Brachytherapy for cancer of the cervix: An Australian and New Zealand survey of current treatment techniques

Abstract

Establishing guidelines for the practice of brachytherapy throughout Australia and New Zealand is one of the goals of the Australasian Brachytherapy Group. To better appreciate Australasian resources and conditions, the group conducted a survey in early 2005. The aims were to survey current practices, to emphasize variations in practice and to determine the availability of advanced imaging and treatment methods to assess resources. A survey was sent to all Australian and New Zealand radiotherapy departments. The survey requested details of treatment with respect to external beam radiotherapy, brachytherapy, optimization methods, reporting methods, scheduling brachytherapy and access to imaging and methods of work-up. Thirty-four departments were contacted with 27 (79%) responses returned. Twenty-one departments use brachytherapy. Doses and fractionation schedules varied and use of sectional imaging was minimal. Individualized dosimetry is practised in a limited fashion by 60% of the surveyed departments. There is high compliance with International Commission on Radiation Units 38 dose reporting recommendations. All brachytherapy units identified have access to CT and 85% to MRI within the hospital settings. Brachytherapy for cancer of the cervix is, currently, largely based on the Manchester system. The survey did emphasize considerable variation in dose and fractionation schemes between departments. The Australasian Brachytherapy Group subgroup intends to proceed with the process of formulating recommendations for cervix brachytherapy. It is intended that these will cover the use of image-based planning and treatment, target definition(s), verification of brachytherapy treatments and a uniform dose-reporting mechanism.

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

“…Dosing schedules of HDR-ICBT (i.e., total dose and fractions in combination with EBRT) differ substantially among various countries, both in clinical practice (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and in published guidelines (21,22). Table 1 lists various schedules for definitive RT with HDR-ICBT along with pelvic control rates for stage I and II cervical cancer (3,4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Immediately evident is the lack of a clear dose-response relationship between biologically effective dose (BED) at point A and pelvic control, which has been previously noted (23).…”

Patterns of practice survey for brachytherapy for cervix cancer in Australia and New Zealand

“…The use of 3D imaging has greatly expanded since the last survey conducted throughout Australia and New Zealand in 2009, Table 2. 17,18 The high levels of CT use are to be expected as the majority of departments (79%) perform imaging in the radiotherapy departments using their own CT scanners. Use of MRI has increased from 15% to 50% in the intervening years.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Previous reports have demonstrated that centres in Australia are adopting image-guided protocols with an increase in the use of 3D imaging in brachytherapy planning from 27% in 2005 to 65% in 2009. 17,18 The purpose of this survey was to explore the current patterns of practice for brachytherapy in cervix cancer in Australia and New Zealand. The survey was also intended to explore clinician attitudes towards IGABT and identify barriers to the implementation of IGABT.…”

Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound

“…Yet, most cervix brachytherapy is applied without image guidance and only planned with the aid of two-dimensional (2D) X-ray imaging. Computed tomography (CT) is slowly replacing traditional simulators, but often the pearshaped distribution based on applicator size and standard loadings continues to be used to cover the paracervical triangle (4)(5)(6).…”