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Volume 23, Number 6, 2018

New developments and controversies in cervical cancer

Angeles Rovirosa, Marcela de la Torre, Meritxell Arenas, Julian Malicki


This special issue of Reports of Practical Oncology and Radiotherapy explores a wide range of issues surrounding the treatment of cervical cancer (CC), which is the 4th most common cancer in women worldwide and is particularly prevalent in underdeveloped and developing countries.1 Since the early 20th century, radiotherapy has been used as a curative intent treatment in non-surgical cases and as an adjunct treatment in the postoperative setting. Early radiotherapy techniques consisted of orthovoltage X-rays and radium brachytherapy, which achieved 5-year survival rates of 30% in the 1930s, although treatment-related toxicity was substantial.2 Improvements in surgical techniques, together with the emergence of cobalt-60 radiotherapy, further increased survival rates, although the late complication rate remained significant. Subsequent advances in radiotherapy included the development of linear accelerators, three-dimensional (3D) planning procedures, and afterloading source projectors for brachytherapy (initially for medium and low-dose rate sources and later for high-dose rate [HDR] sources). These improvements increased 5-year survival rates to 40–50%. At the end of the 1990s, new developments included intensity-modulated radiotherapy (IMRT) and 3D-planning for brachytherapy, with a greater use of iridium sources for HDR and pulsed-dose rate treatments.3 The concomitant use of cisplatin-based chemotherapy with external beam radiotherapy (EBRT) further increased 5-year survival rates by as much as 10%. At present, chemotherapy plus radiotherapy is the treatment of choice for large tumors (>4 cm).4 The clear association between human papillomavirus (HPV) and CC, which was identified as the leading cause of CC in recent decades, has led to the development of highly-effective vaccines. Although these vaccines are available in most developed countries, their routine administration implies a substantial cost, an issue that is explored in a cost analysis study presented in this issue.

Signature: Rep Pract Oncol Radiother, 2018; 23(6) : 481-483

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