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Outpatient combined intracavitary and interstitial cervical brachytherapy: barriers and solutions to implementation of a successful programme - a single institutional experience.

Tan PW, Koh VY, Tang JI - J Contemp Brachytherapy (2015)

Bottom Line: This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning.In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy.This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore.

ABSTRACT
Involvement of parametrial disease in locally advanced cervical patients poses a challenge for women undergoing brachytherapy. Current use of the Fletcher suit applicator may not adequately cover the high risk clinical target volume (HR CTV), especially in the parametrial region due to the physical qualities of brachytherapy from the inverse square law and the need to respect organs at risk (OAR) constraints, and leads to lower local control rates. Combined intracavitary and interstitial brachytherapy with the use of 1 or 2 interstitial needles allows adequate coverage of the HR CTV and the clinical evidence have demonstrated a correlation with better clinical results. This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning. In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy. This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

No MeSH data available.


Patients with bilateral parametrium disease benefit the greatest from interstitial brachytherapy
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Figure 0001: Patients with bilateral parametrium disease benefit the greatest from interstitial brachytherapy

Mentions: Patients with cervical stage 2B and stage 3B with parametrial residual disease post chemotherapy and external beam radiotherapy would benefit the most from interstitial cervical brachytherapy, especially for patients with residual bilateral parametrial disease [10] (Figure 1). Compared to 3D Fletcher suit applicator, the greatest advantage of combined intracavitary and interstitial brachytherapy is the superior dosimetric coverage of the HR CTV, allowing for better therapeutic ratio [8–10]. This permits the HR CTV to be above 87 Gy, thus improving local control rates. This form of adaptive brachytherapy is personalized to each individual patient's anatomy in order to lead to the best results. Other patient selection factors include fitness to undergo anaesthesia, suitable pelvic anatomy, and tumor topography for appropriate applicator placement, as well as availability to preplanning clinical examination and imaging findings.


Outpatient combined intracavitary and interstitial cervical brachytherapy: barriers and solutions to implementation of a successful programme - a single institutional experience.

Tan PW, Koh VY, Tang JI - J Contemp Brachytherapy (2015)

Patients with bilateral parametrium disease benefit the greatest from interstitial brachytherapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499522&req=5

Figure 0001: Patients with bilateral parametrium disease benefit the greatest from interstitial brachytherapy
Mentions: Patients with cervical stage 2B and stage 3B with parametrial residual disease post chemotherapy and external beam radiotherapy would benefit the most from interstitial cervical brachytherapy, especially for patients with residual bilateral parametrial disease [10] (Figure 1). Compared to 3D Fletcher suit applicator, the greatest advantage of combined intracavitary and interstitial brachytherapy is the superior dosimetric coverage of the HR CTV, allowing for better therapeutic ratio [8–10]. This permits the HR CTV to be above 87 Gy, thus improving local control rates. This form of adaptive brachytherapy is personalized to each individual patient's anatomy in order to lead to the best results. Other patient selection factors include fitness to undergo anaesthesia, suitable pelvic anatomy, and tumor topography for appropriate applicator placement, as well as availability to preplanning clinical examination and imaging findings.

Bottom Line: This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning.In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy.This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore.

ABSTRACT
Involvement of parametrial disease in locally advanced cervical patients poses a challenge for women undergoing brachytherapy. Current use of the Fletcher suit applicator may not adequately cover the high risk clinical target volume (HR CTV), especially in the parametrial region due to the physical qualities of brachytherapy from the inverse square law and the need to respect organs at risk (OAR) constraints, and leads to lower local control rates. Combined intracavitary and interstitial brachytherapy with the use of 1 or 2 interstitial needles allows adequate coverage of the HR CTV and the clinical evidence have demonstrated a correlation with better clinical results. This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning. In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy. This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

No MeSH data available.