Last time we talked about the history and usefulness of radiotherapy for cervical cancer, and this time we will talk about the methods of radiotherapy. Did you know: there are three types of radiotherapy for cervical cancer The first is radical radiotherapy. This is mainly for patients with mid- to late-stage cervical cancer and must be combined with intracavitary and extracavitary. Doing only one kind cannot achieve radical effect. The limitations of radiotherapy equipment and the technical ability of operators lead to uneven levels of radiation therapy in different places. There are limited units with radiation machines for cervical cancer in China, and only three or four in Shanghai with internal radiation machines. However, we hope that internal and external irradiation can be performed successively in the same hospital and within a certain period of time. Therefore, patients with mid- to late-stage cervical cancer should be extra cautious when choosing a hospital for radiotherapy. The second is adjuvant radiotherapy. At present, radical surgery for cervical cancer is developing rapidly, and most people without high-risk factors can be cured through surgery. However, those who have high-risk factors need to receive a certain dose of radiotherapy after radical surgery, i.e. adjuvant radiotherapy. To facilitate patients’ understanding, I have divided the high-risk factors into “major triplets” and “minor triplets”. The “minor triplets” include large masses, vascular thrombosis, and deep muscle infiltration. “Major triplets” are lymph node metastasis, positive cut margins, and positive parametrium. Most patients only need postoperative external radiotherapy, while only a small number of patients with positive surgical margins need internal radiotherapy. The third is palliative radiotherapy. It is mainly for patients with bone metastasis, recurrence, and painful lesions, and can be used for pain relief. Did you know that intensity-modulated radiotherapy is a “personalized” radiotherapy method? Initially, radiotherapy required doctors to feel the bones and other bony markers for positioning. Later, with the help of imaging, doctors were able to locate the bones with a blurred image under a black and white fluoroscope. After 2000, radiation therapy has changed by leaps and bounds with the emergence of fashionable methods such as precision radiotherapy and intensity-modulated radiotherapy. To use an analogy, people go to the store to buy clothes in average sizes and custom-made ones. The former fits most people, but it is difficult to take care of the details. This is how early radiotherapy is done. Intensity-modulated radiotherapy is when your doctor makes a “personal order” for you. First, the radiation therapy equipment scans and stores all the information about the patient’s body, like a CT. Then, the doctor will map out the tumor areas that need to be irradiated and the normal tissues that need to be protected, intensifying the irradiation in the tumor areas and reducing or masking the source in the normal tissue areas. This can better protect the normal tissues, improve the quality of life and reduce the incidence of radiation cystitis and proctitis. Therefore, intensity-modulated radiotherapy is a kind of “personalized” radiotherapy. Although this method is good, it is not available in all hospitals. Firstly, the operation of intensity-modulated radiotherapy equipment is difficult and requires a high level of technical skill. Secondly, because of the strong local irradiation of intensity-modulated radiotherapy, if there is no alignment of the lesion, even the slightest difference will accumulate to a thousand differences in the efficacy of treatment.