High-dose rate brachytherapy for carcinoma of the cervix

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Increasingly popular in Europe and Asia as the intracavitary component for cervical cancer radiotherapy, high-dose rate brachytherapy demonstrates certain advantages over historical low-dose rate treatments. High-dose rate intracavitary treatment improves radiation safety, lessens treatment times, allows for outpatient treatment regimens, and has improved packing and retraction techniques, which can decrease rectal and bladder doses. Although retrospective studies of high-dose rate treatment show survival rates comparable with those of historical low-dose rate intracavitary treatment, there have been few randomized, prospective studies to support the use of high-dose rate techniques. Low- and high-dose rate comparisons are further complicated by the lack of standardized fractionation schemes and dose prescriptions for high-dose rate treatment. Recent data showing decreased local control in advanced cervical cancer with the prolonged overall treatment time of low-dose rate treatment suggest the practical advantage of outpatient high-dose rate intracavitary brachytherapy, which uses fractionated regimens and shortens overall treatment times. Although high-dose rate treatment has not been shown to improve survival compared with low-dose rate treatment, its practical advantages may account for its increasing use.

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