Why brachytherapy boost is the treatment of choice for most women with locally advanced cervical carcinoma?

The standard treatment approach for women with locally advanced cervical carcinoma is definitive radiation treatment with concurrent cisplatin chemotherapy. Radiation treatment is typically external beam radiation therapy to the pelvis followed by intracavitary brachytherapy (BT) boost to the cervix. Numerous studies confirmed very successful outcomes with this approach. In recent years, however, the use of BT to boost the cervix in women with cervical carcinoma was reported to be on the decline. With the advent of advanced external beam radiation therapy techniques, few attempts have been made to substitute the BT boost with stereotactic body radiation therapy or intensity-modulated radiation therapy techniques, but there is a lack of prospective data to justify the routine use of these alternate boost techniques. The aim of this review is to highlight the differences between the use of stereotactic body radiation therapy or intensity-modulated radiation therapy, in lieu of intracavitary BT boost in women with locally advanced cervical cancer, and to argue that BT seems to be truly irreplaceable at the present time and with the knowledge and expertise accumulated to date.