{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:16Z","timestamp":1787028916058,"version":"build-2736575974"},"reference-count":90,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T00:00:00Z","timestamp":1695772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The standard of care for locally advanced cervical cancer is external beam radiotherapy (EBRT) with simultaneous chemotherapy followed by an internal radiation boost. New imaging methods such as positron-emission tomography and magnetic resonance imaging have been implemented into daily practice for better tumor delineation in radiotherapy planning. The method of delivering radiation has changed with technical advances in qualitative imaging and treatment delivery. Image-guided radiotherapy (IGRT) plays an important role in minimizing treatment toxicity of pelvic radiation and provides a superior conformality for sparing the organs at risk (OARs) such as bone marrow, bowel, rectum, and bladder. Similarly, three-dimensional image-guided adaptive brachytherapy (3D-IGABT) with computed tomography (CT) or magnetic resonance imaging (MRI) has been reported to improve target coverage and reduce the dose to normal tissues. Brachytherapy is a complementary part of radiotherapy treatment for cervical cancer and, over the past 20 years, 3D-image-based brachytherapy has rapidly evolved and established itself as the gold standard. With new techniques and adaptive treatment in cervical cancer, the concept of personalized medicine is introduced with an enhanced comprehension of the therapeutic index not only in terms of volume (three-dimensional) but during treatment too (four-dimensional). Current data show promising results with integrated IGRT and IGABT in clinical practice and, therefore, better local control and overall survival while reducing treatment-related morbidity. This review gives an overview of the substantial impact that occurred in the progress of image-guided adaptive external beam radiotherapy and brachytherapy.<\/jats:p>","DOI":"10.3390\/medicina59101735","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T01:42:12Z","timestamp":1695865332000},"page":"1735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Recent Advances and Adaptive Strategies in Image Guidance for Cervical Cancer Radiotherapy"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4616-1553","authenticated-orcid":false,"given":"Beatrice","family":"Anghel","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Radiation Oncology, Sanador Oncology Centre, 010991 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crenguta","family":"Serboiu","sequence":"additional","affiliation":[{"name":"Department of Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Marinescu","sequence":"additional","affiliation":[{"name":"Radiology and Imaging Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulian-Alexandru","family":"Taciuc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Nuclear Medicine Department, Oncological Institute \u201cProf. Dr. Alexandru Trestioreanu\u201d, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8944-3857","authenticated-orcid":false,"given":"Florin","family":"Bobirca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"General Surgery Department, Cantacuzino Clinical Hospital, 73206 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Daniela","family":"Stanescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Obstetrics and Gynecology, St. John Emergency Hospital, Bucur Maternity, 040292 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis","volume":"8","author":"Arbyn","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E199","DOI":"10.1503\/cmaj.191292","article-title":"Canadian Cancer Statistics Advisory Committee","volume":"192","author":"Brenner","year":"2020","journal-title":"CMAJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.clon.2018.10.004","article-title":"The human papillomavirus as a common pathogen in oropharyngeal, anal, and cervical cancers","volume":"31","author":"Otter","year":"2019","journal-title":"Clin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F","article-title":"Human papillomavirus is a necessary cause of invasive cervical cancer worldwide","volume":"189","author":"Walboomers","year":"1999","journal-title":"J. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1056\/NEJMoa1917338","article-title":"HPV Vaccination and the Risk of Invasive Cervical Cancer","volume":"383","author":"Lei","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5119","DOI":"10.1002\/cncr.30906","article-title":"Cervical cancer survival in the United States by race and stage (2001\u20132009): Findings from the CONCORD-2 study","volume":"123","author":"Benard","year":"2017","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijrobp.2013.05.033","article-title":"Trends in the utilization of brachytherapy in cervical cancer in the United States","volume":"87","author":"Han","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","unstructured":"(2023, August 22). Cervical Cancer Version 1.2024. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/cervical.