AccScience Publishing / ARNM / Online First / DOI: 10.36922/ARNM025160017
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REVIEW ARTICLE

Local radiation dose escalation in cancer treatment: Interventional radiotherapy versus modern external beam techniques

Maria C. La Milia1 ,  Natalia Barogi1 ,  Gyoergy Kovacs2* ,  Luca Tagliaferri1,3 ,  Maria A. Gambacorta1,3 ,  Valentina Lancellotta1
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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
ARNM, 025160017 https://doi.org/10.36922/ARNM025160017
Received: 17 April 2025 | Revised: 17 June 2025 | Accepted: 18 June 2025 | Published online: 25 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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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 definitive and multimodal oncologic treatment strategies. Referral to IRT, as well as its implementation, often involves a multidisciplinary team including specialists from radiation oncology, surgical oncology, and medical oncology. To enhance oncological outcomes, numerous studies have investigated the incorporation of a radiotherapy boost–either IRT or external beam radiotherapy (EBRT)–targeting residual tumor following exclusive radio-chemotherapy. The decision to use an IRT boost versus an EBRT boost remains a topic of discussion and frequently depends on the equipment available at cancer centers. This systematic review aims to evaluate 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 of interest include local control, cancer-specific survival, overall survival, distant metastasis-free survival, and treatment-related toxicity. Taking into and account, the proven clinical and economical advantages of a high-workload IRT center, education in IRT and multidisciplinary cooperation of different specialties should be forced.

Keywords
Brachytherapy
Boost
Interventional radiotherapy
Outcomes
Toxicity
Funding
None.
Conflict of interest
Gyoergy Kovacs and Luca Tagliaferri are members of the Editorial Board of this journal but were not involved in any way, directly or indirectly, in the editorial and peer-review process for this paper. Separately, the other authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Print ISSN: 3060-8554, Published by AccScience Publishing
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