Background/Objectives: Recent advancements in the treatment of LACC have focused on improving outcomes through systemic treatment intensification. Therefore, this review aims to analyze the brachytherapy (BT) techniques employed in recent studies that are likely to change upcoming clinical guidelines, and to discuss the evolving role of IGABT in optimizing patient outcomes. Methods: This review focuses on BT practices reported across main phase III trials—OUTBACK, INTERLACE, CALLA, and KEYNOTE A18—compared with the EMBRACE I study. Analyzed parameters include BT modality, dose prescription techniques, imaging guidance, and overall treatment time (OTT). Results: In EMBRACE I, MRI-based IGABT was mandatory, with 43% of patients receiving an intracavitary/interstitial (IC/IS) applicator; cumulative EQD2 D90 HR-CTV was 90 Gy with a median OTT of 46 days. The OUTBACK trial relied predominantly on point A-based BT, with limited use of volume-based BT (28%). The INTERLACE trial reported mixed BT approaches: 70% point A-based, 30% volume-based, and 20% 2D BT. A median cervical dose of 79.4 Gy was reported. CALLA maintained strong protocol adherence, with 60% volume-based BT and a median tumor EQD2 dose of 83 Gy, although lower in the Japan cohort. In the KEYNOTE A 18 cohort, volume-based BT was performed in 88% of patients, with a median D90 HR-CTV dose of 87 Gy; IC/IS applicators were used in 23% of cases. Conclusions: Across these major studies, the following consistent pattern emerges: the quality and technique of BT impact survival outcomes and toxicity profile in LACC. MRI-based IGABT—with the use of IC/IS applicators when needed—is essential.
背景/目的：近期局部晚期宫颈癌（LACC）的治疗进展聚焦于通过强化全身治疗改善预后。因此，本综述旨在分析可能改变未来临床指南的最新研究中采用的近距离放疗（BT）技术，并探讨影像引导自适应近距离放疗（IGABT）在优化患者预后方面不断演进的作用。方法：本综述重点关注OUTBACK、INTERLACE、CALLA和KEYNOTE A18等主要III期试验中报告的BT实践，并与EMBRACE I研究进行比较。分析参数包括BT模式、剂量处方技术、影像引导及总治疗时间（OTT）。结果：在EMBRACE I研究中，基于磁共振成像（MRI）的IGABT是强制要求，43%的患者使用了腔内/组织间插植（IC/IS）施源器；累积EQD2 D90 HR-CTV剂量为90 Gy，中位OTT为46天。OUTBACK试验主要依赖基于A点的BT，基于体积的BT使用有限（28%）。INTERLACE试验报告了混合BT方案：70%基于A点，30%基于体积，20%为二维BT。报告的中位宫颈剂量为79.4 Gy。CALLA试验保持了严格的方案依从性，60%采用基于体积的BT，中位肿瘤EQD2剂量为83 Gy，但日本队列的剂量较低。在KEYNOTE A18队列中，88%的患者接受了基于体积的BT，中位D90 HR-CTV剂量为87 Gy；23%的病例使用了IC/IS施源器。结论：在这些主要研究中，呈现出一致的模式：BT的质量和技术影响LACC的生存结局和毒性特征。基于MRI的IGABT——必要时结合使用IC/IS施源器——至关重要。
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