Effectiveness of Image-guided Brachytherapy in Patients With Locally Advanced Cervical Squamous Cell Carcinoma Receiving Concurrent Chemoradiotherapy

Anticancer Res. 2019 Jun;39(6):3015-3024. doi: 10.21873/anticanres.13434.


Aim: To compare the advantage of image-guided brachytherapy (IGBT) over conventional two-dimensional brachytherapy (2DBT) in patients with advanced cervical squamous cell carcinoma.

Patients and methods: This study included 253 patients with stage IB2-IVA diseases treated with two schemes of brachytherapy. One hundred and thirty-six patients received 2DBT, whereas 117 patients received IGBT. Tumor stage, age, and tumor diameter were matched between the two groups. Local relapse-free survival, overall survival, and cumulative incidences of gastrointestinal and genitourinary complications were compared between the two groups.

Results: The overall and local relapse-free survival rates were similar between the two groups. The cumulative rate of grade 2 and higher gastrointestinal complication was 21.3% for the 2DBT group, and 8.5% for the IGBT group (p=0.007), whereas that of grade 2 and higher genitourinary injury was 11.8% for the 2DBT group, and 1.7% for the IGBT group (p=0.002).

Conclusion: In patients with advanced cervical squamous cell carcinoma, IGBT achieves a higher therapeutic ratio compared to 2DBT technique by minimizing the late toxicities.

Keywords: Cervical cancer; image-guided brachytherapy; intensity-modulated radiation therapy; therapeutic ratio.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / administration & dosage
  • Brachytherapy / adverse effects
  • Brachytherapy / methods*
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy / adverse effects
  • Chemoradiotherapy / methods*
  • Cisplatin / administration & dosage
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Progression-Free Survival
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Retrospective Studies
  • Time Factors
  • Tomography, X-Ray Computed*
  • Uterine Cervical Neoplasms / diagnostic imaging
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*


  • Antineoplastic Agents
  • Cisplatin