Intracavitary brachytherapy (ICBT) is essential in managing locally advanced cervical cancer. Brachytherapy as a modality has the advantage of a higher dose to the tumour with a dose fall off at the periphery as per the inverse square law. The dose per fraction is much higher than external beam radiotherapy. So proper application and dosimetry are of paramount importance to reduce late toxicity.

A retrospective analysis of 69 patients who underwent three ICBT applications of 7 Gray in each fraction was done. The factors under consideration were the type of pain management (spinal anaesthesia (SA) versus conscious sedation (CS)), the initial size of the disease (bulky and non-bulky) and subsequent fractions (first fraction versus third fraction). The dosimetric parameters analysed were the doses received by points A, B and P and that of the critical organs (bladder, rectum and sigmoid colon).

The dose received by critical organs was comparable concerning all the factors under consideration. The dose to point P on the left side was significantly lower in the CS group than in the SA group (p-value = 0·031). Also, the dose to point P on the right side was significantly lower in the third fraction compared with the first fraction (p-value = 0·016).

ICBT under spinal anaesthesia resulted in a higher dose to the pelvic wall. The initial size of the tumour or the subsequent fractions does not significantly affect the dose received by critical organs.

Cervical cancer remains a significant public health concern in sub-Saharan Africa, with treatment modalities such as chemoradiotherapy impacting patients’ quality of life (QoL). This study assessed the QoL of cervical cancer patients undergoing definitive chemoradiotherapy.

This cross-sectional study was conducted at the National Radiotherapy, Oncology and Nuclear Medicine Centre, Korle-Bu Teaching Hospital, Accra, between February and May 2023. A total of 120 adult female cervical cancer patients, treated with definitive chemoradiotherapy, were purposively recruited. Data were collected using the FACT-Cx questionnaire, which assessed physical, social, emotional and functional well-being as well as additional concerns. Statistical analysis included descriptive and inferential methods with Spearman Rho used to examine correlations.

The mean age of participants was 53·5 years (SD 15·6), with most (77%) employed and half (50%) married. QoL scores were highest in social well-being (mean = 17·3/24·0) and emotional well-being (mean = 16·8/24·0), but lower in physical (mean = 15·4/28·0) and functional well-being (mean = 12·3/24·0). Most participants (66·7%) reported a good QoL, while 6·7% reported poor QoL. Key challenges included fatigue, pain and dissatisfaction with sex life, although participants received strong emotional support from their families. Correlations between age and QoL domains were statistically insignificant (p > 0·05).

The findings suggest that despite the physical and functional challenges faced during chemoradiotherapy, most participants reported good overall QoL, largely attributed to strong family and social support. Future studies should incorporate longitudinal designs with baseline data collection to better understand treatment-related changes in QoL.

The normal tissue objective (NTO) is a tool used in inverse-planned intensity-modulated radiation therapy (IMRT) to minimize dose dispersion to surrounding tissues. The current study focuses on the NTO’s impact on RapidArc treatment plans for cervical cancer patients or its role in reducing doses to healthy surrounding tissues.

This study included 11 cervical cancer patients who underwent RapidArc treatment. We assessed plans both with and without the NTO objective by evaluating parameters such as homogeneity, conformity, gradient index (GI), IMRT factor, integral dose and the volume of normal tissues receiving low doses of 40, 30, 20 and 10 Gy. Further, differences between automatic NTO and manual NTO were evaluated using Wilcoxon signed-rank test.

There were no significant differences in the conformity index, homogeneity index, IMRT factor and integral dose between plans with automatic NTO and those with manual NTO RapidArc plans. However, we did observe a clear advantage in using manual NTO for controlling low-dose exposure to normal tissues. The comparisons between automatic and manual NTO resulted in a GI of 3·1 ± 0·3 versus 2·7 ± 0·68 (p = 0·008). Furthermore, we noticed a significant reduction in the volumes receiving low doses (V10, V20, V30 and V40) with the manual NTO settings.

The NTO plays a crucial role in optimizing RapidArc plans for treating cervical cancer. Based on the findings of this study, manual NTO settings of distance from PTV border xstart = 0·5 mm, start dose f0 = 105%, end dose f∞ = an average of 40%, dose fall-off 0·2 mm–1 were optimal. Further research involving a larger sample size and exploration of various NTO parameters is necessary to validate our results.

Intracavitary brachytherapy (IBT) is the standard boost treatment for patients with locally advanced cervical cancer. Volumetric modulated arc therapy (VMAT) boost serves as an alternative to IBT boost, but it has inferior target tumour coverage and organ at risk (OAR) sparing. In this study, a pear-shaped dose distribution was generated in the applicator-guided (AG)-VMAT boost on the existing IBT boost patient by an intercomparison with the existing VMAT boost practice.

The treatment plan of eight patients treated with the VMAT boost and ten patients treated with the IBT boost was analysed. Then, the IBT boost CT images were exported from the OnCentra Brachytherapy treatment planning system (TPS) to Eclipse TPS to plan AG-VMAT boost to reproduce the pear-shaped dose distribution.

AG-VMAT boost successfully reproduced the pear-shaped outline using the 100% isodose line from the IBT boost. The IBT boost treatment planning had the best dosimetry coverage for tumours by D90 23·33 Gy and CI 1·00. The D2cc of the bladder, rectum and femoral heads in the VMAT boost were in significantly higher doses than IBT and AG-VMAT boosts (p ≤ 0·05). The cumulative EQD2 for the D90 in the IBT boost only fell within the tolerance limit. Meanwhile, the D2cc of all the OAR doses in these three techniques was within the dose constraint set by the American Brachytherapy Society (ABS).

24 Gy/3 fractions AG-VMAT boost successfully reproduced the pear-shaped dose distribution for D90 of the target, with D2cc of the OAR remaining within the ABS limit.

High dose rate (HDR) intracavitary brachytherapy (ICBT) plays a crucial role in cervix cancer treatment, with variations in fractionation schedules across different radiation societies. This study aims to assess the effectiveness and tolerability of a 7 Gy per fraction twice daily schedule over two successive weeks versus an 8 Gy per fraction once weekly schedule over three successive weeks.

From 2020 to 2022, 87 patients with uterine cervix cancer (Stages II and III) underwent concomitant external beam radiotherapy (EBRT) and chemotherapy, followed by HDR-ICBT. Patients were randomised into two arms: Arm A (8 Gy per fraction once weekly for 3 fractions) and Arm B (7 Gy per fraction twice daily once a week for 4 fractions). Local control is defined as any patient free from local progression (CR + PR + SD) in the first year after ending brachytherapy (BTH).

The median follow-up was 16·5 months. Local control at 1 year was 78·7% in Arm A and 89·2% in Arm B (p = 0·24). No clinically significant differences in rectal and bladder toxicities were observed between the two arms (p = 0·40).

There were limited treatment machines and other BTH challenges in Egypt, and the HDR BTH schedule of 7 Gy per fraction twice daily over 2 successive weeks presents an acceptable alternative to the current national standard of 8 Gy per fraction once weekly over 3 weeks. Both schedules demonstrate comparable local control, late toxicity and progression-free survival. Notably, the 7 Gy per fraction twice daily per week for 4 fractions offers the advantage of a reduced total treatment time.