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5802","DOI":"10.1200\/JCO.2008.16.4368","article-title":"Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: A systematic review and meta-analysis of individual patient data from 18 randomized trials","volume":"26","author":"Vale","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1056\/NEJM199904153401501","article-title":"Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer","volume":"340","author":"Morris","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1056\/NEJM199904153401503","article-title":"Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma","volume":"340","author":"Keys","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1200\/JCO.1999.17.5.1339","article-title":"Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: A Gynecologic Oncology Group and Southwest Oncology Group study","volume":"17","author":"Whitney","year":"1999","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1200\/JCO.2000.18.8.1606","article-title":"Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix","volume":"18","author":"Peters","year":"2000","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1056\/NEJM199904153401502","article-title":"Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer","volume":"340","author":"Rose","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/S0360-3016(01)02785-7","article-title":"Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies","volume":"52","author":"Mundt","year":"2002","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/S0360-3016(03)00325-0","article-title":"Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy","volume":"56","author":"Mundt","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1016\/j.ijrobp.2006.11.005","article-title":"Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy: Comparison with conventional radiotherapy","volume":"67","author":"Chen","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ijrobp.2006.12.023","article-title":"Early clinical outcome with concurrent chemotherapy and extended-field, intensity-modulated radiotherapy for cervical cancer","volume":"68","author":"Beriwal","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_19","first-page":"48","article-title":"The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC\u2014ESTRO GYN working group and the EMBRACE studies","volume":"9","author":"Tanderup","year":"2018","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1148\/radiol.2019190088","article-title":"2018 FIGO staging system for uterine cervical cancer: Enter cross-sectional imaging","volume":"292","author":"Lee","year":"2019","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1111\/j.1754-9485.2011.02333.x","article-title":"Evaluation of carcinoma cervix using magnetic resonance imaging: Correlation with clinical FIGO staging and impact on management","volume":"56","author":"Dhoot","year":"2012","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0090-8258(03)00409-8","article-title":"Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma","volume":"91","author":"Bipat","year":"2003","journal-title":"Gynecol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.radonc.2008.04.009","article-title":"On line MRI guidance for healthy tissue sparing in patients with cervical cancer","volume":"88","author":"Kerkhof","year":"2008","journal-title":"Radiother. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijrobp.2008.10.033","article-title":"Dosevolume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy","volume":"75","author":"Dimopoulos","year":"2009","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1007\/s00330-010-1998-x","article-title":"Staging of uterine cervical cancer with MRI: Guidelines of the European Society of Urogenital Radiology","volume":"21","author":"Balleyguier","year":"2011","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13014-016-0591-0","article-title":"A practical review of magnetic resonance imaging for the evaluation and management of cervical cancer","volume":"11","author":"Fields","year":"2016","journal-title":"Radiat. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S0360-3016(99)00228-X","article-title":"Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging","volume":"45","author":"Hatano","year":"1999","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1002\/cncr.23817","article-title":"Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2\/II cervical carcinoma with chemoradiation therapy: Correlation of radiologic findings with surgico-pathologic results","volume":"113","author":"Vincens","year":"2008","journal-title":"Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.mri.2014.05.009","article-title":"Assessment of early response to concurrent chemoradiotherapy in cervical cancer: Value of diffusion-weighted and dynamic contrast-enhanced MR imaging","volume":"32","author":"Park","year":"2014","journal-title":"Magn. Reson. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ygyno.2004.12.007","article-title":"FDG\u2014PET for management of cervical and ovarian cancer","volume":"97","author":"Havrilesky","year":"2005","journal-title":"Gynecol. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1097\/MNM.0b013e3283570fd3","article-title":"Clinical impact of 18F-FDG PET\/CT in the pretreatment evaluation of patients with locally advanced cervical carcinoma","volume":"33","author":"Akkas","year":"2012","journal-title":"Nucl. Med. Commun."