Page 22 - ARNM-3-3

Advances in Radiotherapy &

Nuclear Medicine

REVIEW ARTICLE
Local radiation dose escalation in cancer

treatment: Interventional radiotherapy versus
modern external beam techniques

2
Maria C. La Milia 1 , Natalia Barogi 1 , Gyoergy Kovacs * , Luca Tagliaferri 1,3 ,
Maria A. Gambacorta 1,3 , and Valentina Lancellotta 1
1 Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di
Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
2 Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
3 Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore,
Rome, Italy

Abstract

Interventional radiotherapy (IRT), also known as brachytherapy, is an advanced
radiotherapeutic modality characterized by the precise placement of radioactive
sources within or near the tumor. This approach enables the delivery of high
radiation doses directly to the tumor site while minimizing exposure to surrounding
healthy tissues. IRT is indicated for various malignancies and is integrated into both
*Corresponding author: definitive and multimodal oncologic treatment strategies. Referral to IRT, as well
Gyoergy Kovacs as its implementation, often involves a multidisciplinary team including specialists
(gyorgy.kovacs@unicatt.it) from radiation oncology, surgical oncology, and medical oncology. To enhance
Citation: La Milia MC, Barogi N, oncological outcomes, numerous studies have investigated the incorporation of
Kovacs G, et al. Local radiation a radiotherapy boost–either IRT or external beam radiotherapy (EBRT)–targeting
dose escalation in cancer treatment:
Interventional radiotherapy versus residual tumor following exclusive radio-chemotherapy. The decision to use an IRT
modern external beam techniques. boost versus an EBRT boost remains a topic of discussion and frequently depends on
Adv Radiother Nucl Med. the equipment available at cancer centers. This systematic review aims to evaluate
2025;3(3):14-29.
doi: 10.36922/ARNM025160017 the comparative effectiveness of an IRT boost versus an EBRT boost in patients with
breast, prostate, endometrial, cervical, head-and-neck, and anal cancers. Outcomes
Received: April 17, 2025
of interest include local control, cancer-specific survival, overall survival, distant
1st revised: June 5, 2025 metastasis-free survival, and treatment-related toxicity. Taking into and account, the
2nd revised: June 17, 2025 proven clinical and economical advantages of a high-workload IRT center, education
in IRT and multidisciplinary cooperation of different specialties should be forced.
Accepted: June 18, 2025
Published online: July 25, 2025
Keywords: Brachytherapy; Boost; Interventional radiotherapy; Outcomes; Toxicity
Copyright: © 2025 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, 1. Introduction
and reproduction in any medium,
provided the original work is The therapeutic efficacy of interventional radiotherapy (IRT), also known as
properly cited. brachytherapy, lies in its ability to deliver highly conformal, high-dose radiation directly
1
Publisher’s Note: AccScience to the tumor near the radioactive sources. A defining feature of IRT is its steep dose
Publishing remains neutral with gradient, characterized by a rapid fall-off beyond the target volume, thereby minimizing
regard to jurisdictional claims in 2-4
published maps and institutional radiation exposure to adjacent healthy tissues. Compared to conventional external
affiliations. beam radiotherapy (EBRT), IRT offers distinct dosimetric advantages, including the

Volume 3 Issue 3 (2025) 14 doi: 10.36922/ARNM025160017