Three-dimensional Image-guided Brachytherapy
Radiation oncologist Akila N. Viswanathan, MD, MPH, is one of a select few radiation oncologists nationwide to offer brachytherapy using real-time, three-dimensional image guidance as an alternative to surgery or non-image guided radiation for select patients with cervical, vulvar, vaginal, and uterine cancers, including patients with recurrent gynecologic cancer.
Introduced in 2002 and further refined since that time, this technique offers many patient benefits, including:
- Additional preservation of normal tissue compared with traditional radiation planning alone;
- Reduction in the risks of rectal bleeding and bladder ulceration;
- Improvement in local cancer control and survival. “International studies have shown at least a 10 percent improvement in local tumor control and survival using 3D image-guided brachytherapy over other techniques,” said Dr. Viswanathan.
Current Trends in Brachytherapy
The first prospective clinical trial using real-time MRI image-guided brachytherapy was led by Dr. Viswanathan and published in 2006 (Int J Radiation Oncology Biol Phys, Vol 66, No 1, pp. 91-99, 2006). In order to assess current trends in image-guided brachytherapy in the United State, Dr. Viswanathan led the design and analysis of a survey of 141 American Brachytherapy Society (ABS) physician members who were not in training (Int. J. Radiation Oncology Biol. Phys., Vol. 76 No. 1, 104-109, 2009.). The study showed that more members (55 percent) use CT postimplantation imaging than plain films (43 percent) or magnetic resonance imaging (two percent) for visualizing the gynecologic brachytherapy apparatus, however, 76 percent prescribe to Point A methods alone rather than using 3Dderived tumor volume imaging (14 percent).
In addition, of the surveyed members, 20 percent do not use imaging to assist with applicator insertion. Of those who have facilities for real-time image guidance, 56 percent reported that they have used ultrasound (US) during the insertion process. When asked on average what percentage of time they use US guidance, the median was 42 percent. Slightly fewer (37 percent) reported using fluoroscopy during insertion, and they implement this method on average in 68 percent of their cases. A total of 24 percent have CT and use this on average for 74 percent of their cases. One center in the U.S. reported using real-time image guidance with MRI, and no center reported real-time PET capability.
“While 70 percent of ABS survey respondents use CT imaging after insertion, the available images are not necessarily optimally used for patient care,” said Dr. Viswanathan. “With additional training and awareness regarding the patient benefits of 3D images, the utilization of available imaging technology should significantly increase in the near future, resulting in substantially improved outcomes for patients.”
Dr. Viswanathan will publish the first book on 3D imagebased brachytherapy for gynecologic cancer, Innovation in Image Based Therapy for Gynecologic Radiation Therapy, later this year. In addition to brachytherapy, she also provides image-guided radiation therapy (IMRT), which is offered for patients with nodal spread of disease for all gynecologic malignancies and for abdominal treatment for high-risk patients. Dr. Viswanathan treats more than 200 patients each year.
Akila N. Viswanathan, MD, MPH
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This page was last modified on 4/13/2016