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Almeida ND, Shekher R, Pepin A, Schrand TV, Goulenko V, Singh AK, Fung-Kee-Fung S. Artificial Intelligence Potential Impact on Resident Physician Education in Radiation Oncology. Adv Radiat Oncol 2024; 9:101505. [PMID: 38799112 PMCID: PMC11127091 DOI: 10.1016/j.adro.2024.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/16/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Neil D. Almeida
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Rohil Shekher
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Abigail Pepin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tyler V. Schrand
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Chemistry, Bowling Green State University, Bowling Green, Ohio
| | - Victor Goulenko
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Simon Fung-Kee-Fung
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Colson-Fearon D, Han K, Roumeliotis MB, Viswanathan AN. Updated Trends in Cervical Cancer Brachytherapy Utilization and Disparities in the United States From 2004 to 2020. Int J Radiat Oncol Biol Phys 2024; 119:154-162. [PMID: 38040060 DOI: 10.1016/j.ijrobp.2023.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/13/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Lower brachytherapy utilization for cervical cancer patients is associated with decreased survival. This study examines more recent trends in brachytherapy utilization from 2004 to 2020 to assess any trend reversal after awareness increased regarding the importance of brachytherapy. METHODS AND MATERIALS This study analyzed data from the National Cancer Database of patients with Federation of Gynecology and Obstetrics (FIGO) IB to IVA cervical cancer treated with radiation therapy between 2004 and 2020. To compare brachytherapy utilization over time, 2- to 3-year categories were created to account for potential variation seen in individual years. A multivariate log binomial regression with robust variance was used to estimate the incidence rate ratio (IRR) of brachytherapy utilization in each year category in reference to the 2004-2006 category. Additionally, risk factors for brachytherapy utilization were identified. RESULTS Overall brachytherapy utilization for cervical cancer increased from 54.9% in 2004 to 75.7% in 2020. Compared with 2004 to 2006 when rates of utilization totaled 55.2%, brachytherapy utilization significantly increased to 63.4% in 2011 to 2014 (IRR, 1.15; 95% CI, 1.11-1.19), 66.0% in 2015 to 2017 (1.20 [1.16-1.23]), and 76.0% in 2018 to 2020 (1.38 [1.34-1.42]). Sociodemographic factors associated with lower brachytherapy utilization included Black race (0.94 [0.92-0.97]), Hispanic ethnicity (0.92 [0.90-0.95]), and age >59 years (age ≥60-69: 0.96 [0.94-0.98]; age ≥70-79: 0.89 [0.87-0.92]; age ≥80: 0.73 [0.69-0.77]). Positive predictors of brachytherapy utilization included having insurance (IRR, 1.11; 95% CI, 1.07-1.14). CONCLUSIONS In patients with FIGO IB-IVA cervical cancer treated with radiation therapy from 2004 to 2020, brachytherapy utilization has increased during the past decade. These results are encouraging given the known benefit to cause-specific survival and overall survival provided by brachytherapy treatment and indicate a reversal in the trend of declining brachytherapy noted previously. Concerns related to disparities by race, ethnicity, and insurance status require further interventions.
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Affiliation(s)
- Darien Colson-Fearon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathy Han
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Michael B Roumeliotis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Chekrine T, Bellefkih FZ, Hatim G, Bouchbika Z, Benchakroun N, Jouhadi H, Tawfiq N, Sahraoui S. Patterns of practice survey for cervical cancer brachytherapy in Morocco. Brachytherapy 2024; 23:154-164. [PMID: 38311545 DOI: 10.1016/j.brachy.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/25/2023] [Accepted: 12/30/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE This study surveyed radiation oncologists in Morocco to explore current practices and perspectives on brachytherapy for cervix cancer. METHODS AND MATERIALS A 37-question survey was conducted in April 2023 among 165 Moroccan radiation oncologists using Google Forms. RESULTS Of the 93 respondents, 39% treated over 20 patients in 2022 using 3D image-guided brachytherapy (BT) through the HDR technique; 2D techniques were not reported in the last five years. Intracavitary BT is uniformly applied with a tandem and ovoid applicator. Only 14% utilized interstitial needles for hybrid BT. Iridium-192 was the primary radioactive source (63%), followed by cobalt (37%). Ultrasound-guided 47% of applicator insertions. All used CT scans for planning, but only 6% used MRI fusion due to limited availability. Guidelines for target volume and dose prescription were mostly based on GEC-ESTRO recommendations (74%), followed by Manchester Point A (30.4%) and ABS (11%). Over 90% delineated CTV-HR and CTV-IR; 30% delineated GTV. All marked the bladder and rectum, while 52% marked the sigmoid, 5% the small bowel, and 3% the recto-vaginal point. For dosimetry, 12% used ICRU 89 points, 54% used dose-volume histograms (DVH), and 36% used both. Most reported EQD2cc for OARs for the rectum and bladder, with nine still using ICRU point doses. The most common fractionation schema was 7 Gy in four fractions (60%) and 7 Gy in three fractions (55%). CONCLUSIONS Brachytherapy remains essential for treating cervical cancer in Morocco. Key areas for improvement include MRI fusion-guided brachytherapy, access to advanced applicators, expanding interstitial techniques, and professional training and national referential.
