Fighting Cervical Cancer with Image-guided Brachytherapy

Charles T. Whipple |  12-06-2017

To Ken Ando, MD, the question is not whether to use brachytherapy; it is how to use this effective therapy with maximum accuracy and minimum patient discomfort. His choice of solutions is worthy of consideration.

Photos: Hans Sautter

In 2016, the National Cancer Center expects more than a million Japanese people to be diagnosed with cancer. Women will account for some 43 percent of these diagnoses, with some 30,000 of them suffering from uterine or cervical cancer.[1] In fact, according to the Japan Journal of Clinical Oncology, cervical cancer incidence and mortality began to increase from 1990, and while the rate of increase is not a rapid climb, the cancer has become the second most lethal among women aged 15 to 45.[2]

This is the last year in the Japanese government’s Basic Plan to Promote Cancer Control Programs, which places cancer treatment at the top of the list of goals. Based on the Basic Plan, each prefecture develops its own plan to promote cancer control. In Gunma Prefecture, northwest of Tokyo, Gunma Prefectural Cancer Center (GPCC), with its 357 beds and fifteen departments, provides diagnosis and therapy for the prefecture as well as for the neighboring prefectures of Saitama and Tochigi. And it is very much a part of Japan’s battle against cancer.

Ken Ando, MD, is a warrior in that battle. As Director of Gynecology Radiation Therapy, he constantly works to reduce cervical cancer mortality, and his work has brought him to brachytherapy.

Benefits of brachytherapy

Prostate, head, and neck cancer are generally treated at the Cancer Center using intensity modulated radiation therapy (IMRT). Radiation oncologists treat as many as 80 patients per day. Brachytherapy, however, is used mostly for cervical and uterus cancer patients. Ando says, “There are some cases of stump reoccurrence and vaginal cancer, but basically we deal with gynecological cancers.

That’s when we turn to brachytherapy, and for years our situation was far from optimal. In the radiation section of the hospital, we did our rather complicated brachytherapy planning based on 2D C-arm images. Applicators were placed and the patient then lifted onto a stretcher and transferred to a CT room, where we did CT imaging and later fused 2D C-arm with the 3D CT images.”

According to Ando, the procedure held a team of doctors, technicians, and nurses on site for three hours in complicated cases. Plus, if the CT scan showed that the applicators had shifted, more time was needed to restore them to the proper place. He wanted a system in which the entire brachytherapy could be done in the same room. Ken Ando finally applied for approval to set up an image-guided brachytherapy (IGBT) suite centered around a SOMATOM Scope Power-Sliding Gantry from Siemens Healthineers. With the system, the workflow changed.

Ken Ando, MD, Director of Gynecology Radiation Therapy, GPCC, Japan
"In this day and age, brachytherapy is a must, and I think that should mean in-room CT systems." Ken Ando, MD, Director of Gynecology Radiation Therapy, GPCC, Japan

A perfect fit

“The biggest advantage of the in-room CT is not having to move the patient from the table,” says Ando. “We can plan, place the applicators, do 3D imaging with our CT scanner, and do the fusion all in the same place. Before, two nurses had to be with the patient throughout the procedure. Now, one nurse is sufficient. A procedure that went smoothly used to take three hours to complete; now it takes two hours and a few minutes.”

Ken Ando seems more than happy that the entire compact system fits in a single room within the Radiation Therapy department.
“The CT aperture is 70 centimeters, ample for patients, producing very clear images – and it makes all the difference in the world to have a good clear picture of the problem area during therapy,” says Ando. “You could even say I’m a little proud of the fact that the system I suggested fits in our available space.”

Ken Ando, MD, Director of Gynecology Radiation Therapy, GPCC, Japan
"The biggest advantage of the in-room CT is not having to move the patient." Ken Ando, MD, Director of Gynecology Radiation Therapy, GPCC, Japan

IGBT: A must

IGBT is still not widely used for cancer therapy in Japan: Only about one-third of the cancer facilities which have brachytherapy capabilities in Japan have IGBT systems. However, Ando pointed out that in-room CT systems have been discussed at the brachytherapy meetings of the Japanese Society for Therapeutic Radiology and Oncology (JASTRO), and he said the opinion leaders in the industry virtually all use such systems. “In this day and age,” says Ando, “IGBT is a must, and I think that should mean in-room CT systems.”

MRI can also be used as an imaging modality in brachytherapy in Europe, but Ken Ando does not think that option is ideal for his situation. MRI would take more manpower. “I’ve talked with MRI technicians and prepared applicators for this purpose. Still, my experience is that the images we get from our CT are really good, even compared to those we might get from MRI.”

As mentioned, Gunma Cancer Center serves a wider area than just one prefecture. Outlying hospitals and clinics learn of its expertise and refer their patients to the Cancer Center. Further, Ando is one of few oncologists in Gunma with extensive experience of IGBT, and he is called upon to help train more physicians, technicians, and nurses in this vital therapy. Now, with the SOMATOM Scope Sliding Gantry CT system and the skills of Ken Ando and his team in image-guided brachytherapy, the enemy called cancer faces competent warriors using accurate and effective weapons.

About the Author

Charles T. Whipple is an international award-winning author and journalist based in Japan. His articles have appeared in magazines and newspapers such as Time, Newsweek, the Chicago Tribune, and the International Herald Tribune. He has lived in Japan since 1977 and is fluent in Japanese.

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[1] Otake T, Cancer diagnoses in 2016 expected to top 1 million for first time. The Japan Times. 2016
[2] ICO HPV Information Centre. Human Papillomavirus and Related Diseases Report. Japan. 2016

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