Akihiro Nishie

Radiotherapy is an essential treatment modality for cervical cancer and has evolved substantially with advances in image guidance and treatment delivery. This review summarizes recent technological developments in external beam radiotherapy and brachytherapy, their clinical applications, and future directions, with particular consideration of Japanese practice in an international context. In external beam radiotherapy, conventional techniques incorporating central shielding are increasingly being replaced by intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc therapy (VMAT). Daily three‐dimensional image‐guided radiotherapy (3D‐IGRT) is essential for the safe implementation of these techniques because of substantial uterine motion and deformation. In brachytherapy, the transition from two‐dimensional point‐based prescription to three‐dimensional image‐guided treatment has enabled individualized assessment of target coverage and doses to organs at risk. Although magnetic resonance imaging‐based brachytherapy is internationally recommended, computed tomography‐based planning predominates in Japan and has achieved favorable outcomes, despite some studies reporting lower cumulative target doses than those recommended internationally. Intracavitary/interstitial brachytherapy (IC/IS BT) further improves dose distribution by combining intracavitary applicators with interstitial needles, particularly when adequate target coverage cannot be achieved with standard intracavitary brachytherapy alone. Future advances may include artificial intelligence (AI)‐assisted treatment planning and adaptive workflows, tissue spacers to overcome anatomical constraints, and the incorporation of genomic, multi‐omics, and radiomics information. Integrating these approaches may enable cervical cancer radiotherapy to progress beyond increasingly safe and precise treatment toward personalized care tailored to individual patient and tumor characteristics.

Prostate‐specific membrane antigen (PSMA) is a Type II transmembrane glycoprotein markedly overexpressed on prostate cancer cells, enabling a single molecular target to support both positron emission tomography (PET) imaging and targeted radionuclide therapy. Over the past decade, PSMA‐PET/CT has been incorporated into international guidelines for primary staging of high‐risk prostate cancer and for biochemical recurrence, with the landmark proPSMA trial establishing its diagnostic superiority over conventional imaging; whether PSMA‐PET‐guided management improves long‐term oncologic outcomes, however, remains an open question addressable only by prospective PSMA‐specific trials. On the therapeutic side, ¹⁷⁷ Lu‐PSMA‐617 has become a standard treatment option for metastatic castration‐resistant prostate cancer (mCRPC) after androgen‐receptor pathway inhibitor (ARPI) and taxane chemotherapy, and is moving into earlier lines of disease. Alpha‐emitting and next‐generation ligands, together with quantitative whole‐body imaging and artificial intelligence, are redefining both patient selection and response assessment, although randomized evidence for many of these approaches remains limited. In Japan, the concurrent 2025 approval of ¹⁷⁷ Lu‐vipivotide tetraxetan and its companion PSMA diagnostic has initiated a national roll‐out that will depend on a hub‐and‐spoke framework of regional PSMA‐PET centers and therapy spokes, a prepared nuclear medicine workforce, and domestic registries to refine Japanese‐specific evidence. This review summarizes the current clinical evidence for PSMA‐PET/CT and ¹⁷⁷ Lu‐PSMA radioligand therapy, highlights interpretive and implementation pitfalls, and outlines practical priorities for the Japanese clinical and academic community.