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Affiliation(s)
- Tarik Chekrine
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Fatima Zahra Bellefkih
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ghita Hatim
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Zineb Bouchbika
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Nadia Benchakroun
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Hassan Jouhadi
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Nezha Tawfiq
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Souha Sahraoui
- Radiation Oncology Department, Mohammed VI Cancer Treatment Centre, Ibn Rochd Hospital, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Ferioli M, Medici F, Forlani L, Cilla S, Fionda B, Cammelli S, Strigari L, Tagliaferri L, Morganti AG, Buwenge M. Augmented reality in brachytherapy: A narrative review. J Contemp Brachytherapy 2024; 16:57-66. [PMID: 38584890 PMCID: PMC10993895 DOI: 10.5114/jcb.2024.137779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 04/09/2024] Open
Abstract
Brachytherapy (BRT) plays a pivotal role in the treatment of tumors, offering precise radiation therapy directly to the affected area. However, this technique demands extensive training and skills development, posing challenges for widespread adoption and ensuring patient safety. This narrative review explored the utilization of augmented reality (AR) in BRT, seeking to summarize existing evidence, discuss key findings, limitations, and quality of research as well as outline future research directions. The review revealed promising findings regarding the integration of AR in BRT. Studies have suggested the feasibility and potential benefits of AR in education, training, intra-operative guidance, and treatment planning. However, the evidence remains limited and heterogeneous, with most studies in preliminary phases. Standardization, prospective clinical trials, patient-centered outcomes assessment, and cost-effectiveness analysis emerge as critical areas for future research. Augmented reality holds transformative potential for BRT by enhancing precision, safety, and training efficiency. To fully implement these benefits, the field requires standardized protocols, rigorous clinical trials, and in-depth patient-centered investigations. Policy-makers and healthcare providers should closely monitor developments in AR and consider its implementation in clinical practice, contingent and robust evidence, and cost-effectiveness analysis. The pro-active pursuit of evidence-based practices will contribute to optimizing patient care in BRT.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Bruno Fionda
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Lidia Strigari
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
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Kumar R, Sherwani Z, Lopez M, Vergalasova I, Zhang X, Eckroate B, Hollingsworth J, Girda E, Hathout L. Disparities in brachytherapy utilization in cervical cancer in the United States: A comprehensive literature review. Gynecol Oncol 2023; 179:79-84. [PMID: 37944329 DOI: 10.1016/j.ygyno.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Brachytherapy (BT) is an integral component of treatment for patients with locally advanced cervical cancer, significantly improving local control and overall survival. There is an overall trend of decreased utilization of BT in United States (US) in the last few decades with around 50% of patients being treated without BT. The cause of decreased utilization is multifactorial including physician comfort, facility volume, low reimbursements rates and costs of starting and maintaining a brachytherapy program. This decrease coincides with an increase in the use of newer advanced techniques like intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) boost resulting in inferior oncological outcomes and increased toxicity. Moreover, racial and socioeconomic disparities in BT utilization have been widely reported in the US. Various factors including age, race, socio-economic status, location, facility type, facility volume and insurance status result in limited access to brachytherapy, which jeopardizes oncologic outcomes. This comprehensive review discusses the BT utilization in the US, examines the impact of race and socioeconomic factors on BT utilization, and highlights its impact on outcomes.
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Affiliation(s)
- Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Zohaib Sherwani
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Melissa Lopez
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Xinxin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Brett Eckroate
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Jessie Hollingsworth
- Department of Gynecology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Eugenia Girda
- Department of Gynecology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America.
