Improving patient outcomes with image-guided brachytherapy for pelvic cancers

Radiotherapy is a core part of multidisciplinary cancer management, with around 40% of those cured having radiotherapy as part of or the whole of their cancer treatment. Brachytherapy (derived from the Greek word brachys meaning ‘shortdistance’) is a form of radiotherapy where a sealed radiation source is placed directly into the body. Brachytherapy has advantages over external beam radiotherapy (EBRT) in cancer treatment. Firstly, it delivers high dose radiation directly into the cancer thereby increasing the probability of local control and, secondly, the rapid fall-off in dose means that adjacent normal organs are spared, resulting in reduced toxicity. Brachytherapy is commonly used in the curative treatment of pelvic cancers with demonstrated advantages over EBRT alone.

Over the last decade the use of MR imaging has been established in the management of cancer of the cervix. Pelvic MRI provides improved staging accuracy and helps guide treatment decisions. Using MRI, brachytherapy treatment planning has evolved from being two-dimensional (2D) planar x-ray based into three-dimensional (3D) volumetric image-guided brachytherapy (IGBT). The use of MR-based IGBT for cervix cancer has resulted in improved cure rates while reducing long term toxicity. In prostate cancer, brachytherapy was introduced routinely over 20 years ago, based on ultrasound image guidance, but increasingly MR imaging is being incorporated into treatment planning to allow more focussed radiation dose boosting with the aim of increasing local control rates without increased toxicity.

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