Brachytherapy Awareness Day: Why this overlooked therapy is crucial in treating cervical cancer

Cervical cancer remains one of the leading causes of cancer-related deaths among women worldwide despite being largely preventable and highly treatable when diagnosed early. Experts say one of the biggest gaps in treatment is the underuse of brachytherapy, a highly targeted form of radiation therapy that is considered the standard of care for locally advanced cervical cancer.

On Brachytherapy Awareness Day, specialists are calling for greater awareness, improved access to advanced treatment facilities and stronger referral networks to ensure more women receive guideline-recommended care that can significantly improve survival and quality of life.

Dr. Sushil Beriwal, Vice President, Medical Affairs of Varian, a Siemens Healthineers Company, spoke to Firstpost about the importance of brachytherapy in cervical cancer treatment, the barriers limiting its adoption, technological advancements transforming patient care and what more needs to be done to make this lifesaving therapy accessible to every eligible patient.

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Excerpts:

As we observe Brachytherapy Awareness Day, why is brachytherapy considered a critical component in the treatment of cervical cancer and what impact does it have on patient outcomes?

Dr Beriwal: Brachytherapy delivers radiation directly inside or next to the tumour through an applicator placed within or very close to it. For women with locally advanced cervical cancer, it is not merely another treatment option—it is an essential part of curative treatment.

Its biggest advantage is the ability to deliver a very high dose of radiation directly to the tumour while minimising exposure to nearby healthy organs such as the bladder, rectum and bowel. No external radiation technique, however advanced, can consistently achieve the same dose distribution.

The evidence is clear. Women who receive guideline-recommended brachytherapy have better local tumour control, higher cure rates and improved overall survival. Conversely, skipping brachytherapy is associated with poorer outcomes.

Despite being a highly effective treatment, brachytherapy remains underutilised in some regions. What are the key barriers to access and adoption, particularly in countries like India?

Dr Beriwal: The biggest challenge is not the science—it is access.

Delivering high-quality brachytherapy requires much more than a radiation machine. It needs trained multidisciplinary teams, advanced imaging, treatment-planning expertise, anaesthesia support, specialised equipment and coordinated patient care.

India has several centres providing world-class brachytherapy, but access remains uneven. Many women travel hundreds of kilometres for treatment, creating financial and logistical burdens that often delay or even prevent them from completing therapy.

Improving outcomes requires stronger regional referral networks, expanded workforce training, sustainable reimbursement models and making brachytherapy available closer to where patients live. Every eligible patient should have access to this lifesaving treatment, regardless of geography or socioeconomic status.

How have advancements in imaging, treatment planning and radiation delivery improved the precision and effectiveness of brachytherapy for cervical cancer?

Dr Beriwal: The transition from two-dimensional planning to MRI- and CT-guided adaptive brachytherapy has transformed cervical cancer treatment.

Today, doctors can precisely visualise the remaining tumour, personalise every treatment according to a patient's anatomy and optimise radiation delivery while protecting healthy tissues.

Hybrid intracavitary-interstitial techniques and advanced applicators also enable clinicians to treat larger or more complex tumours while reducing radiation exposure to critical organs. These innovations have become part of the standard of care.

The result is better tumour control, fewer treatment-related complications and improved quality of life.

There are several misconceptions surrounding radiation therapy. What are some common myths about brachytherapy that you would like to address?

Dr Beriwal: Modern brachytherapy is among the most sophisticated and precise forms of radiation therapy available today.

One common misconception is that patients remain radioactive after treatment. In high-dose-rate brachytherapy, the radioactive source is removed immediately after each session, so patients do not remain radioactive.

Another myth is that advanced external-beam radiation can routinely replace brachytherapy. For definitive treatment of cervical cancer, clinical evidence clearly shows that brachytherapy remains indispensable for achieving the best outcomes.

Some women also worry that the procedure is extremely painful. While there can be discomfort during applicator placement, it is effectively managed with anaesthesia and pain medication.

What role can healthcare providers, policymakers and industry play in ensuring more women have access to guideline-recommended brachytherapy?

Dr Beriwal: Healthcare providers must ensure timely referrals, multidisciplinary coordination and accurate patient counselling to address misconceptions that may discourage treatment.

Policymakers should invest in infrastructure, workforce development, reimbursement mechanisms and quality standards, while industry must continue innovating and supporting education, affordability and reliable service delivery.

Ultimately, success should not be measured by the number of machines installed but by the number of lives saved through the optimal use of this technology. We have also conducted several practical workshops to support the implementation of modern image-guided brachytherapy.

Looking ahead, how do you see brachytherapy evolving, and what innovations could further improve cervical cancer care?

Dr Beriwal: Artificial intelligence for automated contouring and treatment planning, MRI-guided adaptive brachytherapy, hybrid applicators, image-guided placement and patient-specific technologies will continue to improve precision and efficiency.

However, the most important innovation will be expanding access. If technological advances are matched with education, training and equitable healthcare infrastructure, we can substantially reduce cervical cancer mortality and ensure every eligible patient receives optimal, guideline-recommended care.