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Mantz C. Comments on "Tipping the Balance: Adding Resources for Cervical Cancer Brachytherapy". Int J Radiat Oncol Biol Phys 2023; 117:1143-1144. [PMID: 37980141 DOI: 10.1016/j.ijrobp.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Constantine Mantz
- Chief Medical Officer and Radiation Oncologist, GenesisCare, Fort Myers, Florida.
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Ferioli M, Medici F, Galietta E, Forlani L, Tagliaferri L, Cilla S, Cammelli S, Morganti AG, Buwenge M. The role of training simulators in interventional radiation therapy (brachytherapy) training: A narrative review. J Contemp Brachytherapy 2023; 15:290-295. [PMID: 37799124 PMCID: PMC10548427 DOI: 10.5114/jcb.2023.131240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Simulators have revolutionized medical education and training across various disciplines, offering unique advantages in skill acquisition and performance improvement. In the context of interventional radiation therapy (IRT), simulators have emerged as valuable tools for training healthcare professionals in these complex procedures. This narrative review summarized the available evidence on the use of simulators in IRT training, highlighting their impact on proficiency, engagement, and self-confidence as well as their benefits for medical physicists and radiation therapists. A systematic search was conducted in PubMed, resulting in inclusion of 10 papers published since 2009, with 5 of them published since 2020. Publications originated from centers in USA, Ireland, Switzerland, Canada, and Japan, covering a range of IRT settings, including general, prostate, and cervical IRT. The review demonstrated that simulators provide a controlled and realistic environment for skill acquisition, allowing healthcare professionals to practice procedures, optimize image quality, and enhance technical proficiency. The use of simulators addressed the barriers associated with limited caseload and procedural complexity, ultimately contributing to improved education and IRT training. While cost considerations may exist, simulators offer long-term cost-effective solutions, balancing the potential benefits in improving educational outcomes and patient care. Overall, simulators play a crucial role in IRT training, enhancing the skills and competence of healthcare providers and improving access to quality IRT care worldwide. Future research should focus on evaluating the long-term impact of simulation-based training on clinical outcomes and patient satisfaction, exploring different simulation models and training approaches, and addressing region-specific barriers to optimize the utilization of IRT.
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Affiliation(s)
- Martina Ferioli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
| | - Federica Medici
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Erika Galietta
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ludovica Forlani
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Tagliaferri
- Gemelli ART (Advanced Radiation Therapy) – Interventional Oncology Center (IOC), Fondazione Policlinico Universitario «Agostino Gemelli» IRCCS, Rome, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Silvia Cammelli
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum – Bologna University, Bologna, Italy
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Underutilization of brachytherapy for cervical cancer in the United States. Brachytherapy 2023; 22:15-20. [PMID: 36504160 DOI: 10.1016/j.brachy.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
Brachytherapy is a critical component of the definitive management of cervical cancer and allows for the safe delivery of about half of the total effective radiation dose needed for optimal outcomes. Moreover, the dose distribution of brachytherapy is highly conformal, allowing for a therapeutic index currently unmatched by alternative techniques. However, a modern brachytherapy program requires special equipment, infrastructure, and procedural expertise. Unfortunately, multiple lines of evidence suggest that brachytherapy is currently underutilized in the United States. In this review, we examine the importance of brachytherapy, contemporary recommendations, and avenues for growth.
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Artamonova N, Sukhina O, Pavlichenko Y. Current status of cervical cancer brachytherapy technologies: scientometric analysis. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.3.2022.41-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Brachytherapy is an important component of cervical cancer (CC) treatment paradigm, so scientometric studies in this area are very relevant.
Purpose – to assess the current state and development trends of cervical cancer brachytherapy te
chnologies through a scientometric analysis of scientific publications.
Materials and methods. Uses the scientometric method of document analysis. The analysis was carried out using the Scopus digital resource for the period 2012–2022. Evaluation of the found documents was carried out according to the following indicators: dynamics of publications, country, author of the publication, publication institution, source and sponsor who financed the work.
Results. Based on the results of the study, 694 documents were found, the distribution of which determines the growth of publications in 2016 (71 documents), 2018 (84 documents), and 2021 (86 documents). The distribution by country made it possible to establish the United States as the leader, followed by India, Japan, France, China. Over the past 5 years, China has moved from fifth place to second, which it shares with India. Among the institutions involved in the development of cervical cancer brachytherapy technologies, Med. University Wien, Austria, Tata Memorial Hospital, India, Institut de Cacy Cackologie Gustave Roussy, France. The most active scientists were singled out: Pötter R., Haie-Meder C., Mahantshetty U., and Tanderup K. Mahantshetty U., Tanderup K. International scientific communications of scientists have been established to address issues of improving the methods of gynecological brachytherapy, in particular cervical cancer, as well as active sponsors. The main scientific sources on the subject of cervical cancer brachytherapy are the journal «Brachytherapy».
