Improving the Efficiency of Image Guided Brachytherapy in Cervical Cancer

Overview

Journal J Contemp Brachytherapy

Date 2017 Jan 25

PMID 28115963

Citations 11

Authors

Sophie Otter

Adrian Franklin

Mazhar Ajaz

Alexandra Stewart

Affiliations

Soon will be listed here.

Abstract

Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. Traditionally, cervical brachytherapy was prescribed to point A but since the GEC-ESTRO guidelines were published in 2005, there has been a move towards prescribing the dose to a 3D volume. Image guided brachytherapy has been shown to reduce local recurrence, and improve survival and is optimally predicated on magnetic resonance imaging. Radiological studies, patient workflow, operative parameters, and intensive therapy planning can represent a challenge to clinical resources. This article explores the ways, in which 3D conformal brachytherapy can be implemented and draws findings from recent literature and a well-developed hospital practice in order to suggest ways to improve the efficiency and efficacy of a brachytherapy service. Finally, we discuss relatively underexploited translational research opportunities.

Citing Articles

A Novel Positive-Contrast Magnetic Resonance Imaging Line Marker for High-Dose-Rate (HDR) MRI-Assisted Radiosurgery (MARS).

Wang L, Ding Y, Bruno T, Stafford R, Lin E, Bathala T Cancers (Basel). 2024; 16(10).

PMID: 38792000 PMC: 11119838. DOI: 10.3390/cancers16101922.

Brachytherapy Workflow Practices: Analysis of Different Workflow Scenarios in Patients With Cervical Cancer and Impact on IGBT Implementation-An IAEA Study.

Ndarukwa S, Flores J, Rosenblatt E, Berger D, Akbarov K, Hedden N JCO Glob Oncol. 2024; 10:e2300336.

PMID: 38386958 PMC: 10898675. DOI: 10.1200/GO.23.00336.

Pain and symptom relief using inhaled methoxyflurane for gynecologic brachytherapy applicator removal.

Stewart A, Brooker C, Vose G, Redmond K, Williams A, Pankhania N J Contemp Brachytherapy. 2023; 15(1):37-42.

PMID: 36970443 PMC: 10034726. DOI: 10.5114/jcb.2023.125581.

Clinical and dosimetric consequences of imperfect applicator insertion in cervical cancer brachytherapy.

Chakrabarti B, Pal S, Sepai H, Roy S, Kar S, Lahiri A J Contemp Brachytherapy. 2018; 10(4):321-336.

PMID: 30237816 PMC: 6142650. DOI: 10.5114/jcb.2018.77954.

The effect of tandem-ovoid titanium applicator on points A, B, bladder, and rectum doses in gynecological brachytherapy using Ir.

Sadeghi M, Sina S, Mehdizadeh A, Faghihi R, Moharramzadeh V, Meigooni A J Contemp Brachytherapy. 2018; 10(1):91-95.

PMID: 29619061 PMC: 5881597. DOI: 10.5114/jcb.2018.74314.

References

Beriwal S, Kannan N, Kim H, Houser C, Mogus R, Sukumvanich P . Three-dimensional high dose rate intracavitary image-guided brachytherapy for the treatment of cervical cancer using a hybrid magnetic resonance imaging/computed tomography approach: feasibility and early results. Clin Oncol (R Coll Radiol). 2011; 23(10):685-90. DOI: 10.1016/j.clon.2011.08.007. View

Grover S, Harkenrider M, Cho L, Erickson B, Small C, Small Jr W . Image Guided Cervical Brachytherapy: 2014 Survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys. 2016; 94(3):598-604. DOI: 10.1016/j.ijrobp.2015.11.024. View

Damato A, Lee L, Bhagwat M, Buzurovic I, Cormack R, Finucane S . Redesign of process map to increase efficiency: Reducing procedure time in cervical cancer brachytherapy. Brachytherapy. 2015; 14(4):471-80. PMC: 4468005. DOI: 10.1016/j.brachy.2014.11.016. View

Hodi F, ODay S, Mcdermott D, Weber R, Sosman J, Haanen J . Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010; 363(8):711-23. PMC: 3549297. DOI: 10.1056/NEJMoa1003466. View

Kirchheiner K, Czajka-Pepl A, Ponocny-Seliger E, Scharbert G, Wetzel L, Nout R . Posttraumatic stress disorder after high-dose-rate brachytherapy for cervical cancer with 2 fractions in 1 application under spinal/epidural anesthesia: incidence and risk factors. Int J Radiat Oncol Biol Phys. 2014; 89(2):260-7. DOI: 10.1016/j.ijrobp.2014.02.018. View