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1200\/JCO.2009.25.4151","article-title":"Lymph node staging by positron emission tomography in cervical cancer","volume":"28","author":"Kidd","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e6158","DOI":"10.1097\/MD.0000000000006158","article-title":"Safety and efficacy of semi-extended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients: An observational study of 10-year experience","volume":"96","author":"Lee","year":"2017","journal-title":"Medicine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.ijrobp.2009.02.020","article-title":"A prospective randomized trial to study the impact of pretreatment FDG\u2014PET for cervical cancer patients with MRI-detected positive pelvic but negative paraaortic lymphadenopathy","volume":"76","author":"Tsai","year":"2010","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1012491","DOI":"10.3389\/fonc.2023.1012491","article-title":"Survival effect of pre-RT PET\u2014CT on cervical cancer: Image-guided intensity-modulated radiation therapy era","volume":"13","author":"Su","year":"2023","journal-title":"Front. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3026","DOI":"10.1200\/JCO.2012.47.3520","article-title":"Prospective multicenter study evaluating the survival of patients with locally advanced cervical cancer undergoing laparoscopic para-aortic lymphadenectomy before chemoradiotherapy in the era of positron emission tomography imaging","volume":"31","author":"Gouy","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_37","first-page":"405","article-title":"The role of [(18)F]FDG\u2014PET\/CT in staging and treatment planning for volumetric modulated RapidArc radiotherapy in cervical cancer: Experience of the European Institute of Oncology, Milan, Italy","volume":"8","author":"Lazzari","year":"2014","journal-title":"Ecancermedicalscience"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1136\/ijgc-2023-004429","article-title":"ESGO\/ESTRO\/ESP Guidelines for the management of patients with cervical cancer\u2014Update 2023","volume":"33","author":"Cibula","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/j.1349-7006.2010.01532.x","article-title":"Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography\/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: Meta-analysis","volume":"101","author":"Choi","year":"2010","journal-title":"Cancer Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.ygyno.2020.08.021","article-title":"[18F] FDG\u2014PET or PET\/CT in the evaluation of pelvic and para-aortic lymph nodes in patients with locally advanced cervical cancer: A systematic review of the literature","volume":"159","author":"Adam","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.radonc.2019.02.007","article-title":"EMBRACE Collaborative Group. Nodal failure after chemo-radiation and MRI guided brachytherapy in cervical cancer: Patterns of failure in the EMBRACE study cohort","volume":"134","author":"Nomden","year":"2019","journal-title":"Radiother. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.3109\/0284186X.2015.1061693","article-title":"Impact of radiation dose and standardized uptake value of (18)FDG PET on nodal control in locally advanced cervical cancer","volume":"54","author":"Ramlov","year":"2015","journal-title":"Acta Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/0360-3016(95)02055-1","article-title":"Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy","volume":"34","author":"Bonin","year":"1996","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_44","unstructured":"International Commission on Radiation Units and Measurements (1993). ICRU Report 50 Prescribing, Recording, and Reporting Photon Beam Therapy, International Commission on Radiation Units and Measurements."},{"key":"ref_45","unstructured":"International Commission on Radiation Units and Measurements (1999). ICRU Report 62 Prescribing, Recording, and Reporting Photon Beam Therapy, International Commission on Radiation Units and Measurements. Supplement to ICRU Report 50."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0167-8140(99)00038-9","article-title":"The benefit of Beam\u2019s eye view-based 3D treatment planning for cervical cancer","volume":"51","author":"Gerstner","year":"1999","journal-title":"Radiother. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1200\/JCO.2017.77.4273","article-title":"Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG oncology-RTOG 1203","volume":"36","author":"Klopp","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1136\/ijgc-2020-001973","article-title":"Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB-IVA: Oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study","volume":"30","author":"Marnitz","year":"2020","journal-title":"Int. J. Gynecol. Cancer."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ijrobp.2020.07.2069","article-title":"Phase III randomized trial of postoperative adjuvant conventional radiation (3DCRT) versus image-guided intensity-modulated radiotherapy (IG-IMRT) in cervical cancer (PARCER): Final analysis","volume":"108","author":"Chopra","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.ijrobp.2016.11.027","article-title":"Bone marrow-sparing intensity modulated radiation therapy with concurrent cisplatin for stage IB-IVA cervical cancer: An international multicenter phase II clinical trial (INTERTECC-2)","volume":"97","author":"Mell","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.clon.2013.11.031","article-title":"A systematic review of organ motion and image-guided strategies in external beam radiotherapy for cervical cancer","volume":"26","author":"Jadon","year":"2014","journal-title":"Clin. Oncol. R. Coll. Radiol."