D. Bernshaw

Ultrasound‐based conformal planning for gynaecological brachytherapy

This report describes the evolving use of transabdominal ultrasound (TAUS) as an imaging tool to verify tandem placement, localize the treatment volume and aid conformal brachytherapy planning for both cervical and uterine corpus cancers. Two patients, one with cancer of the cervix and one with cancer of the endometrium, are used as examples to illustrate the advantages of using TAUS. TAUS is used to guide applicator insertion and check the applicator in the treatment position. The dimensions of the uterus are recorded. Brachytherapy isodose plans are generated based on these measurements. Confirmation of uterine dimensions and isodose coverage is obtained using MRI taken after the initial fraction of treatment has been delivered. We illustrate how TAUS is successfully used to correct and verify tandem placement after the patient has been moved from insertion to treatment position. We also show how to use TAUS for conformal planning, based on individually derived target dimensions. TAUS has successfully been used to conformally plan treatment to the uterus and cervix, minimizing brachytherapy‐related toxicity to surrounding structures. Ultrasound is portable, inexpensive and simple to use and allows for accurate, conformal, reproducible and adaptive treatments.

ORIGINAL ARTICLE: Use of 3D imaging and awareness of GEC‐ESTRO recommendations for cervix cancer brachytherapy throughout Australia and New Zealand

Introduction:  A 2005 survey of practices indicated limited use of three‐dimensional (3D) imaging modalities and planning methods in cervix cancer brachytherapy in Australia and New Zealand. However, advancing technologies and published recommendations are influencing change. This survey aims to identify both changes in practice and awareness and uptake of Groupe European de Curietherapie of the European Society for Therapeutic Radiology and Oncology (GEC‐ESTRO) recommendations.

Brachytherapy for cancer of the cervix: An Australian and New Zealand survey of current treatment techniques

Establishing guidelines for the practice of brachytherapy throughout Australia and New Zealand is one of the goals of the Australasian Brachytherapy Group. To better appreciate Australasian resources and conditions, the group conducted a survey in early 2005. The aims were to survey current practices, to emphasize variations in practice and to determine the availability of advanced imaging and treatment methods to assess resources. A survey was sent to all Australian and New Zealand radiotherapy departments. The survey requested details of treatment with respect to external beam radiotherapy, brachytherapy, optimization methods, reporting methods, scheduling brachytherapy and access to imaging and methods of work‐up. Thirty‐four departments were contacted with 27 (79%) responses returned. Twenty‐one departments use brachytherapy. Doses and fractionation schedules varied and use of sectional imaging was minimal. Individualized dosimetry is practised in a limited fashion by 60% of the surveyed departments. There is high compliance with International Commission on Radiation Units 38 dose reporting recommendations. All brachytherapy units identified have access to CT and 85% to MRI within the hospital settings. Brachytherapy for cancer of the cervix is, currently, largely based on the Manchester system. The survey did emphasize considerable variation in dose and fractionation schemes between departments. The Australasian Brachytherapy Group subgroup intends to proceed with the process of formulating recommendations for cervix brachytherapy. It is intended that these will cover the use of image‐based planning and treatment, target definition(s), verification of brachytherapy treatments and a uniform dose‐reporting mechanism.

Patterns of failure and outcomes of patients with node positive vulva carcinoma treated with radiotherapy

Objectives: To evaluate the accuracy and safety of sentinel lymph node (SLN) mapping in patients with endometrial cancer using TC99m colloid and blue dye, and to evaluate the contribution of preoperative mapping by planar lymphoscintigraphy (PLSG) and SPECT/CT. Methods: Retrospective analysis of patients who underwent SLN mapping as part of their primary surgery for endometrial cancer from January 2013 until November 2014. Patients underwent preoperative SLN mapping by PLSG and later with additional SPECT/CT. Intraoperative mapping was performed by using both Tc99m colloid and blue dye by cervical injections. SLNs were sent separately to pathologic evaluation with ultrastaging. Results: Fifty three patients were included in this study. Successful preoperative mapping was achieved in 31 of 37 patients (84.5%) undergoing SPECT/CT, compared to only 30 of 45 patients (67%) undergoing PLSG. SPECT/CT localizations of SLNs were accurate in 91% of cases. Intraoperative detection of at least one SLN was 77%, while bilateral detection rate was 49%. Failed mapping was more prevalent in patients with advanced age (p=o.o41).Six cases of nodal metastasis were diagnosedFour by positive SLN, including two cases by ultrastaging only, and two more cases with failed mapping were diagnosed using side-specific full dissection according to the SLN algorithm. There were no cases of false negative results. Conclusions: SLN mapping using a cervical injection with combined Tc99m colloid and blue dye is feasible, safe and accurate in patients with endometrial cancer. Preoperative SPECT/CT has high detection rate and provides accurate anatomic location of the SLN. Copyright

ORIGINAL ARTICLE: Use of 3D imaging and awareness of GEC-ESTRO recommendations for cervix cancer brachytherapy throughout Australia and New Zealand: Cervix cancer brachytherapy

Introduction:  A 2005 survey of practices indicated limited use of three‐dimensional (3D) imaging modalities and planning methods in cervix cancer brachytherapy in Australia and New Zealand. However, advancing technologies and published recommendations are influencing change. This survey aims to identify both changes in practice and awareness and uptake of Groupe European de Curietherapie of the European Society for Therapeutic Radiology and Oncology (GEC‐ESTRO) recommendations.