title: Image-guided adaptive brachytherapy in locally advanced cervical cancer: recent advances and perspectives.
abstract: Image-guided adaptive brachytherapy (IGABT) is a high-precision radiation that allows defining accurately treatment targets and optimizing their coverage whereas sparing efficiently the surrounding organs at risk. Ten years ago, in a will of harmonizing the reporting of brachytherapy, the Groupe Européen de Curiethérapie - European Society for Radiation Oncology (GEC-ESTRO) published recommendations on target definitions and dosimetric parameters. During the last years, clinical and dosimetric studies supporting their relevance led the International Commission on Radiation Units and Measurements to propose a report on prescribing and reporting. This review aims to highlight the recent advances in IGABT and its future developments.
  
  
  
  Clinical evidence demonstrating the superiority of IGABT over radiographs-based brachytherapy is accumulating. In parallel, dose-volume effects have been established between dose-volume parameters and tumor response or the occurrence of late radiation morbidity. Preliminary studies indicate that planning aims could be adapted to clinical situations and cofactors. The first publications from the large studies led by the GEC-ESTRO enforce these findings.
  
  
  
  A trend emerges toward a personalization of treatment with the adaptation of planning aims to prognostic features and the development of individualized applicators. Image-guidance modalities are developed with a better use of MRI or conversely the use of more accessible modalities such as transrectal ultrasound.
authors.affiliation: aBrachytherapy Unit, Department of Radiation Oncology, Gustave Roussy, University of Paris-Saclay bMolecular Radiotherapy, INSERM 1030, Gustave Roussy cInstitut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Castelnau-Marchand
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
mesh_terms: D001918:Brachytherapy / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods* / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*