Cobalt-60 is a logical, economical and comparable alternative to Ir-192: analysis and institutional experience from western India

Nandwana, Upendra; Rathore, Narendra; Gupta, Sukanya Sen; Shukla, Arvind Kumar; Kumar, Satish; Intodia, Kiran; Bana, Poonam Chand; Jain, Abhay

doi:10.1080/20742835.2015.1083720

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…LDR, MDR and HDR respectively. Iridium 192 is the most commonly used isotope for intracavitary HDR brachytherapy worldwide [ 6 ]. There is limited data on outcomes from cobalt 60 for high dose brachytherapy in resource-constrained settings.…”

Section: Introductionmentioning

confidence: 99%

High dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

Chibonda

Ndlovu

Tsikai

et al. 2021

Infect Agents Cancer

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Background and purpose Cervical cancer is the fourth commonest cancer in women in the world with the highest regional incidence and mortality seen in Southern, Eastern and Western Africa. It is the commonest cause of cancer morbidity and mortality among Zimbabwean women. Most patients present with locally advanced disease that is no longer amenable to surgery. Definitive concurrent chemoradiation (CCRT), which is the use of external beam radiotherapy (EBRT) and weekly cisplatin, includes use of intracavitary brachytherapy, as the standard treatment. In the setting of this study, cobalt-60 (Co60)-based high dose rate brachytherapy (HDR-BT) has been in use since 2013. This study sought to review practices pertaining to use of brachytherapy in Zimbabwe, including timing with external beam radiotherapy, adverse effects and patient outcomes. Methods A retrospective analysis of data from records of patients with histologically confirmed cervical cancer treated with HDR-BT at the main radiotherapy centre in Zimbabwe from January 2013 to December 2014 was done. Outcome measures were local control, overall survival as well as gastro-intestinal and genito-urinary toxicity. Results A total of 226 patients were treated with HDR-BT during the study period, with a 97% treatment completion rate. All patients received between 45-50Gy of pelvic EBRT. Seventy-four percent received concurrent platinum-based chemotherapy. In 52% of the patients, HDR-BT was started when they were still receiving EBRT. The commonest fractionation schedule used was the 7Gy × 3 fractions, once a week (87%). Clinical complete tumour response was achieved in 75% at 6 weeks post treatment, 23% had partial response. Follow-up rates at 1 year and 2 years were 40 and 19% respectively. Disease free survival at 1 year and 2 years was 94 and 95% respectively. Vaginal stenosis was the commonest toxicity recorded, high incidence noted with increasing age. Four patients developed vesico-vaginal fistulae and two patients had rectovaginal fistulae. Conclusion One hundred and seventeen patients patients started HDR-BT during EBRT course, with a treatment completion rate of 97%. The overall treatment duration was within 56 days in the majority of patients. Early local tumour control was similar for all the HDR-BT fractionation regimes used in the study, with a high rate (75%) of complete clinical response at 6 weeks post-treatment. Prospective studies to evaluate early and long-term outcomes of HDR-BT in our setting are recommended.

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Section: Introductionmentioning

confidence: 99%

High dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

Chibonda

Ndlovu

Tsikai

et al. 2021

Infect Agents Cancer

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“…As a result of these safety issues, iridium-192 sources or other sources with a short half-life may be held at customs and not released in a timely manner preventing routine source swaps and impacting clinical care. In a study comparing the dosimetry of cobalt-60 to iridium-192 in HDR brachytherapy, Nandwana et al demonstrated the ability of cobalt-60 to meet the necessary qualifications as an intracavitary radiotherapy source under the International Commision on Radiation Units guidelines ( Nandwana et al, 2015 ). Thus, cobalt-60 could be considered as an alternative to iridium-192 in limited resource settings in order to decrease the frequency of source exchange and potential customs complications.…”

Section: Cervical Cancer Treatment In Lmicmentioning

confidence: 99%

Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery

LaVigne

Triedman

Randall

et al. 2017

Gynecologic Oncology Reports

123

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The global cervical cancer burden falls disproportionately upon women in low and middle-income countries. Insufficient infrastructure, lack of access to preventive HPV vaccines, screening, and treatment, as well as limited trained personnel and training opportunities, continue to impede efforts to reduce incidence and mortality in these nations. These hurdles have been substantial challenges to radiation delivery in particular, preventing treatment for a disease in which radiation is a cornerstone of curative therapy. In this review, we discuss the breadth of these barriers, while illustrating the need for adaptive approaches by proposing the use of brachytherapy alone in the absence of available external beam radiotherapy. Such modifications to current guidelines are essential to maximize radiation treatment for cervical cancer in limited resource settings.

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“…Follow up intervals ranged from 6 years to 6 months, with 29 patients without disease at 1 year. Moreover, 109 patients experienced improvement of symptom management and reduction in tumor burden [30]. Kelly and Burnham [28] concluded that this improvement alone, regardless of cure, justified this application of radiotherapy in cervical and vaginal cancer.…”

Section: Brachytherapy Alone In Limited Resource Settingsmentioning

confidence: 99%

“…Operators must therefore be extensively trained in both operation and upkeep of units in order to ensure treatment efficacy and safety. Nandwana et al [30] demonstrated the ability of cobalt-60 to meet the necessary qualifications as an intracavitary radiotherapy source under the International Commision on Radiation Units guidelines [30]. Thus, cobalt-60 could be considered as an alternative to iridium-192 in limited resource settings in order to decrease the frequency of source exchange and potential customs complications.…”

Section: Brachytherapy Alone In Limited Resource Settingsmentioning

confidence: 99%

High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

2018

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Brachytherapy as a form of treatment for gynecological tumors has been used for a long time in Brazil (since 1991) and can be considered as a form of radiotherapy treatment. High Dose Rate (HDR) brachytherapy aims at delivering high dose rates of radiation in restricted volumes of the body, thereby increasing disease control and lower treatment toxicity for adjacent normal tissues. Cervical cancer (CC) is a disease that still affects women in developing countries and, despite being detected by laboratory and imaging tests, in many developing countries these techniques are not yet accessible to all that are affected by cervical cancer. HDR presents important results when isolated or in association with other treatment techniques. Numerous studies have shown that HDR for gynecological cancer presents results that can reach up to 85% cure, and with this it is concluded that there are few complications during or after treatment, since adjacent tissues are preserved, making HDR a safe procedure for patients and professionals.

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Cobalt-60 is a logical, economical and comparable alternative to Ir-192: analysis and institutional experience from western India

Cited by 3 publications

References 10 publications

High dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

High dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery

High dose rate (HDR) brachytherapy in gynecologic cancer regression: a review of the literature

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