The first clinical report on the use of a new hybrid gynecologic applicator

 

The first clinical report on the use of a new hybrid gynecologic applicator (Venezia) for treating advanced cervical cancer has been published in the journal Brachytherapy (1).  The results as presented in this publication highlight advancements in the treatment of this disease. Authors from LMU Munich hospital reported using both intracavitary (IC) and interstitial (IS) brachytherapy, under image-guidance, in 10 patients (40 treatment fractions) with FIGO stage IIB to IVA. All patients received external beam radiation treatment, with concomitant cisplatin, prior to brachytherapy. Treatment plans of the gross tumor volume (GTV), high risk clinical target volume (HR-CTV) and intermediate risk clinical target volume (IR-CTV) were defined according to GEC-ESTRO guidelines.  A dose of 90 – 95 Gy was delivered in four treatment sessions.

The authors used MRI image-guided brachytherapy. The patient was scanned prior to the first brachytherapy fraction in order to assess treatment response to external beam radiation. An MRI scan was also performed with the applicator in place for the first fraction, with subsequent CT’s performed for all other treatment fractions. Nine out of 10 patients were in full remission at 4 month median follow up. One patient experienced distant metastases but no locoregional recurrence.

Previous studies show the importance of using combined IC/IS brachytherapy techniques when treating advanced cervical cancer. Results from retroEMBRACE demonstrated an improvement in local control when IC/IS brachytherapy was used compared to IC treatment alone (2). The use of hybrid applicators may be a convenient tool for doctors who want to improve local control while reduce toxicities. The authors of the current study concluded “This clearly shows that the combined IC/IS BT by using a hybrid applicator can not only improve dose conformity and dose coverage of the target volume but at the same time increase dose sparing of OARs.

Link to report

 

  1. Walter F, et al. Combined interstitial and intracavitary brachytherapy of cervical cancer using the novel hybrid applicator Venezia: clinical feasibility and initial results. Brachytherapy. 2018;17:775-781
  2. Fokdal L, et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: analysis from the retroembrace study. Radiother Oncol. 2016;120:434-440.