Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

“…However, it does not deliver significant radiation outside the cervix which may be a limitation in bulky locally advanced cervical cancers (LACC). Hence, brachytherapy after EBRT with concurrent chemotherapy became the standard curative management for LACC . For many decades, brachytherapy planning has utilized 2D x‐ray imaging with radiation dose prescribed at specific points, rather than to a defined volume, which may have led to some complications .…”

“…Presently, this rather invasive technique is the best practical option in generating conformal plans for LACC. But, tumor dose conformity and OAR doses are very sensitive to the number and precise positioning of the needles and expertise of the physician in needle insertion . Recently, some IMBT devices such as electronic brachytherapy, directional brachytherapy sources, dynamic and rotating shield brachytherapy, and stationary direction‐modulated multichannel shielded applicators have been introduced to improve dose conformity around the tumor.…”

The Effect of Body Mass Index and Weight Change on Late Gastrointestinal Toxicity in Locally Advanced Cervical Cancer Treated With Intensity-modulated Radiotherapy

“…Imageguided adaptive brachytherapy (IGABT) in LACC is increasingly recognized as the new paradigm replacing 2-dimensional brachytherapy. 39 The IGABT could optimize bowel dosimetry, especially for underweight patients with no or less intraabdominal fat, as the bowel loops are usually in very close proximity to the cervix and uterus. 18 Despite these limitations, the strength of this study was the inclusion of 245 patients treated with IMRT in a consistent fashion and a follow-up period of more than 5 years.…”

A brief look at model-based dose calculation principles, practicalities, and promise

“…Within the past decade, the international study on MRI-guided brachytherapy in locally advanced cervical cancer and related retroEMBRACE study have clearly demonstrated that image-guided adaptive brachytherapy can substantially improve disease outcome and reduce treatment-related morbidity [56]. Could the use of MBDCAs serve to facilitate similar improvements in treatment techniques and outcomes at other treatment sites, for which TG-43 dosimetry is demonstrably inaccurate?…”