Gynecology brachytherapy An indispensible part of radiation therapy

Why brachytherapy for GYN?

ESMO and ABS recommend the use of brachytherapy as an essential component of the definitive treatment of locally advanced cervical cancer (LACC) – <sup>1, 2</sup>

* Expand references and footnotes

  • Gynaecological (GYN) GEC-ESTRO recommendations I-IV have been used as a framework for 3D imaging based 3D treatment planning approach to brachytherapy of cervical cancer – 3-6

 

 

 

1. C Marth et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Annals of Oncology 28 (Supplement 4): iv72–iv83, 2017.
2. AN Viswanathan et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy. Brachytherapy. 2012 Jan-Feb;11(1):47-52
3. C Haie-Meder 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 Mar;74(3):235-45.

 

 

 

 

  • Image guided adaptive brachytherapy (IGABT) combined with radiochemotherapy leads to improved local and regional control and survival rates compared to 2D brachytherapy in LACC. In parallel with improving disease outcome, IGABT has shown reduction of treatment-related morbidity – 7, 8

4. R Poetter at al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol. 2006 Jan;78(1):67-77.
5. TP Hellebust et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radiother Oncol. 2010 Aug;96(2):153-60.
6. JC Dimopoulos et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol. 2012 Apr;103(1):113-22.

  • Combined intracavitary and interstitial brachytherapy improves the local control in large LACC tumors without adding treatment-related late morbidity – 9

 

 

 

 

7. R Poetter et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018 Jan 11;9:48-60.
8. C Charra-Brunaud et al. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: results of the French STIC prospective study. Radiother Oncol. 2012 Jun;103(3):305-13.
9. L Fokdal et al. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol. 2016 Sep;120(3):434-440.

 

 

 

 

Ensuring a smooth clinical workflow

Connectivity to MOSAIQ® OIS

Confidence for you and your patients


  • Contributes to paperless brachytherapy workflow information
  • Automated scheduling and billing process
  • Documented dose and structure sets
  • Automatically exchange treatment plans created with Oncentra Brachy and treatment records generated by the afterloader
  • Perform dose tracking based on the treatment plan and treatment record for the selected and verified patient
  • Provide a more efficient and electronic way to capture information that will be included in the patient’s Continuity of Care Document (CCD), data as required for meaningful use (Stage 1 and beyond)

Applicator selection

Diagnostic imaging guides the applicator choice


Gynecological brachytherapy applicators

Broadest range of CT/MR compatible applicators

Our wide array of applicators for gynecological brachytherapy are available for many applications, ranging from intracavitary to interstitial use and designed to deliver increasingly more precise doses in gynecologic brachytherapy.

“With Venezia, I expect to treat advanced cervical cancer patients with more ease. Venezia will allow me to reach tumors extended to the parametrium because I can position needles at multiple angles, in the vagina and through the perineum.”
Petch Alisanant, MD
Division of Radiation Oncology
Chulalongkorn University
Bangkok, Thailand

A short selection of our gynecological applicators


Tandem & ovoid applicators

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Utrecht interstitial CT/MR applicator

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Fletcher CT/MR applicator

Tandem & ring applicators

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Venezia advanced gynecological applicator

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Ring CT/MR applicator

Vagina and endometrium

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Vaginal CT/MR multi-channel applicator

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Rotte applicator set

Applicator insertion

An applicator for every treatment choice and clinical set-up


Venezia™

Advanced Gynecological Applicator
A new option for treating advanced stage cervical cancer

Elekta's new Advanced Gynecological Applicator, Venezia, is a new applicator system that  will enable clinicians to easily reach the cervix, parametrium and vaginal extensions in stage IIIA and IIIB tumors. This area has been difficult to reach with current brachytherapy techniques. Venezia enables physicians to treat advanced cervical disease with interstitial brachytherapy in a pre-defined and reproducible way, ensuring optimal dose distribution for the majority of patients. Because of the one-click system Venezia is easy to insert and assemble, eliminating the need for screws or tools.

The combination of Flexitron® treatment delivery and Oncentra Brachy® treatment planning with Venezia provides a truly integrated brachytherapy solution.

