Journal of Contemporary Brachytherapy
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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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Original paper

Enhancing brachytherapy in cervical cancer: Initial dosimetric experience and assessment of Tulip hybrid applicator – the Add-On advantage

Ayesha Iqbal Maniyar
1, 2
,
Ram Charith Alva
1, 2
,
Kirthi Koushik
2, 3
,
Sagarika Nithyanand
1, 2
,
Janaki M. G.
4
,
Revathy P.
4
,
Arul Ponni T. R.
4
,
Mohan Kumar
4
,
Lithika Lavanya
4

  1. Aster International Institute of Oncology (AIIO), Bengaluru, India
  2. M. S. Ramaiah Medical College and Hospital, Bengaluru, India
  3. HCG Cancer Hospital, Bengaluru, India
  4. Department of Radiation Oncology, M. S. Ramaiah Medical College and Hospital, Bengaluru, India
J Contemp Brachytherapy 2026
Online publish date: 2026/04/30
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1. Indian Council of Medical Research, National Centre for Disease Informatics and Research. GLOBOCAN India 2020: Report on cancer incidence and mortality [Internet]. ICMR-NCDIR; 2020.
2. Datta NR, Kumar S, Singh S et al. Brachytherapy in the treatment of cervical cancer: Current status and emerging trends. Gynecol Oncol 2015; 138: 412-419.
3. Pötter R, Tanderup K, Kirisits C et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies in image guided adaptive brachytherapy for cervical cancer. Clin Transl Radiat Oncol 2018; 9: 48-60.
4. Viswanathan AN, Thomadsen B. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: High-dose-rate brachytherapy. Brachytherapy 2012; 11: 47-52.
5. Chargari C, Deutsch E, Blanchard P et al. Physics aspects of modern cervical cancer brachytherapy. Cancer Radiother 2014; 18: 236-239.
6. Nomden CN, de Leeuw AA, Moerland MA et al. Clinical use of the Utrecht interstitial CT/MR applicator in cervical cancer brachytherapy: Dose-volume parameters in relation to clinical outcome. Radiother Oncol 2012; 103: 173-180.
7. Mahantshetty U, Krishnatry R, Hande V et al. Magnetic resonance image guided adaptive brachytherapy in locally advanced cervical vancer: An experience from a tertiary cancer center in a low and middle income countries setting. Int J Radiat Oncol Biol Phys 2017; 99: 608-617.
8. Pötter R, Haie-Meder C, Van Limbergen E et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy – 3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2005; 78: 67-77.
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10. Yoshida K, Yamazaki H, Kotsuma T et al. Simulation analysis of optimized brachytherapy for uterine cervical cancer: Can we select the best brachytherapy modality depending on tumor size? Brachytherapy 2016; 15: 57-64.
11. Dimopoulos JCA, Lang S, Kirisits C, Pötter R. The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: clinical feasibility and preliminary results. Int J Radiat Oncol Biol Phys 2006; 66: 83-90.
12. Pötter R, Tanderup K, Kirisits C et al., EMBRACE Collaborative Group. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol 2018; 9: 48-60.
13. Beriwal S, Demanes DJ, Erickson B et al. American Brachytherapy Society consensus guidelines for interstitial brachytherapy for vaginal cancer. Brachytherapy 2012; 11: 68-75.
14. Fokdal L, Tanderup K, Nielsen SK et al. Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer using the Vienna applicator. Int J Radiat Oncol Biol Phys 2013; 85: 641-646.
15. Kirisits C, Pötter R, Lang S et al. Dose-volume histogram parameters and local control in magnetic resonance image-guided cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys 2006; 66: 508-516.
16. Hong DQ, Li Z, Wang L et al. Dosimetric benefit of IC/IS+ISBT-DP based on parametrial extension width in image-guided brachytherapy for locally advanced cervical cancer. Brachytherapy 2020; 19: 211-219.
17. Wark A, Hüfner L, Meixner E et al. Clinical impact of MRI-guided intracavitary–interstitial brachytherapy in the curative management of advanced stage cervical cancer. Curr Oncol 2025; 32: 136.
18. Haider J, Faheem M, Nazemniya F et al. Acute toxicity profile and treatment response of image guided hybrid brachytherapy using Venezia applicators in locally advanced cervical cancer: a single centre experience in Pakistan. Ecancermedicalscience 2025; 19: 1883.
19. Le NA, Patel S, Mutyala K et al. Outpatient hybrid intracavitary-interstitial brachytherapy for cervical cancer with minimal sedation in a freestanding setting. Pract Radiat Oncol 2025; 59: 101767.
20. Rivera A, Wassel M, Brodin PN et al. Hybrid tandem and ovoids brachytherapy in locally advanced cervical cancer: impact of dose and tumor volume metrics on outcomes. J Contemp Brachytherapy 2021; 13: 158-166.
21. Najjari-Jamal D, Juarez M, Cordoba S et al. The crucial role of advanced image-guided brachytherapy for locally advanced cervical cancer in the era of systemic treatment intensification. Cancers (Basel) 2025; 17: 1809.
22. Chino J, Beriwal S, Albuquerque K et al. The American Brachytherapy Society (ABS) consensus guidance for hybrid intracavitary interstitial brachytherapy for locally advanced cervical cancer. Brachytherapy 2025; 24: 463-478.
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