The Current use of Adaptive Strategies for External Beam Radiotherapy in Cervical Cancer: A Systematic Review

Area of Science:

• Radiation Oncology
• Medical Physics
• Gynecologic Oncology

Background:

• Cervical cancer radiotherapy faces challenges due to anatomical variability, impacting treatment precision.
• Adaptive radiotherapy (ART) offers improved precision and outcomes but lacks consensus on optimal strategies and faces workload concerns.
• This systematic review evaluates current ART strategies for cervical cancer to define an optimal approach.

Approach:

• A systematic literature review was conducted from January 2012 to May 2023 using major scientific databases.
• The review assessed workflows, dosimetric benefits, and resource implications of identified ART strategies.
• Five ART approaches were identified: reactive, scheduled, ITV-based LOP, fixed-margin LOP, and real-time adaptation.

Key Points:

• All identified ART approaches reduced irradiated volumes without compromising target coverage compared to non-ART methods.
• The library of plans (LOP)-based internal target volume (ITV) approach is the most frequently used and clinically evaluated strategy.
• Retrospective simulation planning studies dominated the literature, with only four studies involving clinical implementation.

Conclusions:

• Optimal ART strategy selection is hindered by limitations in dosimetric assessment.
• Implementing ART in cervical cancer requires optimizing clinical benefits and resources.
• Further research, including optimal frequency determination and prospective toxicity evaluations, is crucial for cervical cancer ART adoption.