From 'points' to 'profiles' in intracavitary brachytherapy of cervical cancer

This article reviews some recent developments that have occurred with the widespread use of imaging modalities during intracavitary brachytherapy in cervical cancer.

The practice of dose prescription with intracavitary brachytherapy continues to be largely based on the traditional hypothetical point - point A. Recent studies have indicated that significant uncertainties could result with such point dose prescriptions. Gradually a shift is perceived towards the incorporation of target and normal structure outlines for dose prescription and treatment planning during intracavitary brachytherapy.

Dose prescriptions during brachytherapy could be framed with certainty if various imaging modalities are integrated during the intracavitary procedure. With the availability of computerized tomography/magnetic resonance imaging-compatible applicators, dose prescriptions and distributions could be based on either anatomical images of the diseased and normal organs obtained from computerized tomography or magnetic resonance imaging studies or on anatometabolic images after co-registration of the anatomical and functional images obtained from computerized tomography/magnetic resonance imaging and positron emission tomography. A shift from traditional two-dimensional 'points' to three-dimensional 'profiles' for targets and normal tissue doses could be expected in the near future with the use of image-guided intracavitary brachytherapy in cervical cancer.