Conclusion. An assessment of the current state and development trends of cervical cancer brachytherapy technologies is given, leading countries, organizations, and scientists involved in the development of new most effective brachytherapy technologies are identified, 20 most cited publications and 5 most cited scientists involved in the development of cervical cancer brachytherapy issues are revealed.
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Bentahila R, Rassy E, Achkar S, Sacino F, Bougas S, Vallard A, Vinh-Hung V, Encaoua J, Gustin P, Mengue S, Pautier P, Morice P, Gouy S, Espenel S, Deutsch E, Chargari C. Providing Patients with Locally Advanced Cervical Cancer Access to Brachytherapy: Experience from a Referral Network for Women Treated in Overseas France. Cancers (Basel) 2022; 14:cancers14122935. [PMID: 35740601 PMCID: PMC9221527 DOI: 10.3390/cancers14122935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/22/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
Image-guided adaptive brachytherapy (IGABT) is part of the standard of care for locally advanced cervical cancer (LACC). Access to IGABT is limited in many regions, thus leading to treatment care disparities. We report the experience of a referral network for women with LACC between radiotherapy facilities in Overseas France and Gustave Roussy. This is a retrospective review of patients with LACC referred to Gustave Roussy, for pulsed-dose-rate (PDR) image-guided adaptive BT after initial radiation therapy in the French overseas between 2014 and 2021. Sixty-four patients were eligible to receive IGABT. Overall treatment time (OTT) was 60.5 days (IQR: 51−68.5). The median follow-up time was 17 months. At two years, estimated probabilities of LC, progression-free survival, and overall survival (OS) were 94.6% (95% CI: 88.9−100.0%), 72.7% (95% CI: 61.1−86.5%), and 82.5% (95% CI: 72.0−94.5%). In multivariable analysis, a D90CTVHR < 85GyEQD2 and a CTVHR volume > 40 cm3 were significant for poorer PFS (p = 0.001 and p = 0.009, respectively) and poorer OS (p = 0.004 and p = 0.004). The centralization of this advanced technique to expert centers requires a well-defined workflow and appropriate dimensioning of resources to minimize OTT.
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Affiliation(s)
- Rita Bentahila
- Radiation Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (R.B.); (S.A.); (S.E.); (E.D.)
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (E.R.); (P.P.)
| | - Samir Achkar
- Radiation Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (R.B.); (S.A.); (S.E.); (E.D.)
| | - Florence Sacino
- Radiotherapy Department, University Hospital of Guadeloupe, 97159 Pointe-à-Pitre, France;
| | - Stefanos Bougas
- Radiotherapy Department, University Hospital of Martinique, 97200 Fort-de-France, France; (S.B.); (A.V.); (V.V.-H.)
| | - Alexis Vallard
- Radiotherapy Department, University Hospital of Martinique, 97200 Fort-de-France, France; (S.B.); (A.V.); (V.V.-H.)
| | - Vincent Vinh-Hung
- Radiotherapy Department, University Hospital of Martinique, 97200 Fort-de-France, France; (S.B.); (A.V.); (V.V.-H.)
| | - Johan Encaoua
- Radiotherapy Department, University Hospital of Reunion Island, 97744 Saint-Denis, France;
| | - Pierre Gustin
- Radiotherapy Department, Hospital Polynésie Française, 98714 Papeete, France; (P.G.); (S.M.)
| | - Sylvie Mengue
- Radiotherapy Department, Hospital Polynésie Française, 98714 Papeete, France; (P.G.); (S.M.)
| | - Patricia Pautier
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (E.R.); (P.P.)
| | - Philippe Morice
- Surgical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.M.); (S.G.)
| | - Sébastien Gouy
- Surgical Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (P.M.); (S.G.)
| | - Sophie Espenel
- Radiation Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (R.B.); (S.A.); (S.E.); (E.D.)
| | - Eric Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (R.B.); (S.A.); (S.E.); (E.D.)
| | - Cyrus Chargari
- Radiation Oncology Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France; (R.B.); (S.A.); (S.E.); (E.D.)
- Correspondence:
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