International brachytherapy practice patterns: a survey of the Gynecologic Cancer Intergroup (GCIG).

TitleInternational brachytherapy practice patterns: a survey of the Gynecologic Cancer Intergroup (GCIG).
Publication TypeJournal Article
Year of Publication2012
AuthorsViswanathan, A, Creutzberg, CL, Craighead, P, McCormack, M, Toita, T, Narayan, K, Reed, NSimon, Long, HJ, Kim, H-J, Marth, C, Lindegaard, JC, Cerrotta, A, Small, W, Trimble, EL
JournalInt J Radiat Oncol Biol Phys
Date Published2012 Jan 1
KeywordsAustralia, Brachytherapy, Dose Fractionation, Europe, Female, Gynecology, Health Care Surveys, Humans, Internationality, Japan, Neoplasm Staging, New Zealand, North America, Practice Patterns, Physicians', Republic of Korea, Societies, Medical, Uterine Cervical Neoplasms

PURPOSE: To determine current practice patterns with regard to gynecologic high-dose-rate (HDR) brachytherapy among international members of the Gynecologic Cancer Intergroup (GCIG) in Japan/Korea (Asia), Australia/New Zealand (ANZ), Europe (E), and North America (NAm).METHODS AND MATERIALS: A 32-item survey was developed requesting information on brachytherapy practice patterns and standard management for Stage IB-IVA cervical cancer. The chair of each GCIG member cooperative group selected radiation oncology members to receive the survey.RESULTS: A total of 72 responses were analyzed; 61 respondents (85%) used HDR. The three most common HDR brachytherapy fractionation regimens for Stage IB-IIA patients were 6 Gy for five fractions (18%), 6 Gy for four fractions (15%), and 7 Gy for three fractions (11%); for Stage IIB-IVA patients they were 6 Gy for five fractions (19%), 7 Gy for four fractions (8%), and 7 Gy for three fractions (8%). Overall, the mean combined external-beam and brachytherapy equivalent dose (EQD2) was 81.1 (standard deviation [SD] 10.16). The mean EQD2 recommended for Stage IB-IIA patients was 78.9 Gy (SD 10.7) and for Stage IIB-IVA was 83.3 Gy (SD 11.2) (p = 0.02). By region, the mean combined EQD2 was as follows: Asia, 71.2 Gy (SD 12.65); ANZ, 81.18 (SD 4.96); E, 83.24 (SD 10.75); and NAm, 81.66 (SD, 6.05; p = 0.02 for Asia vs. other regions).The ratio of brachytherapy to total prescribed dose was significantly higher for Japan (p = 0.0002).CONCLUSION: Although fractionation patterns may vary, the overall mean doses administered for cervical cancer are similar in Australia/New Zealand, Europe, and North America, with practitioners in Japan administering a significantly lower external-beam dose but higher brachytherapy dose to the cervix. Given common goals, standardization should be possible in future clinical trials.

Alternate JournalInt. J. Radiat. Oncol. Biol. Phys.
PubMed ID21183288
PubMed Central IDPMC3489266
Grant ListK07 CA117979 / CA / NCI NIH HHS / United States