Lim K, Lu J, Wynne C, Back M, Mukherjee R, Razvi K . A study of complications arising from different methods of anesthesia used in high-dose-rate brachytherapy for cervical cancer. Am J Clin Oncol. 2004; 27(5):449-51. DOI: 10.1097/01.coc.0000128723.00352.ad. View

Petric P, Kirisits C . Potential role of TRAns Cervical Endosonography (TRACE) in brachytherapy of cervical cancer: proof of concept. J Contemp Brachytherapy. 2016; 8(3):215-20. PMC: 4965497. DOI: 10.5114/jcb.2016.60502. View

Stone S, Marques Rossetti R, Lima A, Lepique A . HPV associated tumor cells control tumor microenvironment and leukocytosis in experimental models. Immun Inflamm Dis. 2014; 2(2):63-75. PMC: 4217549. DOI: 10.1002/iid3.21. View

Small Jr W, Strauss J, Hwang C, Cohen L, Lurain J . Should uterine tandem applicators ever be placed without ultrasound guidance? No: a brief report and review of the literature. Int J Gynecol Cancer. 2011; 21(5):941-4. DOI: 10.1097/IGC.0b013e31821bca53. View

10.

Kosmaczewska A, Bocko D, Ciszak L, Wlodarska-Polinska I, Kornafel J, Szteblich A . Dysregulated expression of both the costimulatory CD28 and inhibitory CTLA-4 molecules in PB T cells of advanced cervical cancer patients suggests systemic immunosuppression related to disease progression. Pathol Oncol Res. 2011; 18(2):479-89. PMC: 3313031. DOI: 10.1007/s12253-011-9471-y. View

11.

Georg P, Lang S, Dimopoulos J, Dorr W, Sturdza A, Berger D . Dose-volume histogram parameters and late side effects in magnetic resonance image-guided adaptive cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2010; 79(2):356-62. DOI: 10.1016/j.ijrobp.2009.11.002. View

12.

Heeren A, Punt S, Bleeker M, Gaarenstroom K, van der Velden J, Kenter G . Prognostic effect of different PD-L1 expression patterns in squamous cell carcinoma and adenocarcinoma of the cervix. Mod Pathol. 2016; 29(7):753-63. PMC: 4931542. DOI: 10.1038/modpathol.2016.64. View

13.

Mohamed S, Kallehauge J, Fokdal L, Lindegaard J, Tanderup K . Parametrial boosting in locally advanced cervical cancer: combined intracavitary/interstitial brachytherapy vs. intracavitary brachytherapy plus external beam radiotherapy. Brachytherapy. 2014; 14(1):23-8. DOI: 10.1016/j.brachy.2014.09.010. View

14.

Davidson M, Yuen J, DSouza D, Batchelar D . Image-guided cervix high-dose-rate brachytherapy treatment planning: does custom computed tomography planning for each insertion provide better conformal avoidance of organs at risk?. Brachytherapy. 2008; 7(1):37-42. DOI: 10.1016/j.brachy.2007.12.003. View

15.

Corn B, Hanlon A, Pajak T, Owen J, Hanks G . Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix. Gynecol Oncol. 1994; 53(3):294-300. DOI: 10.1006/gyno.1994.1137. View

16.

Dimopoulos J, Kirisits C, Petric P, Georg P, Lang S, Berger D . The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: clinical feasibility and preliminary results. Int J Radiat Oncol Biol Phys. 2006; 66(1):83-90. DOI: 10.1016/j.ijrobp.2006.04.041. View

17.

Schaner P, Caudell J, De Los Santos J, Spencer S, Shen S, Kim R . Intraoperative ultrasound guidance during intracavitary brachytherapy applicator placement in cervical cancer: the University of Alabama at Birmingham experience. Int J Gynecol Cancer. 2013; 23(3):559-66. DOI: 10.1097/IGC.0b013e3182859302. View

18.

Owrangi A, Prisciandaro J, Soliman A, Ravi A, Song W . Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program. J Contemp Brachytherapy. 2015; 7(5):417-22. PMC: 4663219. DOI: 10.5114/jcb.2015.55541. View

19.

Weitmann H, Gustorff B, Vaupel P, Knocke T, Potter R . Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy. Strahlenther Onkol. 2003; 179(9):633-40. DOI: 10.1007/s00066-003-1060-x. View

20.

Rijkmans E, Nout R, Rutten I, Ketelaars M, Neelis K, Laman M . Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy. Gynecol Oncol. 2014; 135(2):231-8. DOI: 10.1016/j.ygyno.2014.08.027. View