Radiotherapy of cervical cancer. Current developments and treatment standards for percutaneous radiotherapy and brachytherapy

Background: Radiotherapy (RT) is an established component of curative treatment for locally advanced cervical cancer. In recent years substantial progress has been made. Objective: Update of percutaneous RT and brachytherapy (BT) techniques as well as concomitant systemic therapy with an overview of currently relevant data. Material and methods: Presentation of the current state of the art in radio-oncological standards and discussion of recent studies concerning RT and concomitant systemic therapy. Results: The PARCER and RTOG 1203 studies confirmed the benefit of intensity-modulated radiotherapy (IMRT) especially with respect to the toxicity. The results of the EMBRACE-I study showed outstanding efficacy of 3D image-guided BT. For neoadjuvant chemotherapy, detailed data from the INTERLACE study have not yet been published. The simultaneous and adjuvant immunotherapy with durvalumab did not appear to be advantageous in the CALLA study. First results of the KEYNOTE-A-18 study on simultaneous and adjuvant administration of pembrolizumab are promising. Conclusion: Platinum-based chemoradiotherapy (CRT) is and remains the current standard for locally advanced cervical cancer. Modern radiation techniques, such as IMRT and 3D image-guided BT, are also now standard. Neoadjuvant chemotherapy is currently of no importance. Adjuvant chemotherapy with pembrolizumab is a new useful and important option for persistent and recurrent tumors after CRT with BT. Immunotherapy is about to be implemented in primary treatment schedules but is currently not yet approved.