The changing landscape of brachytherapy for cervical cancer: a Canadian practice survey

• Published in: Current oncology (Toronto) Vol. 22; no. 5; pp. 356 - 360
• Main Authors: Phan, T, Mula-Hussain, L, Pavamani, S, Pearce, A, D'Souza, D, Patil, N G, Traptow, L, Doll, C M
• Format: Journal Article
• Language: English
• Published: Canada Multimed Inc 01-10-2015
• Subjects: Original; radiation oncology; Cervical cancer; brachytherapy
• ISSN: 1198-0052; 1718-7729; 1718-7729
• DOI: 10.3747/co.22.2562

We documented changes in practice from 2009 to 2012 for cervical cancer brachytherapy in Canada.
Centres with gynecologic brachytherapy services were sent an e-mail questionnaire querying their 2012 practice. Responses are reported and compared with practice patterns identified in a similar survey for 2009.
The response rate was 77% (24 of 31 centres). Almost all use high-dose-rate brachytherapy (92%); low-dose-rate brachytherapy has been completely phased out. Most continue to move patients from the site of applicator insertion to the radiation treatment simulation suite (75%) or to a diagnostic imaging department (29%), or both. In 2012, the imaging modalities used for dose specification were computed tomography [ct (75%)], magnetic resonance imaging [mri (38%)], plain radiography (21%), and cone-beam ct (8%). The number of institutions using mri guidance has markedly increased during the period of interest (9 vs. 1). Most respondents (58% vs. 14%) prescribed using guidelines from the Groupe Européen de Curiethérapie and the European Society for Therapeutic Radiology and Oncology, but they also used point A as a reference. Commonly used high-dose radiation regimens included 30 Gy in 5 fractions and 24 Gy in 3 fractions.
In Canada, image-guided brachytherapy for cervical cancer continues to evolve. Although ct-based imaging remains the most commonly used modality, many centres have adopted mri for at least 1 brachytherapy treatment. More centres are using fewer fractions and a slightly lower biologically effective dose, but are still achieving EQD2 (2-Gy equivalent) doses of 80-90 Gy in combination with external-beam radiation therapy.