Image-guided brachytherapy found effective against cervical cancer



Washington: Two large, landmark radiotherapy studies have shown that it is possible to treat cervical cancer effectively using image-guided brachytherapy.

Researchers will tell the 2nd Forum of the European Society for Radiotherapy and Oncology (ESTRO) that image-guided brachytherapy is able to deliver very high doses of radiotherapy, which prevent the tumour from growing in over 90 percent of patients, with few serious side-effects to the surrounding normal organs.

One of the problems with radiotherapy for cervical cancer is that the vagina receives a high dose of radiotherapy, which can cause symptoms such as vaginal dryness, vaginal narrowing and shortening, with a loss of flexibility (stenosis), vaginal inflammation (mucositis), bleeding, or a hole in the wall of the vagina (vaginal fistula) - one of the most serious but rare complications. The bowel and bladder can also be affected by radiotherapy for cervical cancer.

Image-guided brachytherapy involves delivering radiotherapy to the tumour by placing a radioactive source in an applicator, positioned internally in the tumour region.

Imaging, either by repeated computer tomography (CT) scans or preferably magnetic resonance imaging (MRI), is used at the time of brachytherapy in order to delineate both the tumour and organs at risk in relation the applicator. This enables radiation oncologists to measure and evaluate the tumour response to the treatment, and adjust the dose accordingly, while sparing surrounding organs.

However, until now, there have been few studies investigating the relationship between the dose of radiotherapy and the effects it has on the vagina during brachytherapy for cervical cancer, according to Kathrin Kirchheiner (MSc), who will be reporting on the international, multi-centre prospective clinical trial EMBRACE (European and international study on MRI-guided brachytherapy in locally advanced cervical cancer) at the meeting.
"Brachytherapy is an essential part of the curative treatment of locally advanced cervical cancer, because of the high dose that can be delivered to the tumour while sparing organs at risk of damage from the treatment. With the possibility of dose adaptation and optimisation in image guided adaptive brachytherapy, a highly individualised and tailored treatment has become possible, comparable to the targeted, personalised therapies in medical oncology," concluded Kirchheiner.

ANI