Indonesia Centre Uses 3D Computed Tomography Imaging to Guide Brachytherapy Treatment of CancerJakarta
Doctors at Dharmais National Cancer Centre apply 3D CT modeling of anatomy to better evaluate brachytherapy dose for gynecological treatments
Advanced CT imaging is giving Dharmais National Cancer Centre (DNCC) clinicians a better idea of the shape and volume of tumors and their relationship to nearby organs, improving the targeting of disease sites while minimizing the exposure to unaffected critical organs during brachytherapy treatments. Since March 2012, DNCC physicians have used 3D CT for selected patients to contour organs-at-risk (OARs) and tumors before repeated brachytherapy treatments using the latest microSelectron® Digital remote afterloader and Oncentra® Brachy Image Guided 3D Treatment Planning system, both manufactured by Nucletron, an Elekta company.
Brachytherapy, is an advanced, highly targeted cancer treatment, in which radiotherapeutic sources are placed in or near a tumor, giving a high radiation dose to the tumor while reducing the radiation exposure to surrounding healthy tissues. DNCC uses the newly acquired Nucletron high dose rate (HDR) brachytherapy system, which introduces the radiation source for a certain time using special applicators depending on the body site treated.
“We are pleased that we could transition to the new 3D based planning techniques, which will improve cancer care for patients in Indonesia,” says Dr. Defrizal, Head of the Radiation Therapy Department at DNCC. “We do hope we can continue these methods for routine clinical use, and appreciate the strong support that Nucletron team specialist and has provided us.”
Simple imaging, treatment workflow
Once the patient receives a CT scan, the 3D data set is exported to Oncentra Brachy Treatment Planning system. Physicians then use the image data to create a 3D model of the patient’s anatomy, including OARs, such as the rectum and bladder. Subsequently, clinicians and the physicist perform a 3D dose planning and evaluate the dose to the bladder and rectum according to the latest international recommendations and standards.
Until recently, doses have been reported as “points” inside these critical structures pursuant to the International Commission on Radiation Units (ICRU) 38 recommendation. The latest GEC ESTRO and American Brachytherapy Society recommendations, however, advise that cancer care providers report doses to OARs using 3D dose/volume relationships.
“The advantage of this system is that it enables us to obtain information about the dose volume histogram [DVH], which is very useful to analyze the doses to healthy tissue,” says Ms. Nuriliana, Physicist in DNCC’s Radiation Therapy Department.
A group of DNCC clinical experts received extensive training at several of the Nucletron brachytherapy training centers across Asia before adapting 3D CT guided brachytherapy into its workflow.
“Building a network of regional expertise will help other Asian hospitals adopt this new technology and provide state-of-the-art treatments to their patients,” says Ulrich Krumme, Sales and Marketing Director, Brachytherapy Far East. “This will be especially important, as technologies that have been developed in Europe will need to be adapted to local infrastructures and patient demographics. The potential clinical benefit of 3D gynecological planning and treatment over the conventional 2D approach makes it valuable for us to help hospitals with the adoption.”