WCB 2021 - Online

Session Item

May 06
09:00 - 10:15
Image guided BT and Outcome for Cervical Cancer: Update from different regions
09:18 - 09:36
Image guided Brachytherapy and Outcomes of Cervical Cancer:: Indian Experience
Lavanya Gurram, India


Image guided Brachytherapy and Outcomes of Cervical Cancer:: Indian Experience
Authors: Naidu Lavanya.(Tata Memorial Hospital, Radiation Oncology, Mumbai, India)
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Abstract Text
Abstract text

Cervical cancer in India accounts for 15% of all the cervical cancer deaths in the world.  Majority of the patients present in locally advanced stages which require concurrent chemoradiation followed by brachytherapy (BT). In the presence of cultural diversities within the country, the implementation of BT in a systematic manner remains a challenge. I would present the journey of adaptation to image guided BT in cervical cancer. The outcomes of patients treated with two dimensional BT over 2 decades in women with cervical cancer were published. The transition from 2D to MRI based BT was achieved with the involvement and participation by tertiary cancer centres in the multicentric EMBRACE trial.  The results of MRI based BT in 2 cohorts from India have been published as separate reports with excellent local control rates. In one of the report, the outcomes were compared with the historical database in which patients were treated with 2D BT. In the limited resource setting, the use of MRI on a daily basis is a difficult task. Hence, the role of CT scan with the aid of ultrasound as a surrogate for MRI has been tested. Further research is ongoing in this regard.  We have contributed to the IAEA trial which evaluated the difference in outcomes in 2 fractionation schedules of BT. Collaborative efforts with the Medical University of Vienna with data pooling of patients treated with advanced BT technique such as Vienna II applicator has resulted in the reporting of outcomes in this group with 5 year local rates of 72%.  Guidelines for cervical cancer BT with an emphasis to the complex Indian settings have been published. These guidelines are more adaptable to our settings in comparison to the ICRU 89 Report. The results of image based BT for post surgical vault recurrences are encouraging with local control rates OF 84% at 5 years. The recruitment of patients for EMBRACE II trial is ongoing. The feasibility and safety of single application multifractionated BT has been tested in a phase II setting which awaits data maturity for outcome analysis.  In addition, continuous audits and quality checks have been implemented regularly and reported.