Aarhus hospital pioneers image-guided brachytherapy for gynaecological cancers

6 December 2006

Aarhus, Denmark. Aarhus University Hospital, Denmark, is pioneering the use of image-guided brachytherapy (IGBT) with the aim to improve treatments and outcomes for gynaecological cancers. The hospital’s leading radiotherapy centre is able to treat patients more precisely with higher, more effective radiation doses using technology from Varian Medical Systems of Palo Alto, California.

Aarhus University Hospital is one of the first cancer centres in Europe aiming to deliver higher, more effective doses and reduce unwanted side effects using image-guided brachytherapy (IGBT). The new technique enables doctors to acquire better patient images needed for planning and delivering brachytherapy treatments for their patients.

A study of the first 14 patients treated by this technique, presented at the ESTRO meeting in Germany in October , showed that optimisation using high quality MRI scans and the planning capabilities of Varian’s BrachyVision treatment planning system significantly improved the brachytherapy treatments.

According to radiation oncologist Dr. Jacob Lindegaard, the challenge in gynaecological treatments is to get sufficient dose to the tumour while avoiding the surrounding normal anatomy. “Without image-guidance we were unable to see and plan treatment that protected healthy anatomy as much as we wanted to,” he explains. “With image guidance we have a powerful new tool that enables us to precisely deliver the dose from brachytherapy in the tumour while avoiding the bladder, rectum and intestines.”

Aarhus University Hospital is carrying out the pioneering work as part of a European network of cancer centres led by the Medical University of Vienna. The objective at Aarhus is to reduce the cervical cancer recurrence rate and decrease severe complications by 50 percent.

Standard gynaecological cancer treatments at Aarhus involve a combination of brachytherapy and external beam radiotherapy. A total dose of 30 Gy is delivered in three 10 Gy fractions using a GammaMed Plus PDR (pulse dose rate) afterloader, a computer-controlled device that automatically inserts the radioactive source. The other 50 Gy is delivered using external beam treatments on Varian linear accelerators.

The use of MRI-compatible applicators is crucial to the Aarhus technique, and Varian has developed a new titanium applicator as a more rigid alternative to existing plastic versions. Such applicators are needed for more precise brachytherapy treatments because they are rigid and do not flex or move, offering a more reproducible and accurate setup.

“Using these applicators we can do the MRI scan with the applicator in place for each fraction of brachytherapy, and we are far more confident that nothing will disturb its position during planning and treatment,” adds Dr. Lindegaard.

The GEC-ESTRO and American Brachytherapy Society groups have recently made recommendations on the use of 3D image-based treatment planning in gynaecological brachytherapy. Applicators compatible with both CT and MR imaging modalities are essential for IBGT.

Aarhus University Hospital expects to publish data on their program within the next two to three years.

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