Aarhus hospital pioneers image-guided brachytherapy for gynaecological
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
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
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.”
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
Aarhus University Hospital expects to publish data on their
program within the next two to three years.