Page 49 - ARNM-2-4

Advances in Radiotherapy
& Nuclear Medicine Outcomes of durations in 2D and 3D BT for CCA

increased incidence of these symptoms, irrespective of groups (35 – 42 days, 9%; 43 – 49 days, 9%; and 50 –
the brachytherapy technique chosen. 62 days, 42%; P = 0.001). Vitzthum et al. also emphasized
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Since the 1990s, studies have compared the combined the importance of rational treatment scheduling, patient
use of brachytherapy and EBRT with EBRT alone for education, and organized radiochemotherapy to maintain
treating cervical cancer. The findings have demonstrated the treatment duration within 56 days and mitigate the
a significant improvement in survival rates and enhanced risk of reduced local control rates that are associated with
local control with the combined use of brachytherapy treatment prolongation.
and EBRT compared with EBRT alone. Subsequent Subsequent studies have explored strategies to reduce
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studies have further validated these findings. Despite the total radiotherapy duration and shorten the waiting
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the advancements in radiation therapy techniques, times for radiotherapy. Vijayakumar et al. proposed that
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innovations in EBRT cannot fully replace the pivotal role patient compliance and education can effectively reduce
of brachytherapy in treating cervical cancer. 12-14 With the the total radiotherapy time. Their study analyzed two
rapid advancement and widespread adoption of 3D image- groups, those treated within 60 days (32.1%) and those
guided brachytherapy (3D-IGABT) in recent years, the treated for >60 days (67.9%). The median radiotherapy
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limitations of traditional 2D brachytherapy have become duration was 68 (51 – 106) days. The authors argued that
increasingly apparent. Studies have demonstrated that reducing radiotherapy duration may impact the local/
3D-IGABT allows for more precise distribution of regional control, DFS, and OS. Furthermore, it can reduce
doses to the clinical target volume and organs at risk, patients’ financial and time burden in regions with limited
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offering significant advantages over the dose distribution healthcare resources. In economically disadvantaged
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achieved with 2D brachytherapy. Similar studies areas, reducing the radiotherapy duration can improve
have demonstrated that the overall long-term toxicity compliance, enhance treatment efficiency in healthcare
associated with 3D-IGABT is lower than that associated facilities, reduce wait times for radiotherapy, and decrease
with 2D brachytherapy during the treatment of locally the probability of disease progression or death during the
advanced cervical cancer. The total number of cases of late waiting period. Dereje et al. proposed that prolonged
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treatment-related toxic reactions and the severity of these waiting times may lead to patient deaths during the waiting
reactions are significantly lower with 3D brachytherapy period. Patients who are administered radiotherapy within
than with 2D brachytherapy. Thus, 3D brachytherapy 60 days of the initial diagnosis are three times less likely
can markedly improve treatment efficacy while reducing to exhibit tumor progression than those who have to wait
toxicity levels. 18-20 for >4 months before starting treatment. Nascimento
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Previous studies have demonstrated that the et al. also demonstrated that waiting for radiotherapy for
radiotherapy duration for patients with cervical cancer >64 days increases the 5-year OS risk.
should be limited to 56 days. In the 1990s, Fyles et al. With the rapid advancements in radiotherapeutic
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demonstrated that a treatment duration of >30 days technology and the widespread availability of radiotherapy
decreased the daily control rate by approximately 1%. equipment, previously studied issues such as dose delivery,
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Similarly, Girinsky et al. demonstrated that radiotherapy adverse effects, and local control of radiotherapy should
administration for >52 days in cervical cancer decreased be reconsidered. Recent studies have primarily focused on
both the local control and OS rates by approximately aspects such as dose distribution and precision in the
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1% per day. Lanciano et al. demonstrated a significant comparison of 3D brachytherapy with 2D brachytherapy.
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decrease in survival rates (P = 0.0001) and pelvic control Till date, no study has evaluated whether treatment
rates (P = 0.0001) with increasing treatment durations that prolongation affects the treatment outcomes of patients
were categorized as <6 weeks, 6 – 8 weeks, 8 – 10 weeks, with cervical cancer who are being treated with different
and >10 weeks. Treatment prolongation was significantly brachytherapy modalities (3D vs. 2D). This study’s
associated with grade III AEs and intrapelvic recurrence. findings indicate that when IMRT is combined with 3D
Based on the aforementioned findings, Chatani et al. brachytherapy, the total treatment duration does not
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proposed that prolongation of treatment adversely impacts significant impact the prognosis. Further studies on this
local control and survival in patients with cervical cancer. topic may provide valuable insights into the evolving
The multivariate analysis in their study revealed that the landscape of cervical cancer treatment and the role of
total treatment duration is the most significant factor different treatment modalities.
affecting local control rates (P = 0.0005). Furthermore, It is essential to consider the combination of
significant differences in the 5-year cumulative recurrence radiotherapy with other treatment modalities. For
rates were observed among different treatment time example, the use of hyperthermia in conjunction with

Volume 2 Issue 4 (2024) 9 doi: 10.36922/arnm.4310