Original paper Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus

Abstract

PurposeThere are limited data at a population level on adjuvant brachytherapy (BT) practice for uterine corpus malignancies. The aims of the current study were to describe BT practice for this disease in New South Wales (NSW), to assess quality of BT, and to determine if a caseload effect on quality exists.Material and methodsPatient, tumour, and treatment related data were collected from all nine NSW radiation oncology departments that treated patients with BT. Included patients had malignancy of the uterine corpus with treatment including BT. Brachytherapy quality was assessed using published quality benchmarks. Higher gynaecological BT caseload departments were compared with lower caseload departments.ResultsOne hundred sixty-three NSW residents with gynaecological cancer were treated with BT. The four higher gynaecological BT caseload departments treated a median of 25.5 NSW residents (range 22-38), compared to median 10 (range 3-18) in the five lower caseload departments. Seventy-five patients underwent BT for uterine malignancies. Most patients had early stage endometrioid disease and were treated adjuvantly with intravaginal cylinders using high-dose-rate BT. Doses were in accordance with guideline recommendations in 83% of cases, and BT was appropriately indicated in 76% of cases. Higher caseload departments were more likely to treat with guideline doses (96% vs. 53%, p < 0.001) but there was no difference in compliance rate with treatment indications (p = 0.75).ConclusionsBrachytherapy patients, techniques, and numbers/unit for uterine corpus malignancies were similar in NSW compared to the USA but more dispersed than in Western Europe. Doses prescribed may not be optimal in lower gynaecological BT caseload departments – the significance of this represents an area in which more research is needed.

Outcomes of salvage high-dose-rate brachytherapy with or without external beam radiotherapy for isolated vaginal recurrence of endometrial cancer

“…Most patients (66.7%) with intervals of ≥ 3 months initially received chemotherapy or surgery for first relapse, delaying the start of salvage radiation treatment. Postoperative brachytherapy with or without EBRT of uterine corpus has been used to treat women in Western countries [ 22 , 23 ]. In contrast, a study by the Japanese Gynecologic Oncologic Group (JGOG2033) showed that OS rate in patients at high to intermediate risk was higher in those who received postoperative chemotherapy than postoperative pelvic radiotherapy [ 2 ].…”

Institutional experience using interstitial brachytherapy for the treatment of primary and recurrent pelvic malignancies

“…Patients with vaginal recurrence of pelvic tumors such as endometrial cancer are infrequently candidates for repeat surgical excision [ 3 ], however combination BT and EBRT provides excellent long-term control and is a potentially curative option in localized disease [ 4 , 5 , 6 ]. Interstitial BT allows for treatment of deeper tumors that would be insufficiently covered by vaginal cylinder intracavitary BT, which is best suited for superficial (≤ 0.5 cm thick) lesions and for adjuvant treatment following hysterectomy [ 7 , 8 , 9 ]. A perineal template is commonly employed to guide placement of afterloading needles that are directly inserted into the vagina and surrounding tissues, with particular attention to the location of normal structures including the rectum, urethra, and bladder [ 10 ].…”

Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review

“…This review included various study designs: population‐based cohort studies that typically used registry data ( n = 12 57–59,62–65,67–69,71,118 ), multicenter cohort studies ( n = 4 54,56,61,66 ), and case‐series which followed patients from a single institution ( n = 4 55,60,70,72 ) (Table 1). The studies were conducted in New South Wales (NSW) and the Australian Capital Territory (ACT) ( n = 10 54–56,59,61,65–67,71,118 ), South Australia (SA) ( n = 4 62,63,70,72 ), Victoria (VIC) ( n = 3 57,60,69 ), Australia‐wide ( n = 2 64,68 ), and Queensland (QLD) ( n = 1 58 ). The Australia Cancer Network (ACN) CPGs (which were developed in partnership with the National Health and Medical Research Council (NHMRC)) ( n = 7), National Comprehensive Cancer Network (NCCN) CPGs ( n = 7), and NHMRC CPGs ( n = 5) were the most commonly used CPGs across the 20 included studies (with 7 studies referring to more than 1 CPG) (Table 1).…”