5.9 Radiotherapy

Updated May 2026

​Primary Radiotherapy

Pelvic +/- para-aortic radiotherapy to a dose of 45-50 Gy in 1.8-2 Gy per fraction is recommended using VMAT/IMRT techniques. Pathologic pelvic or para-aortic lymph nodes (or PET positive nodes) should receive a dose boost, using simultaneous integrated boost or sequential techniques. Pelvic radiotherapy only is recommended in cases with negative nodes. Para-aortic irradiation is recommended in cases with at least 1 pathologic node at the common iliac or above, or 3 or more pathologic pelvic nodes.

External beam radiotherapy must be accompanied by HDR image-guided brachytherapy. Combined intracavitary/interstitial brachytherapy techniques must be considered in cases of large residual disease, asymmetrical tumours, significant lateral extension and unfavourable anatomy to cover the high-risk CTV (HR-CTV) while sparing normal tissue/organs at risk (OARs). 3D image guidance is mandatory for all cervical brachytherapy cases (CT and preferably MRI at least for the first fraction). Target volumes and OARs, including bladder, rectum, sigmoid and small bowel, are contoured and volumetric dose prescription and reporting must be done following the Gyn GEC ESTRO recommendations.

Every effort should be done to deliver brachytherapy boost for cervical cancer, including referral to other BC centres for complex brachytherapy techniques. In cases of extensive residual disease following external beam radiotherapy that cannot be safely encompassed with interstitial brachytherapy, an external beam boost or salvage surgery can be considered following multidisciplinary discussion.

The overall treatment time (OTT) defined as the time from beginning to the end of (chemo) radiotherapy (including external beam and brachytherapy) for definitive treatment of intact cervical cancer should be within 50 days (and not longer than 56 days), with the following conditions:

  • External beam radiotherapy start date should not be delayed (meeting the OTT of 7 weeks).
  • Shorter OTT needs to be balanced against proper and safe brachytherapy implantation and treatment.

 Brachytherapy dose and fractionation is typically 28 Gy in 4 fractions. Other fractionation schedules over 3 or 5 fractions can be delivered in an outpatient or inpatient setting as clinically advisable.

Adjuvant Radiotherapy

Pelvic radiotherapy to a dose of 45-50 Gy in 1.8-2 Gy per fraction is recommended. A brachytherapy boost can be considered in select cases.