LETTER TO THE EDITOR
Year : 2010 | Volume
: 6 | Issue : 3 | Page : 400--401
A critique of "American Brachytherapy Society Survey of three-dimensional imaging in gynecologic brachytherapy"
Daya Nand Sharma
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
Daya Nand Sharma
F-39, Ansari Nagar, New Delhi - 110 029
|How to cite this article:|
Sharma DN. A critique of "American Brachytherapy Society Survey of three-dimensional imaging in gynecologic brachytherapy".J Can Res Ther 2010;6:400-401
|How to cite this URL:|
Sharma DN. A critique of "American Brachytherapy Society Survey of three-dimensional imaging in gynecologic brachytherapy". J Can Res Ther [serial online] 2010 [cited 2020 Oct 1 ];6:400-401
Available from: http://www.cancerjournal.net/text.asp?2010/6/3/400/73327
Three-dimensional imaging is increasingly being used in gynecologic brachytherapy but most centers in developing countries (including India) continue to practice point-based dosimetry rather than 3-D image-based dosimetry. Since gynecological cancers constitute the major cancer burden in India and resources are limited, there may be practical difficulties in implementing 3-D image based gynecological brachytherapy. Recently an interesting article "Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society" has been published by Viswanathan et al.  The survey highlights the increasing use of 3-D imaging in gynecological brachytherapy. Our present critique of this article brings certain points to the notice of authors and the readers.
Firstly, though titled "Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society", the study deals with only cervical brachytherapy. The survey questionnaire does not have any question pertaining to other brachytherapy procedures used for vaginal, endometrial or vulval cancers. Therefore, article should have been better titled "Three-dimensional imaging in cervical brachytherapy: a survey of the American Brachytherapy Society".
Secondly, even for cervical brachytherapy, certain important questions have been missing in the 19-point questionnaire used for this survey. The much deserving interstitial brachytherapy (IBT) for cervical carcinoma has not been addressed at all and the focus of entire study is on intracavitary radiotherapy (ICRT). Though there are guidelines/recommendations published by American Brachytherapy Society (ABS) [2-4] from time to time addressing ICRT, but there is hardly any one for cervical IBT, per se. This could be one of the reasons for declining practice of IBT. There are no consensus guidelines regarding the image guidance, dose fractionation schedules or delineation of various target or OAR volumes. The ABS guidelines published in 2000 by Nag et al.,  did address the cervical IBT based on the study by Demanes et al.,  Unfortunately, even after almost 10 years of that ABS study,  not even a single study has been published reporting the use of these guidelines for cervical IBT. It would have been certainly interesting to include certain questions in present survey  relating to the 3-D imaging in cervical IBT and the attitude of ABS members. This could have been of great help in framing specific guidelines for cervical IBT by ABS in future.
Thirdly, the GEC-ESTRO guidelines  were published almost 2 years before the present ABS survey.  The specific point, whether these guidelines were followed, could have been included in this survey. This attitude of the members toward GEC-ESTRO guidelines could possibly help in further improving these guidelines to enhance its acceptance.
|1||Viswanathan AN, Erickson BA. Three-dimensional imaging in gynecologic brachytherapy: A survey of the American Brachytherapy Society. Int J Radiat Oncol Biol Phys 2010;76:104-9.|
|2||Nag S, Orton C, Young D, Erickson B. American Brachytherapy Society Survey of brachytherapy practice for carcinoma of the cervix in the United States. Gynecol Oncol 1999;73:111-8.|
|3||Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high dose rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000;48:201-11. |
|4||Nag S, Chao C, Erickson B, Fowler J, Gupta N, Martinez A, et al. The American Brachytherapy Society recommendations for low dose rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2002;52:33-48. |
|5||Demanes DJ, Rodriguez RR, Bendre DD, Ewing TL. High dose rate transperineal interstitial brachytherapy for cervical cancer: High pelvic control and low complication rates. Int J Radiat Oncol Biol Phys 1999;45:105-12. |
|6||Haie-Meder C, Pφtter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005;74:235-45.|