GHP Q4 2018

24 GHP / Q4 2018 , The American Brachytherapy Society (ABS) supports the continued utilization of HDR GYN Brachytherapy in the curative treatment of non-operable, locally advanced cervical cancer. Cervical Cancer Treatment: Cure Is Possible If Patients Receive Brachytherapy Patients with non- operable, locally advanced cervical cancer have some of the highest cure rates compared to other advanced cancers, but only if HDR GYN Brachytherapy is a part of their treatment. Despite Pap smear screening and HPV (human papillomavirus) vaccinations, 13,000 women will be diagnosed and unfortunately, 4,000 women will die of cervical cancer in 2018.1 While the majority of patients with early stages of cervical cancer are cured with surgery, those with advanced stages are still curable when High Dose Rate (HDR) Brachytherapy is used in combination with daily pelvic External Beam Radiation Therapy (EBRT) and chemotherapy. EBRT is the delivery of high-powered x-rays targeting the cervix and lymph nodes, in combination with weekly chemotherapy which enhances the effectiveness of radiation. HDR Brachytherapy is a radiation treatment that involves the temporary placement of a radioactive material inside the body, in or near a tumor, for a specific amount of time. In HDR Brachytherapy, a high dose of radiation is delivered to the tumor in a short burst, lasting only a few minutes. HDR GYN Brachytherapy is a treatment that delivers higher doses of radiation to the cervical cancer while minimizing the radiation exposure to nearby tissues, such as the bladder and rectum. HDR GYN Brachytherapy is used to “boost” the radiation dose to the cervical cancer following pelvic external beam radiation therapy treatments. Other treatment options that do not include HDR GYN Brachytherapy, such as using alternative types of external beam radiation, are not as successful as brachytherapy for curing non-operable, locally advance cervical cancer. The use of HDR GYN Brachytherapy is critical in the successful treatment of non- operable, locally advanced cervical cancer and has been used for over a century.2 The addition of HDR GYN Brachytherapy to external beam radiotherapy increases the treatment efficacy and is directly linked to enhanced tumor control and improved survival. A noteworthy study of over 7,000 patients with non-operable, locally advanced cervical cancer treated with radiation therapy between 1988 to 2009 found that patients who received HDR GYN Brachytherapy as part of their cancer treatment had higher rates of survival than patients who received external beam radiation alone. At 4 years after treatment, the survival rate was 12% higher in patients receiving brachytherapy.3 Furthermore, researchers reported the results of a large patient study of non-operable, locally advanced cervical cancer patients treated in the United States between 2004 to 2011, who sought to evaluate the impact that different types of “boost” radiation (the treatment that follows the initial pelvic external beam radiation) have on treatment outcomes. The researchers found better cure rates in patients treated with HDR GYN Brachytherapy compared to other types of “boost” radiation therapy and concluded that HDR GYN Brachytherapy remains a critical treatment component for non-operable, locally advanced cervical cancer.4 Unfortunately, there has been a decline in the use of HDR GYN Brachytherapy in the treatment of cervical cancer in the United States, with a prior survey showing over one-third of patients do not receive brachytherapy.3 Therefore, women with cervical cancer, who are not surgical candidates, need to be seen and evaluated by a radiation oncologist who has an expertise in HDR GYN Brachytherapy in order to maximize cure rates and survival. Daniel G. Petereit, MD, President-Elect of the American Brachytherapy Society and Medical Director of Cancer Disparities, Rapid City Regional Hospital, Rapid City, SD, commented: “The general public needs to be aware of the much higher cure rates when HDR GYN Brachytherapy is used in the treatment of non-operable, locally advanced cervical cancer. It is our hope that all patients with advanced cervical cancer will be seen by a radiation oncologist who has an expertise in brachytherapy.” To ensure that patients and providers learn about and have access to all treatment options, the American Brachytherapy Society has been instrumental in promoting and supporting the continued incorporation of HDR GYN Brachytherapy in the curative approach to treating non-operable, locally advanced cervical cancer. To assist radiation oncologists, the ABS has published a three-part series of HDR GYN Brachytherapy guidelines for locally advanced carcinoma of the cervix.5 Kristin Bradley, MD, Director of Gynecologic Radiation Oncology and Radiation Oncology Residency Program Director, Department of Human Oncology, University of Wisconsin, notes, “It is critical that women diagnosed with locally advanced cervical cancer be informed of their treatment options and understand that the incorporation of HDR GYN Brachytherapy results in improved disease control and survival. To maximize the likelihood of curing a locally advanced cervical cancer, providers not comfortable with performing image guided brachytherapy should refer patients to those specializing in HDR GYN Brachytherapy.” Knowledge is Power. For more information regarding HDR GYN Brachytherapy, please visit: https:// www.americanbrachytherapy.org/ resources/cervical-brachy/