Table 1.

Changes in concurrent chemoradiotherapy practices for the treatment of locally advanced cervical cancer

	Past (1993 to the mid-2000s)	Current	Points
Primary lesion extent	Physical examination, cystoscopy, and sigmoidoscopy	Extension of tumor on MRI → cystoscopy, sigmoidoscopy in selected cases	Selective invasive staging examination
PALN evaluation	CT scan	PET-CT and MRI	False-negative rate of 12% in para-aortic lymph node metastasis prediction of PET-CT → recommend routine surgical staging even in patients with negative PALN uptake on PET-CT
Chemotherapy	Weekly cisplatin		Doublet chemotherapy during RT or adjuvant chemotherapy was investigated, with high complications in most cases. Two RCTs are pending
EBRT	Conformal three-dimensional plan	IMRT plan with simultaneous nodal integrated boost	Reduction of the overall treatment time and complications (the bladder, intestine, and bone marrow)
			No additional nodal boost
Brachytherapy	Two-dimensional brachytherapy, midline block	Image-guided adaptive brachytherapy	Early adaptation of BT based on response
			High-dose delivery to residual tumor with increase in fraction size: better local control
			Complication ↓ and overall treatment time ↓

MRI, magnetic resonance image; PALN, para-aortic lymph node; PET-CT, positron emission tomography-computed tomography; RT, radiation therapy; RCT, randomized clinical trial; IMRT, intensity-modulated radiation therapy; EBRT, external beam radiotherapy; BT, brachytherapy.