RESUMEN
The incidence of cervical cancer in India is significantly high, and the average recurrence age is much less. The standard line of treatment consists of concurrent chemoradiotherapy. If a recurrence occurs, the treatment options or set of interventions are limited and suboptimal. Through this review, we have analyzed and classified the possible prognostic factors for cervical cancer into three broad categories, viz., (a) disease-related factors, (b) patient-related factors, and (c) treatment-related factors. Disease-related factors include tumor histology, tumor size, stage, parametrial involvement (PMI), Prognostic Nutritional Index (PNI), lymphovascular space invasion (LVSI), and nodal status. Patient-related factors include overall treatment time (OTT), nutritional status, hemoglobin level, comorbidities, and age. Treatment-related factors include addition of chemotherapy, techniques of external beam radiotherapy (EBRT), techniques of brachytherapy, and quality assurance for radiation therapy delivery. Out of these, extremely significant prognostic factors were tumor size and stage, nodal status, PMI, nutritional status, and addition of chemotherapy. Impactful factors include younger age, histology, LVSI, associated comorbidities, hemoglobin level, OTT, and patient-specific quality assurance. The factor that is not related or significant is the technique used for EBRT and brachytherapy delivery.
RESUMEN
As systemic therapies, alongside radiation, for cancer treatment continue to evolve, the radiation oncology community is facing an increasing number of reirradiation (re-RT) of tumor sites subject to recurrences. There are multiple factors associated with choosing re-RT as a treatment option for a previously irradiated site. The factors include the site of previous radiotherapy (RT), the current extent of the disease, the nature of recurrence, the technique used for previous irradiation, and the previous RT details including dose and dose fractionation. There is a persistent heterogeneity in the workflow and decision-making in cancer care centers worldwide. The current review is an attempt to dive into the practices of decision-making for re-RT, interdisciplinary attention given to the re-RT patients, and acceptable doses to the organ at risk (OAR) deduced from the understanding of previous RT and radiobiology of the tumor and sites evidence of better techniques for effective execution.