},{"key":"ref_52","unstructured":"Keall, P.J., Hsu, A., and Xing, L. (2004). Textbook of Radiation Oncology, Saunders. [3rd ed.]."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.radonc.2007.11.023","article-title":"A (short) history of image-guided radiotherapy","volume":"86","author":"Verellen","year":"2008","journal-title":"Radiother. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1016\/j.ijrobp.2007.08.055","article-title":"Inter- and intrafractional tumor and organ movement in patients with cervical cancer undergoing radiotherapy: A cinematic-MRI point-of-interest study","volume":"70","author":"Chan","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.radonc.2011.03.013","article-title":"Toward an individualized target motion management for IMRT of cervical cancer based on model-predicted cervix-uterus shape and position","volume":"99","author":"Bondar","year":"2011","journal-title":"Radiother. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.clon.2021.06.007","article-title":"Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation","volume":"33","author":"Shelley","year":"2021","journal-title":"Clin. Oncol. R. Coll. Radiol."},{"key":"ref_57","first-page":"e41886","article-title":"Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes","volume":"15","author":"Dumitrescu","year":"2023","journal-title":"Cureus"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ijrobp.2013.10.032","article-title":"Comment on Trends in the utilization of brachytherapy in cervical cancer in the United States","volume":"88","author":"Smith","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1259\/0007-1285-11-132-809","article-title":"A dosage system for use in the treatment of cancer of the uterine cervix","volume":"11","author":"Tod","year":"1938","journal-title":"Br. J. Radiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1259\/0007-1285-26-305-252","article-title":"Treatment of cancer of the cervix uteri, a revised Manchester method","volume":"26","author":"Tod","year":"1953","journal-title":"Br. J. Radiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ijrobp.2014.06.005","article-title":"Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer","volume":"90","author":"Viswanathan","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.radonc.2004.12.015","article-title":"Recommendations from Gynaecological (GYN) GEC\u2014ESTRO Working Group (I): Concepts and terms in 3D image-based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV","volume":"74","author":"Briot","year":"2005","journal-title":"Radiother. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.radonc.2005.11.014","article-title":"Recommendations from Gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy","volume":"78","author":"Barillot","year":"2006","journal-title":"Radiother. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.ygyno.2014.08.027","article-title":"Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy","volume":"135","author":"Rijkmans","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.ijrobp.2018.11.012","article-title":"Intensity Modulated Radiation Therapy and Image-Guided Adapted Brachytherapy for Cervix Cancer","volume":"103","author":"Lin","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.ijrobp.2006.12.021","article-title":"Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: Results of a prospective trial and preliminary guidelines for standardized contours","volume":"68","author":"Viswanathan","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S1470-2045(20)30753-1","article-title":"MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): A multicentre prospective cohort study","volume":"22","author":"Tanderup","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1016\/S0167-8140(17)30499-1","article-title":"OC-0055: Local failures after radiochemotherapy and MR-image-guided brachytherapy in cervical cancer patients","volume":"123","author":"Schmid","year":"2017","journal-title":"Radiother. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1016\/j.brachy.2016.04.010","article-title":"Image-guided brachytherapy in cervical cancer: A comparison between intracavitary and combined intracavitary\/interstitial brachytherapy in regard to doses to HR CTV, OARs and late morbidity\u2014Early results from the Embrace study in 999 patients","volume":"15","author":"Fortin","year":"2016","journal-title":"Brachytherapy"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/j.brachy.2021.06.112","article-title":"PO24: High Dose-Rate Tandem and Ovoid 3D CT Based Brachytherapy in Cervical Cancer: Initial Single Center Experience","volume":"20","author":"Anghel","year":"2021","journal-title":"Brachytherapy"},{"key":"ref_71","first-page":"305","article-title":"Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study","volume":"102","author":"Harter","year":"2012","journal-title":"Radiother. