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Brachytherapy or external beam radiotherapy as a boost in locally advanced cervical cancer: a Gynaecology Study Group in the Italian Association of Radiation and Clinical Oncology (AIRO) review
  1. Maura Campitelli1,
  2. Roberta Lazzari2,
  3. Federica Piccolo3,
  4. Patrizia Ferrazza4,
  5. Anna Rita Marsella5,
  6. Gabriella Macchia6,
  7. Andrei Fodor7,
  8. Riccardo Santoni8,
  9. Luca Tagliaferri1,
  10. Annamaria Cerrotta3 and
  11. Cynthia Aristei9
  1. 1 Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
  2. 2 Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
  3. 3 Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
  4. 4 UO Radioterapia Oncologica, Ospedale Santa Chiara, Trento, Italy
  5. 5 S.C. Radioterapia Oncologica, P.O. "San G. Moscati", Taranto, Italy
  6. 6 Radiotherapy Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
  7. 7 Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
  8. 8 Department of Biomedicine and Prevention, University of Rome Tor Vergata, UNIROMA2, Rome, Italy
  9. 9 Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Umbria, Italy
  1. Correspondence to Dr Maura Campitelli, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome 00168, Italy; maura.campitelli{at}


This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.

  • cervical cancer
  • brachytherapy
  • radiation oncology
  • radiotherapy
  • intensity-modulated

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  • Contributors MC, RL, CA, FP, PF, ARM, and GM provided substantial contributions to the conception and design of the work, and for the acquisition, analysis and interpretation of data. MC and CA drafted the work and revised it critically for important intellectual content. MC and CA provided final approval of the version published. AF, RS, LT, and AC gave their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.