FEASIBILITY AND ACCEPTANCE OF INTERSTITIAL BRACHYTHERAPY FOR GYNECOLOGICAL

FEASIBILITY AND ACCEPTANCE OF INTERSTITIAL BRACHYTHERAPY FOR GYNECOLOGICAL MALIGNANCIES IN CANCER CENTERS [INDIA]- A SURVEY Dr. Kanhu Charan Patro Consultant- Radiation Oncology MAHATMA GANDHI CANCER HOSPITAL VISAKHAPATNAM Mr. E. B. Rajmohon CHIEF PHYSICYST MAHATMA GANDHI CANCER HOSPITAL VISAKHAPATNAM

BACKGROUND Cancer Cervix is very common in our country. EBRT followed by intracavitray brachytherapy is the evidence based standard of care. Some cases are not suitable for intracavitray brachytherapy and left as such or unnecessary surgeries and chemotherapy treatment is given without any proper result and evidence. Interstitial brachytherapy is other mode of treatment to unsuitable cases

OUR HOSPITAL DATA PERIOD TOTAL CERVIX TOTAL CASES ICRT RECEIVED EBRT TOTAL MUPIT MAY 2011 -MAY 2012 [1 YEAR] 438 358 0 JUNE 2012 -DEC. 2012 [6 MONTH] 268 218 32 [12%] 3

OBJECTIVE To find out the barriers to practice interstial brachytherapy [A well explained established simple procedure] in cancer centers in India 4

MATERIAL & METHOD Done through telephonic conversation Around 100 brachytherapy practicing centers in major metro cities and some other cities of India. Proper data available from 50 centres Practicing Vs. not practicing If not practicing then the cause under following headings Availability of applicator/planning system Awareness More Cost More Time Casual Non availability of Expertise 5

RESULT 6

PROCEDURE CARRIED OUT

Awareness-15 8

TIME CONSTRAINT-14 9

AVAILABILITY EXPERTISE-15 10

COST ISSUE-10 11

NON AVAILABILITY OF RESOURCES-8 12

CASUAL-5 13

Non practicing issues-28 TIME-14 AWARENESS COST-10 -25 NON AVAILABILITY CASUAL 5 8 AVAILABILITY EXPERTISE 13

REVIEW LITERTURE/DISCUSSION This is the first and unique survey of its kind. We have searched the pubmed, medscape etc. not exact study found but some of data found in related article 15

Nag et. al-IJROBP-1998 1. Bulky parametrial extension; 2. Extensive paravaginal or distal vaginal involvement; 3. Narrow vagina or poor geometry not accommodating an ovoid (colpostat application) 4. Endocervical canal not allowing a tandem placement 5. Prior radiation therapy to the implanted area 16

Nag et. al Interstitial brachytherapy can be safely used to treat patients unsuitable for standard intracavitary brachytherapy. When intracavitary dose distribution is expected to be suboptimal, interstitial brachytherapy is a good alternative Gynecologic – 32 Oncology, Volume 70, Issue 1, July 1998, Pages 27

TIME TAKEN AT OUR CENTRE DOCTOR APPLICATION TIME [MIN] PLANNING TIME[MIN] [AVG] DELIVERY TIME[MIN] [AVG] TOTAL TIME [MIN] A 25 30 30 85 B 35 30 30 95 C 30 30 30 90 18

WEAKNESS OF MY SURVEY VERBAL BIAS NOT ANALYSED STATISTICALLY. SAMPLE SIZE IS LESS. DATA NOT TAKEN FROM ALL BRACHY CENTERS. 19

Conclusion It gives best alternative when not suitable for ICRT. The procedure is safe and can be practiced in all outlaying hospitals. Cost and time consumption is not much more than all other radiation procedures. Where ICRT facility available they should upgrade the set up with this facility. 20

LET’S PRACTICE BRACHYTHERAPY 21

ACKNOWLEDGEMENT DR. UMESH MAHANSETTY DR VOONA MURALIKRISHNA MY ASOOCIATE STAFF MY PATIENTS MY HOSPITAL 22

Long way to go THANKS 23