Imaging

Determine applicator position relative to tumor and OaR


2D X-ray imaging (in OR) Manchester system (Point A)
2D X-ray imaging (in OR) Manchester system (Point A)

 

 

MR imaging
MR imaging
“The best case scenario is where you have the availability of ultrasound so that you can actually control the depth of the needles in real time as you’re placing them.”
Dr. Biagioli
Florida Hospital, US

 

 

CT imaging
CT imaging

Treatment planning

Homogeneous dose delivery on the target while sparing the OaR


Oncentra Brachy

Comprehensive treatment planning software

Designing the optimal dose distribution can be a time-consuming job. The latest version of Oncentra Brachy offers a series of useful tools that simplify many repetitive tasks, such as contouring and reconstruction. Oncentra Brachy buys you time to focus on what counts: creating the optimal dose distribution.

Oncentra Brachy also helps you optimize treatment plan accuracy, providing easy navigation to any plane that offers the most relevant information per region of interest. Template solutions for repetitive tasks, such as the new Implant Modeling tool and the popular Applicator Modeling feature, help reduce implant reconstruction time. DVH presets and the ROI Catalog Manager can help improve accuracy and reproducibility. Powerful inverse planning optimization automates volume-based planning, making the process fast and efficient.


Reduce implant reconstruction time

  • Instant applicator reconstruction in relation to anatomy
  • Contains the complete geometry of Elekta’s gynecological applicators
  • Includes the measured source paths of ring applicators
  • Accounts for dose attenuation resulting from shielding during planning and shields are fully visible

Dose distribution calculated by ACE

  • Algorithm based on the TG-186 recommendations published by the AAPM workgroup in 2012
  • Algorithm based on the TG-186 recommendations published by the AAPM workgroup in 2012
  • Discriminates between tissue, air and bone
  • Accounts for tissue heterogeneities, lack of backscatter from areas with no tissue, applicator attenuation and shielding

Implant modeling tool

  • Reconstruct multicatheter implants immediately
  • Drag & Drop 3D applicator geometry for accurate and fast reconstruction
  • Extra Coordinate System (ECS) allows quick and easy navigation to the correct plane views

Automatic dose optimization

IPSA

  • Paired with the Dwell Time Deviation Constraint (DTDC)
  • Limits high variation in dwell times

HIPO

  • Improves plan optimization with Dwell Time Gradient Restriction (DTGR)
  • Control high and low peaks in dwell times
  • Focus optimization where it is needed with needle locking

Treatment delivery

Safe, simple, intuitive brachytherapy workflow


Five simple features are the basis for the Flexitron way of working, introducing a new standard in treatment delivery

  • Standardized transfer lengths, less prone to human errors during reconstruction as there is only one indexer length.
  • Reference zero at entrance of applicator, no need to measure the distal tip.
  • Metric dwell position numbering, 1 mm step size in a treatment window of 400 mm.
  • Forward stepping results in a reproducible source positioning within 0,5mm accuracy
  • Intuitive user interface, smooth navigation saves time.

Why Flexitron?

  • Simple quality assurance
  • 40-channel option for large implants
  • Connected to major oncology systems such as MOSAIQ®
  • Safe investment with future upgrade potential
  • Available in either Iridium-192 or Cobalt-60*

* Not available in all countries.

Patient out

Find out about brachytherapy for other body regions


 
human-body-figure H e a d a n d n e c k B r e a s t Gyn e c ol o g y B r on c h u s a n d e sop h a g u s S k i n B l add e r P r o s t a t e R e c t u m
 

What our customers say

Spencer Thompson, MD at University of Oklahoma, on Gynecological Brachytherapy

Spencer Thompson, MD at University of Oklahoma, on Gynecological Brachytherapy

Sabhakar Mutyala, MD at University of Arizona, on Gynecological Brachytherapy

Sabhakar Mutyala, MD at University of Arizona, on Gynecological Brachytherapy

 

BrachyAcademy

Empowering through education


Peer-to-peer education platform for brachytherapy professionals

The BrachyAcademy comprises a complete peer-to-peer medical education library and includes programs such as clinical workshops and training visits to leading hospitals worldwide.

 

About Brachytherapy

Elekta also offers the only online brachytherapy portal for patients including awareness materials:

Elekta Care™



Elekta Care supports you from startup through your product's lifecycle with comprehensive options from education, training and upgrades to solutions allowing you the highest uptime and improved operational efficiency.

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