The standard definitive treatment for locally advanced cervical cancer includes both external beam radiation therapy (EBRT) and brachytherapy. Brachytherapy is necessary to deliver a highly effective dose to the primary tumor: more than 80-85 Gy biologically equivalent dose in 2-Gy fractions (EQD2) can routinely be delivered to the tumor periphery while the central cervix receives even higher doses (>120 Gy EQD2). The ability to safely deliver a high dose to central disease undoubtedly explains the excellent local control rates that can be achieved when cervical cancers are treated with a combination of EBRT and brachytherapy. Recently, Han et al (1) published Surveillance, Epidemiology, and End Results (SEER) data for brachytherapy use in patients treated for cervical cancer in the United States. In that study of 7359 patients who received EBRT between 1988 and 2009, only 63% were also reported to have received brachytherapy. Furthermore, the rate of brachytherapy use fell from 75%-80% in the 1980s and 1990s to <60% after 2003. Importantly, patients who were treated with combined EBRT and brachytherapy had a significantly better overall survival than those treated with EBRT alone (65% and 50%, respectively); there were no significant differences in non-cancer-related deaths between the 2 groups
source: Kari Tanderup, Patricia J. Eifel, Catheryn M. Yashar, Perry W. Griegsby | Elsevier Inc.