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Journal of Cancer Research and Therapeutics, Vol. 6, No. 3, July-September, 2010, pp. 400-401 Letter to the Editor A critique of "American Brachytherapy Society Survey of three-dimensional imaging in gynecologic brachytherapy" Daya Nand Sharma Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India Correspondence Address:Daya Nand Sharma, F-39, Ansari Nagar, New Delhi - 110 029, India, sharmadn@hotmail.com Code Number: cr10101 PMID: 21119291 DOI: 10.4103/0973-1482.73327 Sir, Three-dimensional imaging is increasingly being used in gynecologic brachytherapy but most centers in developing countries (including India) continue to practice point-based dosimetry rather than 3-D image-based dosimetry. Since gynecological cancers constitute the major cancer burden in India and resources are limited, there may be practical difficulties in implementing 3-D image based gynecological brachytherapy. Recently an interesting article "Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society" has been published by Viswanathan et al. [1] The survey highlights the increasing use of 3-D imaging in gynecological brachytherapy. Our present critique of this article brings certain points to the notice of authors and the readers. Firstly, though titled "Three-dimensional imaging in gynecologic brachytherapy: a survey of the American Brachytherapy Society", the study deals with only cervical brachytherapy. The survey questionnaire does not have any question pertaining to other brachytherapy procedures used for vaginal, endometrial or vulval cancers. Therefore, article should have been better titled "Three-dimensional imaging in cervical brachytherapy: a survey of the American Brachytherapy Society". Secondly, even for cervical brachytherapy, certain important questions have been missing in the 19-point questionnaire used for this survey. The much deserving interstitial brachytherapy (IBT) for cervical carcinoma has not been addressed at all and the focus of entire study is on intracavitary radiotherapy (ICRT). Though there are guidelines/recommendations published by American Brachytherapy Society (ABS) [2-4] from time to time addressing ICRT, but there is hardly any one for cervical IBT, per se. This could be one of the reasons for declining practice of IBT. There are no consensus guidelines regarding the image guidance, dose fractionation schedules or delineation of various target or OAR volumes. The ABS guidelines published in 2000 by Nag et al., [4] did address the cervical IBT based on the study by Demanes et al., [5] Unfortunately, even after almost 10 years of that ABS study, [3] not even a single study has been published reporting the use of these guidelines for cervical IBT. It would have been certainly interesting to include certain questions in present survey [1] relating to the 3-D imaging in cervical IBT and the attitude of ABS members. This could have been of great help in framing specific guidelines for cervical IBT by ABS in future. Thirdly, the GEC-ESTRO guidelines [6] were published almost 2 years before the present ABS survey. [1] The specific point, whether these guidelines were followed, could have been included in this survey. This attitude of the members toward GEC-ESTRO guidelines could possibly help in further improving these guidelines to enhance its acceptance. References
Copyright 2010 - Journal of Cancer Research and Therapeutics |
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