Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country

Background: The purpose of this study is to detail the implementation of HDR brachytherapy at the only radiotherapy center in Nicaragua. Methods: Patients are treated with external-beam radiotherapy to 46–50Gy at 2Gy/fraction to the pelvis. A gynecologic examination is performed weekly. Once the cer...

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Autores principales:	Sommer R. Nurkic, Ana Isabel Ocampo, Mario Josè Pinell Gadea, Julie Greenwalt, Mario Jose Vicente, Anielka Lucia Velasquez, Lisbeth Concepcion Lopez Peralta, Franck Soto Herrera, Osmara Calero Romero, Francisco Lopez Tenorio, Harving Lorente Zamora, Luis Matamoros Munguia, Anamaria Yeung
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2018
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/ac3b3a22ed7d4c4ea0c934dbe3566683
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spelling	oai:doaj.org-article:ac3b3a22ed7d4c4ea0c934dbe35666832021-12-02T04:31:54ZImplementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country2214-999610.29024/aogh.2377https://doaj.org/article/ac3b3a22ed7d4c4ea0c934dbe35666832018-11-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2377https://doaj.org/toc/2214-9996Background: The purpose of this study is to detail the implementation of HDR brachytherapy at the only radiotherapy center in Nicaragua. Methods: Patients are treated with external-beam radiotherapy to 46–50Gy at 2Gy/fraction to the pelvis. A gynecologic examination is performed weekly. Once the cervical os is visualized, brachytherapy is initiated. HDR is delivered in four fractions of 7Gy twice weekly. HDR occurs in two phases: preparation and delivery. Treatment preparation occurs in the procedure room, which includes anesthization, cervical dilation, and brachytherapy applicator placement using fixed-geometry tandem and ring with a rectal blade. The applicator is immobilized and the patient transferred to a stretcher and transported to the treatment delivery room. HDR is performed with the patient on the stretcher to minimize motion. AP and lateral films are taken using portable equipment. Physics staff digitize Point A, rectal point, and bladder point. A standard plan is loaded and approved prescribing 7Gy to Point A. If dose to the rectal or bladder points exceeds the constraint, the applicator is adjusted or vaginal packing is added and films repeated. Results: Nearly 10 years after implementing the HDR program, the center is treating 11–15 women with HDR brachytherapy for cervix cancer daily. Because the procedure is carried out over two separate rooms, patients can be staggered and more treated daily. The rooms turn over every 45 minutes. Conclusions: HDR brachytherapy for cervix cancer has been successfully established in Nicaragua. Significant challenges remain, and there is a role for developed countries to collaborate.Sommer R. NurkicAna Isabel OcampoMario Josè Pinell GadeaJulie GreenwaltMario Jose VicenteAnielka Lucia VelasquezLisbeth Concepcion Lopez PeraltaFranck Soto HerreraOsmara Calero RomeroFrancisco Lopez TenorioHarving Lorente ZamoraLuis Matamoros MunguiaAnamaria YeungUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 84, Iss 4, Pp 679-682 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Sommer R. Nurkic Ana Isabel Ocampo Mario Josè Pinell Gadea Julie Greenwalt Mario Jose Vicente Anielka Lucia Velasquez Lisbeth Concepcion Lopez Peralta Franck Soto Herrera Osmara Calero Romero Francisco Lopez Tenorio Harving Lorente Zamora Luis Matamoros Munguia Anamaria Yeung Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
description	Background: The purpose of this study is to detail the implementation of HDR brachytherapy at the only radiotherapy center in Nicaragua. Methods: Patients are treated with external-beam radiotherapy to 46–50Gy at 2Gy/fraction to the pelvis. A gynecologic examination is performed weekly. Once the cervical os is visualized, brachytherapy is initiated. HDR is delivered in four fractions of 7Gy twice weekly. HDR occurs in two phases: preparation and delivery. Treatment preparation occurs in the procedure room, which includes anesthization, cervical dilation, and brachytherapy applicator placement using fixed-geometry tandem and ring with a rectal blade. The applicator is immobilized and the patient transferred to a stretcher and transported to the treatment delivery room. HDR is performed with the patient on the stretcher to minimize motion. AP and lateral films are taken using portable equipment. Physics staff digitize Point A, rectal point, and bladder point. A standard plan is loaded and approved prescribing 7Gy to Point A. If dose to the rectal or bladder points exceeds the constraint, the applicator is adjusted or vaginal packing is added and films repeated. Results: Nearly 10 years after implementing the HDR program, the center is treating 11–15 women with HDR brachytherapy for cervix cancer daily. Because the procedure is carried out over two separate rooms, patients can be staggered and more treated daily. The rooms turn over every 45 minutes. Conclusions: HDR brachytherapy for cervix cancer has been successfully established in Nicaragua. Significant challenges remain, and there is a role for developed countries to collaborate.
format	article
author	Sommer R. Nurkic Ana Isabel Ocampo Mario Josè Pinell Gadea Julie Greenwalt Mario Jose Vicente Anielka Lucia Velasquez Lisbeth Concepcion Lopez Peralta Franck Soto Herrera Osmara Calero Romero Francisco Lopez Tenorio Harving Lorente Zamora Luis Matamoros Munguia Anamaria Yeung
author_facet	Sommer R. Nurkic Ana Isabel Ocampo Mario Josè Pinell Gadea Julie Greenwalt Mario Jose Vicente Anielka Lucia Velasquez Lisbeth Concepcion Lopez Peralta Franck Soto Herrera Osmara Calero Romero Francisco Lopez Tenorio Harving Lorente Zamora Luis Matamoros Munguia Anamaria Yeung
author_sort	Sommer R. Nurkic
title	Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
title_short	Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
title_full	Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
title_fullStr	Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
title_full_unstemmed	Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country
title_sort	implementation of high dose-rate brachytherapy for cervix cancer in a low-income country
publisher	Ubiquity Press
publishDate	2018
url	https://doaj.org/article/ac3b3a22ed7d4c4ea0c934dbe3566683
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Implementation of High Dose-rate Brachytherapy for Cervix Cancer in a Low-income Country

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