Controversies and New Developments in Gynecologic Brachytherapy: Image-Based Intracavitary Brachytherapy for Cervical Carcinoma

The current clinical practice for cervical cancer intracavitary brachytherapy in most centers is to prescribe the dose to point A. However, this is an empirical point and does not necessarily reflect dose to the tumor. Although 3-dimensional image-based treatment planning is extensively used in prostate brachytherapy, only a few institutions have used it to shape the dose distribution in cervical brachytherapy. To facilitate and standardize image-based dosimetry for cervical cancer brachytherapy, the American Image-guided Brachytherapy Working Group and the European Gynecological GEC-ESTRO Working Group have recently proposed nomenclature for volume definition and recommendations for image-based intracavitary brachytherapy for cervical cancer. The recommendations of the 2 groups are very similar and are discussed together in this article. Proposals are made for research in image-based brachytherapy for cervical cancer. At a recent transatlantic image-based cervical cancer brachytherapy workshop (Chicago, IL, July 28, 2005), it was suggested that because the recommendations are so similar and to prevent confusion, the nomenclature suggested by the European Group be adopted and future joint contouring workshops be organized to facilitate image-based cervical cancer brachytherapy.