Three-dimensional conformal radiation therapy (3DCRT) has emerged as a preferred treatment for gynecologic malignancies. Yet its superiority to conventional radiotherapy (2-dimensional radiotherapy (2DRT)) for gynecologic malignancies has not been well established. Data from the 2005 to 2010 National Health Insurance Research Database (NHIRD) provided by the National Research Institutes in Taiwan were analyzed to address this issue. Patients were initially diagnosed as having cervical cancer according to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 180, and this clinical diagnosis was confirmed histopathologically or cytologically. Kaplan-Meier method and Cox proportional hazards regression were used to analyze the reported data. Between January 2005 and December 2010, there were 776 patients with newly diagnosed cervical cancer without metastasis, local recurrence, or surgical treatment before RT and 132 and 644 patients, respectively, who received 2DRT and 3DCRT. After adjustment for age, diabetes mellitus, hypertension, coronary heart disease, hyperlipidemia, side effects, urbanization level, geographic region, and enrollee category in the 5-year follow-up period, the HR was 1.82 (95% CI, 1.16–2.85, ). The 5-year survival rate in the 2DRT and 3DCRT groups was 73.0% and 82.3%, , respectively. Cervical cancer patients treated with 3DCRT had better overall survival. 1. Introduction Cervical cancer is the second most frequent cancer among women worldwide and the most frequent cancer among women in Africa, Asia, and South America [1]. Concurrent chemotherapy with external beam radiotherapy (EBRT) shows benefit for patients with bulky and locally advanced cervical cancer [2–5]. Though dose is related to local control and overall survival, the risk of tissue toxicity (acute or late) currently limits the total radiation dose that can safely be delivered [6, 7]. Risk factors for morbidity include the volume of irradiated normal tissue, total tumor dose, EBRT dose, fraction size, and age [8–10]. These factors can lead to unplanned treatment breaks and long overall treatment times that may negatively influence the outcome. Therefore, dose escalation, decreasing toxicity to normal tissues, and the use of novel systemic agents have tremendous potentials to improve the outcome. Conventional radiotherapy (2-dimensional radiotherapy (2DRT)) uses bony landmarks to define the target volume for pelvic radiotherapy. Treatment is delivered either with anterior and posterior opposed fields or with a four-field box
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