title: Moving from standardized to personalized boxes and pears in radiation planning for cervical cancer.
abstract: OBJECTIVE
  We reviewed the most recent literature on advancements in external beam radiation therapy, brachytherapy, and stereotactic body radiation therapy (SBRT) in the treatment of cervical cancer.
  
  
  RESULTS
  There is a growing transition from three-dimensional-conformal radiation therapy to intensity modulated radiation therapy, and from point A-based two-dimensional prescriptions to three-dimensional volume-based prescriptions in image-guided brachytherapy (IGBT). These advances allow dose-escalation to at-risk regions while sparing normal tissues. Implementation of these techniques is resulting in improved local control and decreased toxicity in patients. With increased local control, the predominant pattern of recurrence is now distant failure, opening the door for SBRT as an emerging treatment option for select patients with limited numbers of metastases (oligometastatic state).
  
  
  CONCLUSIONS
  The integration of IGBT, as well as dose sculpting with intensity modulated radiation therapy, is improving outcomes in women with locally advanced cervical cancer. The clinical evidence strongly supports moving away from point A-based prescriptions and adopting IGBT techniques. The existing data supporting SBRT for gynecologic oligometastases are more limited and require further research before widespread adoption; however, evidence from other disease sites is promising.
authors.affiliation: aUniversity of California Irvine, School of Medicine bDepartment of Radiation Oncology, University of California, Los Angeles, California, USA.
authors.forename: Shane
authors.initials: S
authors.lastname: Mesko
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
mesh_terms: D001918:Brachytherapy / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*