Adaptive management of cervical cancer radiotherapy.

Since the breakthrough 10 years ago with concomitant radio-chemotherapy, substantial progress in the treatment of locally advanced cervical cancer has been lacking. Radiotherapy continues to be the cornerstone in the treatment of this disease and now shows much potential for progress, as image guidance of both external beam radiation therapy and brachytherapy, linked with strong tools for treatment planning and dose delivery, is becoming available. With these new techniques, it again seems possible to improve the therapeutic ratio as we begin to understand how the treatment for each patient can be individualized, not only in terms of volume (3-dimensional), but also during treatment (4-dimensional), as the tumor regresses and the topography of the target and organs at risk change significantly. New promising data with increased loco-regional control and decreased morbidity compared with the past are appearing. At the dawn of this new era, it is the aim of the present article to give an overview of the use of image-guided adaptive radiotherapy in the multimodal management of locally advanced cervical cancer.