Ultrasound-guided Brachytherapy for Cervix Cancer

Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restric...

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Bibliographic Details
Published in:Clinical oncology (Royal College of Radiologists (Great Britain)) 2021-09, Vol.33 (9), p.e403-e411
Main Authors: van Dyk, S., Khaw, P., Lin, M.-Y., Chang, D., Bernshaw, D.
Format: Article
Language:English
Subjects:
Brachytherapy
image guidance
ultrasound
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Summary:Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need. •Ultrasound is accessible, portable, affordable and provides real-time feedback.•Ultrasound accurately depicts the uterus and cervix and can be used for verification of implants throughout the procedure.•Ultrasound-guided applicator insertions improve the technical quality of implants.•Improved technical quality of implants improves local control and reduces toxicity.•Ultrasound can be used to guide planning in resource-constrained environments.
ISSN:0936-6555
1433-2981
DOI:10.1016/j.clon.2021.02.011