Purpose: The standard of care for patients with locally advanced cervical cancer is definitive chemoradiation followed by a brachytherapy boost. This review describes the current status and future directions of image-guided adaptive brachytherapy for locally advanced cervical cancer. Methods: A systematic search of the PubMed and Clinicaltrials.gov databases was performed, focusing on studies published within the last 10 years. The search queried “cervical cancer [AND] image-guided brachytherapy [OR] magnetic resonance imaging (MRI) [OR] adaptive brachytherapy”. Discussion: The retroEMBRACE and EMBRACE-I trials have established the use of MRI as the standard imaging modality for brachytherapy application and planning. Quantitative imaging and radiomics have the potential to improve outcomes, with three ongoing prospective studies examining the use of radiomics to further risk-stratify patients and personalize brachytherapy. Another active area of investigation includes utilizing the superior soft tissue contrast provided by MRI to increase the dose per fraction and decrease the number of fractions needed for brachytherapy, with several retrospective studies demonstrating the safety and feasibility of three-fraction courses. For developing countries with limited access to MRI, trans-rectal ultrasound (TRUS) appears to be an effective alternative, with several retrospective studies demonstrating improved target delineation with the use of TRUS in conjunction with CT guidance. Conclusions: Further investigation is needed to continue improving outcomes for patients with locally advanced cervical cancer treated with image-guided brachytherapy.
目的：局部晚期宫颈癌的标准治疗方案为根治性放化疗联合近距离放疗增强。本综述旨在阐述图像引导自适应近距离放疗在局部晚期宫颈癌治疗中的现状与未来发展方向。方法：系统检索PubMed及Clinicaltrials.gov数据库中近十年发表的相关研究，检索策略为"宫颈癌[与]图像引导近距离放疗[或]磁共振成像[或]自适应近距离放疗"。讨论：retroEMBRACE与EMBRACE-I试验已确立磁共振成像作为近距离放疗施照与计划制定的标准影像学方法。定量影像与影像组学技术有望提升治疗效果，目前有三项前瞻性研究正在探索如何运用影像组学进一步实现风险分层与个体化近距离放疗。另一活跃研究方向是利用磁共振成像优越的软组织对比度，提高单次分割剂量并减少治疗次数，多项回顾性研究已证实三分割方案的安全性与可行性。在磁共振资源有限的发展中国家，经直肠超声联合CT引导可作为有效替代方案，多项回顾性研究显示该技术能显著提升靶区勾画精度。结论：需进一步深入研究以持续改善局部晚期宫颈癌患者接受图像引导近距离放疗的临床疗效。
肿瘤(癌症)患者之家