This allows better delineation and coverage of target volumes, as well as organs at risk (bladder, rectum, sigmoid) protection. Local recurrences have been consequently reduced and survival has been improved. In addition, improvement and development of new applicators have facilitated the delivery of interstitial treatments. Afterloading applicators, associated with 3D imaging, allow dosimetry optimization in order to improve the coverage of the target volumes (dose in 90% of the high risk clinical target volume) and to limit dose to the organs at risk. In the future, more personalized treatments will be achieved through more advanced applicators and/or by improving the accuracy of imaging at the time of brachytherapy.