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.radonc.2006.10.016","article-title":"Uncertainties when using only one MRI-based treatment plan for subsequent high-dose-rate tandem and ring applications in brachytherapy of cervix cancer","volume":"81","author":"Kirisits","year":"2006","journal-title":"Radiother. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.clon.2009.03.007","article-title":"Single magnetic resonance imaging vs magnetic resonance imaging\/computed tomography planning in cervical cancer brachytherapy","volume":"21","author":"Beriwal","year":"2009","journal-title":"Clin. Oncol. R. Coll. Radiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.brachy.2014.09.002","article-title":"Cost-effectiveness analysis of 3D image-guided brachytherapy compared with 2D brachytherapy in the treatment of locally advanced cervical cancer","volume":"14","author":"Kim","year":"2015","journal-title":"Brachytherapy"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.brachy.2020.06.012","article-title":"Education and training for image-guided adaptive brachytherapy for cervix cancer-The (GEC)-ESTRO\/EMBRACE perspective","volume":"19","author":"Tan","year":"2020","journal-title":"Brachytherapy"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ijrobp.2006.04.041","article-title":"The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Clinical feasibility and preliminary results","volume":"66","author":"Dimopoulos","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.radonc.2007.10.026","article-title":"Potential of dose optimisation in MRI-based PDR brachytherapy of cervix carcinoma","volume":"88","author":"Mousa","year":"2008","journal-title":"Radiother. Oncol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.ijrobp.2007.10.032","article-title":"MRI-guided 3D optimization significantly improves DVH parameters of pulsed-dose-rate brachytherapy in locally advanced cervical cancer","volume":"71","author":"Lindegaard","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.radonc.2016.08.007","article-title":"Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome","volume":"120","author":"Tanderup","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1136\/ijgc-2021-003056","article-title":"Image-guided brachytherapy in cervical cancer including fractionation","volume":"32","author":"Sturdza","year":"2022","journal-title":"Int. J. Gynecol. Cancer: Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_81","first-page":"96","article-title":"Image guided adaptive brachytherapy of cervical cancer\u2014Practical recommendations","volume":"36","year":"2023","journal-title":"Klin. Onkol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ijrobp.2021.04.022","article-title":"Nomogram predicting overall survival in patients with locally advanced cervical cancer treated with radiochemotherapy including image-guided brachytherapy: A Retro-EMBRACE study","volume":"111","author":"Sturdza","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Dumitru, M., Berghi, O.N., Taciuc, I.A., Vrinceanu, D., Manole, F., and Costache, A. (2022). Could Artificial Intelligence Prevent Intraoperative Anaphylaxis? Reference Review and Proof of Concept. Medicina, 58.","DOI":"10.3390\/medicina58111530"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13014-019-1308-y","article-title":"MR-guidance in clinical reality: Current treatment challenges and future perspectives","volume":"14","author":"Corradini","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1117874","DOI":"10.3389\/fonc.2023.1117874","article-title":"MRI-LINAC: A transformative technology in radiation oncology","volume":"13","author":"Ng","year":"2023","journal-title":"Front. Oncol."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Randall, J.W., Rammohan, N., Das, I.J., and Yadav, P. (2022). Towards Accurate and Precise Image-Guided Radiotherapy: Clinical Applications of the MR-Linac. J. Clin. Med., 11.","DOI":"10.3390\/jcm11144044"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ejmp.2021.05.010","article-title":"Artificial Intelligence in magnetic Resonance guided Radiotherapy: Medical and physical considerations on state of art and future perspectives","volume":"85","author":"Cusumano","year":"2021","journal-title":"Phys. Med."},{"key":"ref_88","first-page":"18","article-title":"Application of 3D printing in cervical cancer brachytherapy","volume":"15","author":"Huo","year":"2022","journal-title":"J. Radiat. Res. Appl. Sci."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijrobp.2022.05.027","article-title":"Applying 3D-Printed Templates in High-Dose-Rate Brachytherapy for Cervix Cancer: Simplified Needle Insertion for Optimized Dosimetry","volume":"114","author":"Marar","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.clon.2020.09.010","article-title":"Image-Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation","volume":"32","author":"Webster","year":"2020","journal-title":"Clin. Oncol. R. Coll. Radiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1735\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:00:11Z","timestamp":1760130011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,27]]},"references-count":90,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101735"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101735","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,27]]}}}